The six schools contacted agreed to participate in the study. Two schools were located in an area of very high socio-economic status, two were at the high level and the other two at the medium level. There is no school located in the socio-economically disadvantaged area of Jakarta. The number of students varied from 111 to 541 per school. In general, schools had no or only one teacher trained in nutrition and health education, usually the physical education teacher or the teacher in charge of the school health post. The two schools located in the moderate socio-economic status (SES) have a teacher trained in nutrition and health education, but only one of the two schools located in the high and very high SES has such a teacher. Two of the four public schools observed in this study shared buildings, sports fields and canteens with other schools. Another school shared the building/area with an orphanage. Table 1 describes the characteristics of schools.
Food access and availability
Table 2 presents each school’s food access and availability based on components 2 and 3 of the PSEA tool. All schools have a school canteen on their premises, open according to school opening hours. No guidelines for a healthy canteen existed in any of the schools. All canteens served a breakfast menu, and the most popular food choices were rice dishes (e.g. fried rice, coconut rice, turmeric rice), fried noodles/vermicelli/ instant breads, sweet breads/rolls, spaghetti and various deep dishes. – fried snacks. A public school canteen had vegetable soup on its menu. Sugary drinks and instant drinks (sachets) were the favorite drinks of students in all schools.
Almost all canteens had fruits or vegetables on their menu. However, canteen staff at all schools noticed that fruit or vegetables were not popular among students. A private school canteen never offered healthy meals to students because they thought no one would buy them. When canteen staff were asked about the promotion of healthy eating on the menu, two canteens in the four public schools mentioned that they offered a healthy meal as a daily special menu which was occasionally promoted. None of the canteens of the two private schools has ever promoted healthy eating. The two schools in the Moderate SES zone admitted to promoting healthy meals on a daily basis, while those in the Higher SES zone either benefited only occasionally or never had the promotion.
“There are vegetables every day, like bean sprouts, mustard greens and tofu, and sometimes spinach. The children’s favorite dish is crispy chicken.
Canteen staff (school 5).
Canteen staff perceived healthy foods as those without high sugar and salt content, but still preferred by children. It would be difficult because children love sweet and salty foods. We found that sugary drinks and fried foods were very popular.
“What is taken into consideration is that the snacks sold in the canteen, the food and the drink itself, must be healthy, not high in sugar and salt, children like it, but must take into account spices and containers used.”
Canteen staff (school 6).
Food prices in this study are expressed in United States (US) dollars and cents. Rice-based meals generally cost less than a dollar, while the cost of snacks (eg, chips, crackers, variety of fried snacks, candy, and chocolate) was even lower (
School canteens are regularly inspected by local public health centers (Puskesmas). Some (2/6) have also been inspected by the Indonesian Food and Drug Agency. The inspections also included street food vendors in the vicinity. All canteen staff considered routine inspection by the Puskesma to be sufficient to maintain the hygiene and quality of the canteen. None of the inspections took into account food variation and nutritional quality, as their main concern was to look at food hygiene and cleanliness. Catering services from external sources were also optional in some schools (3/6), especially in private schools. These services were usually organized by parents or a former teacher. This external food source was provided at an additional cost to the students. The catering service provided a full lunch box consisting of rice, meat/chicken, vegetables, fruit and dessert (eg ice cream/probiotic drinks).
Almost all schools had easy access to street vendors. Only one school did not have access to street vendors because it is located in a narrow alley, which limited vendors’ access to the school environment. Most schools (5/6) did not have strict regulations prohibiting their students from buying food from street vendors, but one private school prohibited their students from accessing street vendors.
“We don’t know if food outside of school is healthy or not; we never ask. We only know the food inside the fence. “
Fried foods, ice cream and sugary drinks were the most common foods offered by street vendors. The price of these foods was even lower than that of foods sold in the school canteen. Because street vendors usually sell food from carts or bicycles, they can easily come and go and thus can avoid inspection by authorities.
School policies and the environment for healthy eating
The school’s healthy eating policies and environment are outlined in Table 3 based on components 4 to 8 of the PEAS tool. All principals reported having a written policy that actively promotes healthy eating among students, which primarily integrates healthy eating topics into the national school curriculum, such as in a natural science lesson. Two of the public schools and one of the private schools had an additional program, such as having a weekly fruit day or a weekly healthy breakfast and providing breakfast with all students and teachers. Some schools (3/6) also claimed to regulate the type of food that should be available in the canteen or in students’ lunch boxes and provided information on healthy food and diet. Teachers delivered the messages through classroom announcements. Nevertheless, almost all schools admitted that they did not strictly monitor the application of these regulations.
Principals and physical education teachers used the number of students who brought a lunch box from home as a metric to measure the effectiveness of the nutrition policy, and five schools reported that policy had been effective. A public school principal admitted that the regulations were ineffective because the canteen is usually full of parents waiting for their children; thus, children get food from street vendors instead. However, he said the schools are already planning to implement a new strategy the following school year.
“From next school year, children are required to bring food from home, so that their food is clean, they learn to be calm and they won’t want to buy food from street vendors as often.”
The principal of the four public schools in the middle and high SES areas said they place high or very high priority on promoting healthy eating. These priorities are manifested by the presence of posters on healthy eating in schools and the establishment of healthy eating habits at certain events. Two other schools were also providing health education in collaboration with the local public health center. However, the two private schools in the very high SES area assumed that healthy eating was not a priority.
All physical education principals and teachers considered the teachers to be a good role model in healthy eating for the students. Teachers usually brought their own lunch box, chose healthier foods from the canteen menu, promoted a healthy lunch box to students, and reminded students not to buy food from street vendors. They also agreed that parents are important and highly supportive factors in promoting healthy eating, especially in motivating students to bring lunch from home.
Policy and environment of physical activities
Physical activity has been promoted through physical education as a compulsory subject in the national school curriculum. However, only two schools (1 public and 1 private) had written regulations on physical activity (Table 3). The duration of physical education in public schools was longer than in private schools. All schools had sports fields and provided sports equipment for students. However, some schools (2/6) have recognized the need for a sports field for the pupils because the schools are surrounded by streets through which many vehicles pass.
“The playground outside the building or the school is very insufficient because it is full of traders who sell, even if there are no traders, the place is also not suitable as a playground given the passage of many vehicles”
They also encouraged students to participate in sports competitions and physical activities. A public school encouraged its students to walk or use bicycles to get to school. All physical education teachers said that the physical activity policy had been quite effective in their schools, as evidenced by the winning of awards in some sports competitions as well as a large number of students walking from home at school. Five schools rated their teachers as very good physical activity role models because of their frequent involvement in student physical activity. One of the private schools organized monthly events for physical activities between teachers and students.