PCIPHC: Indonesia Case Study

Indonesia has long prioritized providing preventive and curative PHC services at the community level. The current PHC infrastructure is based on a national system of 10,000+ community health centers called puskesmas. These health centers are supplemented by a community-level network of auxiliary centers, including integrated health posts, mobile clinics, and village-level posts to provide geographic coverage across the country’s ~1,000 inhabited islands. These local primary healthcare networks form the basis of the country’s health system, and the organization and coordination of services within and across these sites are critical for providing person-centered and integrated care.An ongoing process of decentralization, which began in 2001, is a key component of Indonesia’s public health strategy given the country’s geographic complexity, demographic diversity, and health equity challenges in access and outcomes. In implementing a decentralized PHC services management model, Indonesia faces persistent challenges in the health workforce, service availability and readiness, and facility organization and management. These capacity challenges undermine the integration of services across the primary care level and the integration of primary with secondary and tertiary levels, which disrupt the coordination, continuity, and comprehensiveness of care.Indonesia operates one of the largest social insurance programs in the world. Established in 2014 by fusing together multiple social security and health financing mechanisms into a single scheme, the Jaminan Kesehatan Nasional (JKN) payment model covers 269 million people or 96.4% of the population. JKN provides capitation payments to public health centers and private clinics based on voluntary empanelment. However, fragmentation in data systems and referral pathways is a barrier to greater public–private sector integration given the low uptake of formal, national information systems among private providers.The Indonesian government is making substantial strides in data digitalization. This effort aims to support better decision-making, enhance transparency in service utilization, and reduce data system fragmentation. Digitalization is complemented by a digital integration strategy that encompasses several key areas: (1) Data Systems Integration: digitizing health data to create a cohesive, interoperable system that improves information flow between public and private healthcare providers; (2) Community-Level Integration: leveraging digital tools to facilitate communication and coordination between healthcare providers and local communities, ensuring more efficient and effective care delivery at the grassroots level; (3) Vertical Integration: enhancing the linkage between primary, secondary, and tertiary care facilities through unified digital platforms, streamlining patient referrals and continuity of care.A pivotal component of this digital strategy is the SATUSEHAT initiative. The goal of SATUSEHAT is to integrate various health information systems to create a single, unified platform that facilitates comprehensive data sharing across all levels of the healthcare system. This platform not only aims to reduce data fragmentation but also ensures that healthcare providers have access to accurate and up-to-date patient information, thereby improving the quality of care. The SATUSEHAT initiative has achieved significant milestones, such as the successful digitization of patient records and the development of robust data-sharing protocols between healthcare facilities. By focusing on this transformative strategy, Indonesia is poised to enhance its healthcare delivery system substantially, ensuring that both public and private stakeholders can collaborate effectively to provide high-quality, patient-centered care.In November 2022, the Indonesian Minister of Health announced a Health Systems Transformation Agenda based on six foundational pillars: primary healthcare, referral care, health resilience system, healthcare funding, healthcare technology, and human resources in healthcare. A target outcome goal of this policy agenda is to improve the integration of healthcare services at the point of care.