On 11 October 2024 the Indonesian Ministry of Health (MoH), World Health Organization (WHO) and key stakeholders agreed on a plan to increase access to quality, comprehensive primary health care (PHC) for every Indonesian. Finalized at the end of a three-day meeting in South Kuta, Bali, the plan aims to better distribute patients and resources across different PHC providers.
Indonesia’s Health Transformation Agenda, launched in 2022, puts PHC at the heart of achieving universal health coverage (UHC), in alignment with WHO guidance. UHC ensures that everyone, everywhere can access essential health services, without financial hardship. In Indonesia, PHC facilities – both public (puskesmas) and private – provide essential health services such as health promotion, disease prevention, treatment, rehabilitation and palliative care.
Central to Indonesia’s PHC reorientation is the National Health Insurance (JKN) scheme. Almost 80% of JKN participants are registered at puskesmas. While this reflects JKN's success and strong public trust in puskesmas services, it risks overwhelming these facilities and compromising the quality of care. To prevent this, a task-sharing mechanism enables patients to transfer between PHC facilities, but only with their consent, as mandated by Presidential Decree No. 59 of 2024 and BPJS-K Regulation No. 4 of 2019 on JKN Redistribution.
To help implement the scheme, the Bali meeting brought together representatives from the MoH’s Directorate of Primary Care Services, the National Health Insurance Agency (BPJS Kesehatan), the Ministry of Home Affairs, the Indonesian Clinic Association, and officials from 10 provinces and 16 cities or districts. Together, participants discussed regulations and quality standards to support redistribution and ensure balanced workloads across PHC providers, sharing best practices from Yogyakarta, Bangli, Maros and Makassar.
“Empowering people should be the top priority,” said Dr. Obrin Parulian, Director of Primary Health Care Services, MoH, Government of Indonesia. “Educating people about their right to choose health facilities based on their needs or preferences will improve their experience and act as a form of quality control for us.”
Participants agreed on the need to identify target facilities and ensure they meet established standards and deliver consistent quality of care. Key factors include doctor-to-patient ratios, operational hours and re-evaluating health worker capacity. Participants also emphasized the need for regulations that enhance collaboration between local governments, healthcare providers and the private sector to close gaps in the quality and accessibility of care.
Next, participants highlighted the critical importance of public awareness and outreach campaigns. These initiatives will encourage people to enroll in health services and choose PHC providers that meet their needs. They will also build trust in the redistribution system, ensuring individuals feel confident when selecting or switching PHC providers.
Finally, participants agreed that continuous monitoring and evaluation will help ensure service quality and address challenges such as inequity or member dissatisfaction. Crucially, this must include cases where patients request to return to their initial PHC facility.
“The redistribution scheme is key to ensuring fair access and reducing strain on overburdened facilities,” said Prof. Roderick Salenga, Ag. Team Lead for Health Systems Strengthening, WHO Indonesia. “By balancing resources, we can enhance the quality of care across the board. WHO stands ready to support Indonesia in making this a reality.”
The meeting concluded with next-step actions to guide redistribution activities, with participants committing to key timelines and milestones. WHO Indonesia is committed to supporting MoH to actively monitor the plan's implementation in 2024 and 2025, ensuring that every Indonesian has access to quality PHC, for healthier lives, leaving no one behind.
Written by Rhiza Kristata, National Consultant for Universal Health Coverage, WHO Indonesia