Dr. Bambang Setiaji (Associate Expert Policy Analyst, Center for Health Security System Policy, BKPK)
Indonesia's ongoing healthcare transformation is essentially an effort to reorient its development, which has historically relied heavily on medical treatment. For years, the success of the healthcare system has often been measured by the number of facilities, medical personnel, and curative services. However, future healthcare challenges demand a more fundamental approach: keeping people healthy before they become ill.
This is where the promotive and preventive pillars of health transformation find their meaning. However, promotive-preventive efforts cannot thrive solely on slogans, campaigns, or calls for healthy lifestyles. They require policy and practice that impact people's daily lives. The Healthy Regency/City concept offers a framework to address this need.
Health is Formed in Everyday Life
Public health is ultimately shaped by various factors, most of which lie outside the healthcare system. Residential environment, water and sanitation quality, traffic safety, availability of green spaces, and even transportation patterns and urban planning significantly influence disease risk and quality of life. These factors are often overlooked when health is viewed solely as a matter of medical services.
Health transformation demands a shift in perspective: health is not simply the result of services, but rather the result of development policies that favor people. Therefore, promotive and preventive efforts must be a cross-sectoral responsibility, especially at the regional level, where policies truly impact citizens.
Healthy Districts/Cities as a Joint Framework
Healthy Districts/Cities is not a new concept. It has long been recognized as an approach that encourages cross-sector collaboration and community participation. However, in the context of health transformation, Healthy Districts/Cities need to be repositioned, not as an additional program, but as a promotive-preventive operational framework.
Through this approach, health does not stand alone but is integrated into policies on housing, transportation, the environment, education, and social protection. Pedestrian-friendly urban planning, adequate sanitation, pollution control, and public spaces that encourage physical activity are all forms of promotive and preventive interventions that have a far broader impact than medical interventions alone.
This approach aligns with the spirit of health transformation, which prioritizes prevention as a long-term investment. A healthy environment reduces the risk of disease, increases productivity, and ultimately reduces the burden of healthcare costs.
From Just a Program to Governance
One of the challenges facing Healthy Districts/Cities has been the tendency to view it as a sectoral program or ceremonial activity. As a result, implementation often relies on the health sector, while other sectors operate independently.
In fact, the strength of Healthy Districts/Cities lies in their governance. When local governments make it a shared agenda across regional agencies, promotive and preventive efforts can be integrated into planning and budgeting. Without integration into documents like the RPJMD (Regional Medium-Term Development Plan) and RKPD (Regional Work Plan), Healthy Districts/Cities struggle to develop into a sustainable movement.
Health transformation demands regional leadership that is able to view health as a shared responsibility, not just the responsibility of the health department.
Answering the Challenges of the Times
Climate change, rapid urbanization, and the potential for global health emergencies demonstrate that health challenges are increasingly complex. A region-based, promotive-preventive approach is becoming increasingly relevant. Healthy Districts/Cities provide the space to respond to these challenges contextually, tailored to the characteristics and needs of the region.
Moreover, this approach opens up space for community participation. Efforts to maintain health are no longer top-down, but rather arise from a shared awareness that a healthy environment is a prerequisite for a better quality of life.
Closing Event
Health transformation will not achieve its goals if it stops at reforming services and sectoral regulations. The promotive-preventive pillar requires a concrete, cross-sectoral, and sustainable implementation platform. Healthy Districts/Cities are one concrete manifestation of this need.
When regional development is designed with a health perspective, promotive and preventive approaches are no longer jargon but rather everyday practices. This is where health transformation finds its footing: prevention before cure, health before healing, and placing the quality of human life as the primary goal of development.
