Health development in many low- and middle-income countries (LMICs) tends to be driven by donor-driven pilot projects frequently framed as innovative and scalable solutions. However, these programs typically disappear once external funding ends, resulting in the failure to achieve sustainability and long-term impact. This commentary explores the limitations of project-based development in LMICs, highlighting how shifts in the global aid architecture create complex pressures on recipient countries. Indonesia serves as a case study to illustrate how the proliferation of non-governmental organizations (NGOs) and competition for donor funding have led to fragmented implementation, donor-dependent strategies, and low levels of community ownership. Keywords: Donor-driven development, health program sovereignty, Indonesia, NGOs
Background: Private health insurance coverage in Indonesia remains very limited, which may increase financial vulnerability despite the dominance of social health insurance. Aims: This study examines factors associated with private health insurance ownership among the Indonesian population. Methods: A cross-sectional study was conducted using data from the 2023 National Socio-Economic Survey (SUSENAS), including 179,339 respondents aged 15–64 years. Multiple logistic regression was applied to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals, controlling for demographic, socioeconomic, and health-related factors Results: The prevalence of private health insurance ownership was 0.5%. Higher education, married status, rich economic status, exposure to internet media, and absence of health complaints were significantly associated with a higher likelihood of ownership. In contrast, respondents aged 25–34 years, those living in households with fewer than five members, and employed individuals were significantly less likely to own private health insurance. Rich economic status was the strongest predictor of private health insurance ownership (adjusted PR = 3.353; 95% CI: 1.997–5.627). Conclusion: Private health insurance ownership in Indonesia is strongly shaped by socioeconomic characteristics and information exposure. These findings provide empirical evidence to support further investigation into the role of private health insurance as a complementary mechanism within Indonesia’s social health insurance-dominated system. Keywords: Indonesia, ownership, private health insurance, socioeconomic factors
Background: Tuberculosis (TB) is a leading global communicable disease. Pediatric tuberculosis, in particular, is prevalent among the population aged 0-14 years and necessitates a treatment duration of at least six months. Aims: This study aims to assess the total treatment cost of pediatric tuberculosis patients and determine the factors associated with the total cost. Methods: A cross-sectional design was employed to collect the retrospective data at a public hospital and PHC in the province-level Special Region of Yogyakarta, Indonesia. Treatment costs are categorized into the following: laboratory costs, professional costs, drug costs, medical and non-medical support costs, and miscellaneous costs. The collected data underwent both descriptive and statistical analysis using regression methods, namely logistic and probit regressions. Results: The analysis revealed that most patients were between 0 and 2 years old and most of them are school-age, with an average treatment cost of USD 62.80 per patient. The study identified laboratory costs (RR 0.198; 95% CI 0.083-0.314), professional costs (RR 9.402; 95% CI 4.108-14.698), drug costs (RR 5.269; 95% CI 2.326-8.212), and medical support costs (RR 0.223;95% CI 0.064-0.382) as the primary contributors to the total cost. Conclusion: The point of this study is that effective treatment is possible with proper financial support. To achieve a successful outcome in treating pediatric tuberculosis, it is imperative to establish an advocacy and collaboration effort to enhance the primary health services. This cooperative effort should prioritize convenient access to treatment and enhancing active case finding. Keywords: cost of illness, cost of treatment, pediatric tuberculosis
Background: The implementation of the Indonesian Minister of Health Regulations No. 3 of 2023 on the standard health service tariff in the national health insurance program, as a replacement for the previous policy, has created confusion among field implementers. The capitation rate is considered sufficient but is sometimes insufficient to cover Public Health Care (PHC) operational costs. Aims: This study aims to analyze standard health service tariffs in the implementation of the health insurance program at PHCs. Methods: The authors used descriptive qualitative methods with a case study as the research design. The unit of analysis was the health service tariff standards at the PHCs. Data collection techniques involved snowball discussions followed by FGDs. Research subjects were selected using a purposive sampling technique. The FGDs consisted of 3 participants from BPJS Kesehatan, 4 from the public health centers, 2 people from private clinics, and 3 individual practitioner doctors. Data were analyzed using Open Code software. In addition, a policy analysis of PHC tariff standards was also conducted. Results: PHCs have implemented the Minister of Health Regulations No. 3 of 2023 since February 2023. In the implementation of health service tariff standards at the PHCs, no significant obstacles were encountered, as they adjusted to the applicable policies. Although the tariff standards follow Minister of Health Regulations No.3 of 2023 and include an increase in the capitation value compared to the previous policy, the amount is perceived as inadequate and still below the reasonable cost required for service delivery. Private clinics and individual practitioners must still cover operational expenses using capitation funds supplemented by income from non-insured patients to meet operational costs related to human resources, equipment, and supporting facilities. Conclusion: PHCs have implemented the standard health service tariff in accordance with the existing policy. However, the increase in capitation fees has not fully covered the costs at PHCs. Keywords: health service; PHC; tariff standard
Background: Measurement of patient safety culture is often conducted using various questionnaire methods and multiple respondents. Patient safety culture cannot be ignored; therefore, understanding these results is crucial for further study. Aim: To investigate the results of measuring patient safety culture in hospitals across various countries. Method: This study is a systematic literature review of articles published between 2013 and 2023. The selection process followed the PRISMA, which included identification, screening, eligibility, and inclusion. Selected articles were evaluated for quality, and the data were then analyzed thematically to identify instruments, approaches, and challenges in measuring patient safety culture. Results: The systematic review identified 45 relevant studies. The HSOPSC instrument was the most widely used, followed by the SAQ and the PSFHI, with varying local adaptations. The analysis revealed challenges with instrument reliability, differences in cultural contexts, and resource limitations. These findings promoted standardization and local adaptation in measuring patient safety culture. Conclusion: After 24 years of global recognition of patient safety, this study confirms that measuring patient safety culture is a strategic pillar in hospital quality improvement. This finding has academic and practical values, supporting cultural improvement strategies and evidence-based patient safety policies. Keywords: Doctor, Hospital Community, Hospital, Nurse, Patient Safety Culture
Background: One of the ways to improve healthcare quality in hospitals is patient-centered care (PCC). In improving patient-centered care, health workers can optimize interprofessional collaboration (IPC), but it remains challenging to understand how they communicate and coordinate, and thus, the impact of IPC on patient satisfaction remains unclear. Aims: It aimed to investigate the impact of IPC implementation on patient satisfaction within the PCC in a teaching hospital. Methods: A mixed-methods design was employed in this study, comprising 140 samples, consisting of 70 healthcare providers (IPC measured by AITCS-II) and 70 patients (satisfaction assessed using a modified SERVQUAL) for the quantitative component. Chi-square and multivariate logistic regression were used to analyze the data. The respondents, three healthcare professionals and three patients, were then interviewed to share their experiences with IPC and patients’ satisfaction. The data were then analyzed by using grounded theory (open, axial, and selective coding). Results: Interprofessional collaboration was reported to improve patient satisfaction (p = 0.016). The indicators that significantly increased the patients' satisfaction are partnership, cooperation, and coordination, with adjusted odds ratios (aORs) of 2.05, 1.80, and 1.72, respectively. These results, then, are in line with the qualitative findings, which reported that the barriers to implementing IPC include communication, teamwork, and hierarchy. Conclusion: It can be concluded that IPC can affect patient satisfaction in PCC implementation Keywords: Health Services Administration, Interprofessional Relations, Patient-Centered Care, Patient Satisfaction, Teaching Hospitals
Background: Innovative oncology medicines offer advanced cancer treatment but often come with high costs, limiting access through public healthcare funding. Aims: This study examines the distribution of self-paying innovative cancer drugs among patients in Malaysian public hospitals. Methods: Using oncology pharmacy records from 2017 to 2020, 157 patient samples were collected, constrained by COVID-19 restrictions. Results: The average patient age was 57 years (SD= 11.47), with a predominance of females (73.9%) and Chinese ethnicity (48%). Breast cancer was the most common diagnosis (47%), followed by lung (17%) and colon cancer (10%). Frequently prescribed drugs included Trastuzumab, Palbociclib, Osimertinib, Cetuximab, and Bevacizumab, most of which are listed in the Ministry of Health’s Formulary of Listed Anticancer Drugs (FLAD). Patients paid an average annual cost of MYR 16,233.90 (SD= 20,424.67) for FLAD medicines and MYR 11,239.75 (SD= 122,793.50) for non-FLAD medicines. Conclusion: The study highlights that out-of-pocket payments are the primary funding source for these treatments, posing significant financial burdens and potential long-term economic strain on cancer patients in Malaysia. Keywords: FLAD, Funding Mechanism, Innovative Oncology Medicine
Background: The National Health Insurance-Contribution Assistance Recipients (JKN-PBI) participants in Indonesia tended to increase. However, out-of-pocket (OOP) health expenditures among participants did not significantly decrease. This phenomenon may have occurred because the impact of this program on OOP health expenditures varied by household group. Aims: This study investigated the heterogeneity impact of the JKN-PBI program across per capita expenditure quartiles and residential regions in 2024. Methods: The study used data from BPS-Statistics Indonesia. Because the determination of JKN-PBI program recipients was endogenous, this study used the Inverse Propensity Score Weighting (IPW) model. Tobit regression was also applied to accommodate the OOP health expenditure reported as a zero value. Results: Participation in JKN-PBI significantly reduced OOP health expenditures. More nominal reductions occurred in higher quartiles, whereas proportional reductions occurred in lower quartiles. This outcome indicated that households in the lower quartiles obtained greater health service advantages relative to households in the higher quartiles. The reduction in OOP health expenditure share was also greater in rural areas. Conclusion: The government must prioritize this program in rural regions and low-income households. In addition, the government needs to identify healthcare service needs by regions and income groups so that the use of the JKN-PBI card is more optimal. Keywords: National Health Insurance Program, Out-of-Pocket Expenditure, Heterogeneous Impact, Inverse Propensity Score Weighting, Tobit Regression
Background: Social protection programs constitute sensitive interventions addressing the underlying causes of stunting. However, empirical evidence regarding the extent to which social protections contribute to reducing stunting remains inconclusive. Aims: This study examines the correlation between social protection programs and the incidence of stunting in Indonesia, utilizing data from the 2022 Survey of the Nutritional Status of Indonesian (SSGI) with a sample size of 323,887 children aged 3 to 60 months. Methods: The study employed binary logistic regression, with childhood stunting incidence as the dependent variable. This method enables the estimation of the probability of stunting based on variations in program exposure. The key programs of interest are Program Keluarga Harapan (PKH), Bantuan Langsung Tunai (BLT), Bantuan Pangan Non-Tunai (BPNT), and Wilayah Prioritas Stunting (DPS), incorporating other control variables related to child, household, and household infrastructure characteristics. Results: BLT is positively associated with stunting, while PKH, BPNT, and DPS show no significant effects. Conversely, access to clean water, sanitation, and clean cooking energy reduces stunting, underscoring the role of health-related infrastructure and the limited contribution of social protection programs to child nutrition. Conclusion: In a policy perspective, the findings underscore the need for greater harmonization between social assistance programs and broader improvements in health, nutrition, environmental conditions, targeted education, health behaviour towards improved nutritional intake, and healthy practices. A novel contribution of this study is offering one of the largest nationally representative analyses linking multiple social protection programs (PKH, BPNT, BLT, and DPS) to stunting outcomes using SSGI 2022 data at the individual level. Keywords: Stunting, Family Hope Program (PKH), Direct Cash Transfer (BLT), Non-Cash Food Assistance (BPNT), Stunting Priority Areas (DPS).
Background: Health service facility utilization is crucial for determining healthcare service success and accessibility. Sociodemographic factors significantly influence utilization patterns. Aims: This research aims to examine the relationship between sociodemographic factors and health facility utilization patterns among the Indonesian population Methods: Secondary data from the 2023 Indonesian Health Survey (Health Development Policy Agency, Ministry of Health) were analyzed using a quantitative cross-sectional approach. Chi-square tests and binary logistic regression were employed for bivariate and multivariate analyses Results: Non-JKN health insurance was the dominant factor with PR = 2.4 (95%CI PR: 2.335-2.645), followed by never in union with PR= 1.328 (95%CI PR:1.269-1.390). Married with PR= 1.3 (95%CI PR: 1.224-1.381), unemployed with PR= 1.262 (95%CI PR: 1.226-1.300), children with PR= 1.181 (95%CI PR: 1.110-1.257), men with PR =1.030 (95% CI PR: 1.005-1.005). Factors reducing utilization likelihood included are rural residence with PR= 0.378 (95%CI PR: 0.368-0.388), secondary education with PR= 0.390 (95%CI PR: 0.376-0.404), adult with PR= 0.650 (95%CI PR: 0.603-0.701), primary education with PR= 0.703 (95%CI PR: 0.684-0.722), non formal occupation with PR= 0.955 (95%CI PR: 0.922-0.989). Conclusion: The binary logistics regression shows that health insurance ownership is the most dominant predictor, with individuals holding non-JKN health insurance being 2.4 times more likely to utilize healthcare services compared to those with JKN insurance. Therefore, geographical disparities and educational levels are critical obstacles that require intervention in efforts to improve access to health services. Keywords: Determinants, Health Facility, Sociodemographic, Utilization, SKI 2023
The Makan Bergizi Gratis (MBG, or free nutritious meal) program was designed by the Indonesian government to enhance community nutrition, particularly for students. Ensuring the effective implementation of programs is essential to achieving various objectives. In general, implementation research serves as a method to identify implementation determinants, formulate strategies, and assess outcomes within the specific context of the MBG program. Therefore, this research aims to investigate the potential use of implementation research methodology for improving the MBG program. Research in the area may rely on the application of frameworks, theories, and models within implementation science. The methodology covered three areas: 1) delineation of the implementation process; 2) identification of factors affecting implementation, and 3) assessment of implementation outcomes. The research can concentrate on the phases of formulating implementation strategies and converting research into practice during the identification of the implementation process. Further opportunities for inquiry include investigating the factors influencing implementation, the effectiveness-implementation hybrid design, outcomes of implementation, economic evaluation, and the phases of scaling up the strategies within the MBG program. The active role of end-users can help ensure that the results are relevant and applicable in practice, thereby increasing the possibility of adoption. Keywords: Free nutritious meals, implementation science, perspectives, school-based program
This commentary discusses Indonesia's strategic decision to move from the WHO Southeast Asia region (SEARO) to the Western Pacific region (WPRO), which was formally approved at the 78th World Health Assembly in May 2025. This move shows that Indonesia wants to be more active in determining the direction of its global health cooperation, while also revealing power imbalances and limitations in the WHO regional system. The article also compares Indonesia's experience with other countries, such as Mongolia and Israel, that have made similar moves. It concludes that the WHO's regional system needs to be adjusted to be more equitable and flexible, and give all member states an equal voice. Keywords: Global health, Indonesia, multilateralism, regionalism, power asymmetry.
Background: Madura Island is often left behind in health development in East Java Province, including in the health sector. Poverty and poor education dominate this region. Aims: The research examined the role of education in National Health Insurance (NHI) membership among Indonesian Madurese. Methods: The study employed 791 respondents. We used NHI membership as an outcome variable, education level as an exposure variable, and seven control variables: regency, residence, gender, employment, age, wealth, and marital status. In the last stage, we employed a binary logistic test. Results: The results showed that 58.2% of Madurese people in Indonesia are members of the NHI. Regarding education level, Madurese with primary education was 1.672 times more likely than those without formal education to be an NHI member (95% CI 1.662-1.683). Meanwhile, Madurese with secondary education was 2.329 times higher than those uneducated to be an NHI member (95% CI 2.306-2.352). Moreover, Madurese with higher education was 4.593 times more likely to be an NHI member than uneducated Madurese (95% CI 4.517-4.669). Conclusions: Education level was associated with NHI membership among Madurese in Indonesia. The higher the education level, the higher the possibility of being an NHI member. Keywords: health insurance, National Health Insurance, Madurese, big data, public health
This editorial article highlights the important role of strengthening the maternal and child health system for the overall increase of the nation’s productivity, as well as the achievement of Indonesia Emas 2045. The discussion emphasized accessibility of maternal health services in community health services like Posyandu through readiness of health cadres, especially after the government implemented Integrated Primary Health Services or Integrasi Layanan Primer (ILP). Moreover, the implementation of exclusive breastfeeding was found to be significantly associated with stunting, making it a pivotal program to decrease stunting prevalence and increase infants’ health quality. Although some challenges like geographic barriers, limitation of knowledge and education, as well as low household income existed, investing in the maternal and child health system would solve the problem of the high mortality rate among mothers and infants. As Indonesia Emas 2045 was set as national development goals, the article stands up for better quality of maternal and child health in Indonesia through collaboration across sectors with an inclusive decision-making process. Keywords: Child health, health system, infant health, maternal health.
Background: Leptospirosis is a public health issue caused by the Leptospira bacterium, leading to significant economic impacts. The cost of illness due to Leptospirosis encompasses hidden costs that significantly affect individuals and society Aims: This study aimed to assess the hidden economic burden (direct and indirect costs) experienced by patients and their families due to healthcare treatment of leptospirosis. Methods: This descriptive cross-sectional study was conducted in Banyumas Regency from February to June 2024. Data were collected from patients who completed leptospirosis treatment in 2023. The variables of cost were categorized into direct treatment cost, treatment cost, and indirect cost, which were analyzed descriptively. Results: Most leptospirosis patients were male, aged 26 – 45 years old, and the majority worked as farmers. Our study reveals that uninsured patients incurred higher out-of-pocket expenses during leptospirosis’ treatment. The productivity loss was estimated at USD 44.75, with significant hidden costs being transportation (USD 31.90), caregiver support (USD 86.38), and hospital treatment (USD 231.40). Conclusion: The significant burden of Leptospirosis in Indonesia highlights the economic impact on individuals and the challenges within the healthcare system. This study calls for enhanced public health strategies focused on prevention, early diagnosis, and improved healthcare access to address the leptospirosis burden effectively. Keywords: Cost of illness, economic burden, financial impact, leptospirosis, productivity loss
Background: The readiness of Posyandu (a community-based health service) cadres’ to implement the Integrated Primary Health Services (Integrasi Layanan Primer/ILP) is vital to advancing preventive and promotive care. Aims: This study aims to evaluate the cadres’ readiness, identify challenges, and propose effective strategies for sustainable implementation. Methods: A mixed-method design from April to June 2024. 113 cadres from Kulon Progo, Sleman, and Yogyakarta City participated in a cross-sectional study. Cadres' readiness was evaluated based on the posyandu cadres’ basic skills training curriculum. Ten informants were interviewed to explore the opportunities, needs, and limitations of the ILP implementation. Descriptive statistics were used for data analysis. Results: Most cadres (63.7%) were aged 41–50 years, 60.2% had completed senior high school, and 72.6% were housewives. The cadres demonstrated high readiness for ILP implementation, with the main needs in the form of improving logistics, funding, training, and community participation. In addition, there was a need to improve the literacy and skills of cadres in providing health services across the life stages, such as immunization, growth and development monitoring, and infant and child feeding. Conclusion: Posyandu cadres are ready to implement the ILP; however, strengthening cadres’ capacity and fostering community collaboration are key strategies for ensuring the sustainability of the program and achieving health transformation. Keywords: cadres, health transformation, integrated primary service, posyandu
Background: To achieve high and equitable immunization coverage, it is important to understand the access and utilization barriers, as well as the influencing determinants among population groups. Aims: This study aims to identify high-risk regencies and explore the application of spatial analysis to support microplanning in immunization programs. Methods: This study employed an implementation research design conducted in Aceh Province, Indonesia. Secondary datasets on immunization coverage, health human resources, facilities, and socio-economic parameters were analyzed. Focus group discussions (FGDs) and training sessions were conducted with health workers. Results: The average coverage of universal child immunization (UCI) across villages was 24.18%, while complete basic immunization (CBI) reached 55.85%. In general, regencies with low UCI and CBI often had limited human resources, inadequate health facilities, and a high proportion of high-risk populations. This study identified hot spots and cold spots in the study area. Additionally, participants reported that mapping using the application was easier and beneficial for supporting the preparation of immunization micro-planning. Conclusion: Spatial analysis can help address inequalities in immunization services and support resources during immunization. Qualitative approaches provided a deeper understanding of undocumented information. The use of mapping applications facilitated more effective microplanning in immunization programs. Keywords: Child mortality, health risk, immunization, microplanning, vaccine.
Background: Patient safety incidents continue to occur in primary health care services despite being 24% to 85% preventable. Promoting and assessing patient safety culture is the primary step to minimize and prevent adverse incidents. Aims: This research examined the level of patient safety culture implementation in Primary Health Centers. Methods: A quantitative descriptive research design was conducted involving 319 employees randomly selected from 11 Primary Health Centers in Jambi province. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire and analyzed descriptively, with an average cut-off point of 75%. Results: The implementation level of patient safety culture in the Primary Health Centers in Jambi Province was 71.5%. Furthermore, seven dimensions of patient safety culture were weakly implemented: staffing, communication openness, organizational learning for continuous improvement, supervisor/manager expectations and actions promoting patients, non-punitive response to error, general perception of patient safety, and frequency of error reporting. Conclusion: Continuous examination should be conducted to ensure better changes in improving patient safety culture. Keywords: Jambi Province, Patient safety culture, Primary health center
Background: Exclusive breastfeeding (EBF) is a lifesaving practice for infants in vulnerable conditions. Therefore, it is crucial to ensure the optimization of EBF coverage in disadvantaged areas. One of the barriers to EBF is limited maternal knowledge, and prenatal classes are designed to improve maternal health knowledge and practices. Aims: The study aimed to analyze the role of prenatal classes in supporting EBF in Papua. Methods: The cross-sectional study examined 640 mothers with children aged 0-5 months from the Papua Region. Prenatal classes were an exposure variable, while EBF practice served as an outcome variable. Nine control variables, including age, marital status, education, work, wealth, sex, infant age, and early initiation of breastfeeding (EIBF), were incorporated into the analysis. Binary logistic regression test was used for analysis. Results: The proportion of EBF in Papua is 50.7%. Mothers who participated in prenatal classes were 1.560 times more likely to practice EBF than those who did not (AOR = 1.560; 95% CI [1.476-1.649]). Additionally, the study identified nine control variables related to EBF in the Papua Region: type of residence, maternal age group, maternal marital status, education level, employment status, wealth status, infant age, infant sex, and EIBF. Conclusion: Participation in prenatal classes is positively associated with the achievement of EBF practice in the Papua Region. Additional characteristics associated with a higher likelihood of EBF among Papuan mothers included having a higher level of education and employment, living in rural regions, experiencing poverty, being married, and achieving successful EIBF. Keywords: exclusive breastfeeding, Papua, prenatal classes, public health, public health nutrition
Background: Remote public health centers (PHCs) have the highest proportion of PHCs without doctors, with Southeast Sulawesi Province ranking fifth in this regard. PHCs serve as the main gateway to health services in rural and remote areas. Despite its high fiscal capacity and provision of support for medical education and incentives, North Konawe District has not succeeded in retaining doctors in its public health centers. Aims: This study aims to analyze factors that influence the retention of doctors in remote PHCs in the North Konawe District. Methods: This qualitative study employed a case study design, involving in-depth interviews with 14 informants and a review of six documents. Results: Factors affecting doctor retention in the North Konawe District include individual factors, work factors, living environment factors, and health system factors. Conclusion: Doctors in remote PHCs in North Konawe District are Ministry of Health placement doctors working on temporary contracts. Strategies to improve the retention of doctors in remote PHCs include improving living conditions in remote areas, supporting job opportunities for doctors' spouses, recruiting doctors early in their careers, implementing government disincentive policies, building PHCs with official housing, requiring mandatory service for recipients of medical education scholarships, and developing doctor attendance information systems. Keywords: Doctor, PHC, remote area, retention.
