Strengthening Primary Health Care in Indonesia
The review on Strengthening Primary Health Care in Indonesia was initiated to conduct a thorough analysis of the situation of Primary Health Care in Indonesia and propose strategic recommendations for strengthening the PHC system that is more responsive to the dynamic of changes.
Objectives
This high-level purpose is then translated into three major objectives: (1) To conduct an overview on situational analysis of PHC, assess, and analyse its various aspects, which include: governance and regulation, financing, human resources for health, medicines and supplies, service delivery, information systems, outdoor and outreach services, as well as community empowerment that focus on health promotion and disease prevention; (2) To conduct equity-disparity analysis of PHC, identifying areas to be improved in locations with geographical challenges, underserved area, borders and outermost islands; and (3) To inform and propose recommendation on a strategic plan in strengthening PHC and provision of the operational framework of PHC in Indonesia.
Methodology
The study utilised mixed methods and drew on quantitative and qualitative data for data collection and analysis. These were used to provide a comprehensive approach to capture areas for improvement in strengthening the PHC system to be responsive to a changing landscape. A final 12 levers (element of analysis) were used. Research with four prioritised topics: Health Financing, Community Empowerment, Referral System, and Health Facilities & Infrastructures (Inc. Information System, Health Care Provider, Medicine, Health Workforce) were delved further into PHC Index.
Result
The review presented that Indonesia has been reforming the country’s health system towards a more integrated PHC system. This is evident from the priorities and targets set in the national development plan: the 2015-2019 and 2020-2024 RPJMN. While decentralisation provides an avenue to innovate for local governments to address their local challenges accordingly, variations in performance and achievements were captured by this review, sourcing from national reports. The Ministry of Health and Ministry of Home Affairs is the key actors providing stewardship roles in orienting national regulation, strategies, and plans around PHC, and with decentralisation, the provision of health services to the population becomes the jurisdiction of provincial and local governments. A synergy, alignment, and synchronisation of objectives and priorities between RPJMN and RPJMD is gatekept by BAPPENAS. Focus on PHC service delivery is still highly aimed at the curative aspect, curtailing the number of diseases as a priority. This illustrated a disproportionate focus on what constitutes PHC service at a local and regional level. A review of several reports confirmed that PHC expenditure spends substantially more on curative and rehabilitative than promotive and preventive services.
Indonesia’s efforts toward a more integrated primary health care system are hampered by existing disparity across the country, specifically between Western and Eastern Indonesia and underserved areas, borders, and outermost islands. The review presented reports and secondary findings that emphasise the discrepancy in health workforce distribution and capacity and physical and technology infrastructure.
Recommendation
With these challenges, the recommendations proposed in this review consistently spotlighted the urgency and importance of inclusion and incorporation of private PHC providers into the health care system to comprehensively strengthen primary health care in Indonesia. The review proposes 50 recommendations across the 12 elements of analysis as the proposed framework in Strengthening Primary Health Care in Indonesia. In addition to these recommendations, the review presents PHC Index as an exploratory tool presenting a snapshot of 13 domains that can assist and support local governments to better prioritise their health objectives and better plan specific mechanisms to address challenges that reflect their current situation. PHC Index is applicable to capture 13 domains from provincial to district levels across 34 provinces and 514 districts in Indonesia.