PROGRAM PEMBANGUNAN DAN PEMBERDAYAAN

MASYARAKAT DESA (P3MD)

DESA CAHAYA MARGA
KECAMATAN PEMULUTAN SELATAN
KABUPATEN OGAN ILIR
PROVINSI SUMATERA SELATAN

BERITA ACARA REMBUK STUNTING

DALAM RANGKA PENCEGAHAN STUNTING DI DESA TAHUN 2023

Dalam memastikan terjadinya intergrasi pelaksanaan intervensi pencegahan dan penurunan stunting di Desa
secara bersama-sama melakukan konvergensi percepatan pencegahan stunting di Desa Cahaya Marga
Kecamatan Pemulutan Selatan Kabupaten Ogan Ilir Provinsi Sumatera Selatan, maka pada hari ini:

Hari dan Tanggal : ……………....……………………............

Jam : ……………....……………………............
Tempat : ……………....……………………............

Telah diadakan kegiatan Rembuk Stunting Desa, yang telah dihadiri oleh wakil-wakil masyarakat yang
meliputi: perwakilan kesehatan dan pendidikan di masing-masing dusun/kelompok dan tokoh masyarakat,
serta unsur lain yang terkait pencegahan stunting Desa sebagaimana tercantum dalam daftar hadir terlampir.

Materi yang dibahas, serta yang bertindak selaku unsur pimpinan rapat dan narasumber dalam membahas
kegiatanmusrenbang Desa adalah:

A. Materi
1. Penyampaian laporan konvergensi pencegahan stunting di desa oleh KPM (Kader Pembangunan
Manusia);
2. Diskusi terarah / Focus group discussion (FGD) terkait dengan rancangan usulan konvergensi
stunting Desa yang disusun dari hasil di RDS (Rumah Desa Sehat);
3. Pembahasan dan penyepakatan usulan kegiatan prioritas berdasarkan persentase laporan hasil
konvergensi pencegahan stunting di Desa; dan
4. Penetapatan prioritas usulan program/kegiatan berdasarkan persentase laporan hasil konvergensi
pencegahan stunting di Desa.

B. Unsur Pimpinan Rapat dan Narasumber

Pemimpin Musyawarah : …..……………………............................ dari KPM
Notulen : …..……………………............................ dari Sekretaris RDS
Narasumber : 1. …..……………………........................ dari Kepala Desa
2. …..……………………........................ dari Tim RDS/TP2S
3. …..……………………........................ dari Tenaga Kesehatan
4. …..……………………........................ dari Unsur Kemendes PDTT
5. …..……………………........................ dari ..............

Setelah dilakukan pembahasan dan diskusi terhadap materi, selanjutnya seluruh peserta musyawarah
menyepakati beberapa hal yang berketetapan menjadi kesepakatan akhir dari pertemuan/musyawarah
yaitu :
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C. Tingkat Keterlibatan Masyarakat

Jumlah Orang yang Mengikuti Kegiatan Komentar Umum
Jumlah Orang miskin untuk
Laki-laki Perempuan
(L + P) kegiatan yang relevan

.................... .................... .................... ....................

D. Kesepakatan Prioritas Usulan Program/Kegiatan

Berdasarkan persentase laporan hasil konvergensi pencegahan stunting di Desa, dibahas dan sepakati
pada rembuk stunting bahwa usulan program/kegiatan tercantum dalam lampiran berita Acara ini.

Demikian Berita Acara ini dibuat dan disahkan dengan penuh tanggung-jawab agar dapat dipergunakan
sebagaimana mestinya.

Cahaya Marga, ...................................... 2022

Pimpinan Rapat, Notulis/Sekretaris,

.......................................... ..........................................

Mengetahui,
Kepala Desa Cahaya Marga,

..........................................

Mengetahui dan Menyetujui,

Wakil dari Peserta Musyawarah

Nama Alamat Tanda Tangan

1. ………………………….. …………………….. 1. ………………..

2. ………………………….. …………………….. 2. ………………..
3. ………………………….. …………………….. 3. ………………..
4. ………………………….. …………………….. 4. ………………..
5. ………………………….. …………………….. 5. ………………..
 LAMPIRAN DAFTAR PRIORITAS USULAN
PROGRAM/KEGIATAN PENCEGAHAN STUNTING DI DESA
TAHUN 2023

NO. USULAN KEGIATAN LOKASI KEGIATAN

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

Cahaya Marga, ...................................... 2022

Pimpinan Rapat, Notulis/Sekretaris,

.......................................... ..........................................

Mengetahui,
Kepala Desa Cahaya Marga,

..........................................
 PROGRAM PEMBANGUNAN DAN PEMBERDAYAAN
MASYARAKAT DESA (P3MD)
DESA CAHAYA MARGA
KECAMATAN PEMULUTAN SELATAN
KABUPATEN OGAN ILIR
PROVINSI SUMATERA SELATAN

NOTULEN REMBUK STUNTING DALAM RANGKA

PENCEGAHAN STUNTING DI DESA
TAHUN 2023

Hari : ....................................................
Tanggal : ....................................................
Jam : ....................................................
Tempat : ..........................................................................

Susunan Acara :
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Rekaman Kegiatan :
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Cahaya Marga, ............................ 2022

Pimpinan Musyawarah, Notulensi,

(......................................) (......................................)

Mengetahui
Kepala Desa Cahaya Marga,

(..................................)
 PROGRAM PEMBANGUNAN DAN PEMBERDAYAAN
MASYARAKAT DESA (P3MD)
DESA CAHAYA MARGA
KECAMATAN PEMULUTAN SELATAN
KABUPATEN OGAN ILIR
PROVINSI SUMATERA SELATAN

DAFTAR HADIR REMBUK STUNTING DALAM RANGKA

PENCEGAHAN STUNTING DI DESA
TAHUN 2023

Hari : ....................................................
Tanggal : ....................................................
Tempat : ..........................................................................

NO NAMA L/P ALAMAT JABATAN TANDA TANGAN

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

11. 11.

12. 12.

13. 13.

14. 14.

15. 15.

16. 16.

17. 17.

18. 18.

19. 19.
NO NAMA L/P ALAMAT JABATAN TANDA TANGAN

20. 20.

21. 21.

22. 22.

23. 23.

24. 24.

25. 25.

26. 26.

27. 27.

28. 28.

29. 29.

30. 30.

31. 31.

32. 32.

33. 33.

34. 34.

35. 35.

36. 36.

Cahaya Marga, ............................ 2022

Pimpinan Musyawarah, Notulensi,

(......................................) (......................................)

Mengetahui
Kepala Desa Cahaya Marga,

(..................................)