Author: Dr. Syahrul Aminullah, SKM, M.Si (Policy Analyst, BKPK, Ministry of Health/Secretary General of the Indonesian Health Professional Organization Forum/FOPKI 2007-2013)
Following the enactment of Law No. 17 of 2023 concerning Health, a sweeping blueprint dubbed "Health Transformation" was officially launched. The "Kuningan Axis," as the policy nerve center within the Ministry of Health, has implemented six strategic pillars to completely overhaul the national health architecture. However, this grandiose slogan faces a real challenge at the heart of decentralization: whether the idea will be able to resonate in public service spaces across the archipelago. Grounding the transformation is not simply a matter of distributing instructions, but rather synchronizing actions between the central government and the 38 governors and 514 regents and mayors, who hold the mandate to provide basic services on the ground.
Without alignment, this transformation will only result in a bureaucratic "ivory tower" that fails to address social realities at the grassroots level. Regional autonomy places health care as a mandatory responsibility, with execution in the hands of regional heads. The success of implementing this policy rests heavily on the willingness of the 552 regional leaders to integrate these pillars into the regional budget structure and adaptive local policies. The Kuningan Poros is now required to transform from a mere regulatory machine into a savvy facilitator that ensures central government policies remain stifled when confronted with the complexities of regional governance.
Fiscal Revitalization and Regional Crisis Resilience
The first critical point in grounding this transformation is the elimination of mandatory budget allocation provisions (mandatory spending) in the latest regulations. This change automatically increases the political responsibility burden for the 514 regents and mayors in determining fiscal priorities. Grounding health policy means ensuring that, even without rigid percentage thresholds, regional budget commitments are not eroded by short-term political interests. The Kuningan Axis must play a role as a budget quality monitor, ensuring regional fiscal independence is aligned with improving minimum service standards at every health facility.
The role of the 38 governors, as representatives of the central government in the regions, is crucial in overseeing this priority. Governors must ensure that their regencies and cities have adequate health resilience, particularly in the face of the frequent natural disaster risks, ranging from seismic threats along the Sumatran fault to hydrometeorological hazards in other parts of the Republic of Indonesia. Embracing the third pillar of health resilience means building the readiness of healthcare workers and medical facilities that remain functional in crisis situations. Investment in health early warning systems and emergency logistics management must be an integral part of regional spending, not simply waiting for a helping hand from the center when disaster strikes.
Regional governments should no longer view the health sector solely from a curative perspective within hospital buildings. The success of the 552 regional health centers should be measured by the effectiveness of upstream prevention efforts through strengthening community health centers (Puskesmas). Grounded funding is allocated to cover promotional efforts, nutritional improvements, and the provision of basic sanitation infrastructure to break the cycle of disease. Fiscal synergy between the national and regional budgets (APBN) must be instrumental in encouraging community health centers to become the primary bulwark in detecting public health threats, whether infectious disease outbreaks or the health impacts of natural disasters.
Access Justice and the Archipelago's Digital Bridge
The next challenge in grounding the transformation is breaking down the barriers of unequal access to medical personnel and technological infrastructure across Indonesia's vast geographical landscape. The second pillar, referring to referrals, and the sixth pillar, health technology, often face challenges in challenging terrain outside Java. The concentration of specialist doctors, which remains urban-centric, leaves many regions facing a service deficit. Grounding the transformation requires 514 regional heads to formulate incentive schemes and environmental support that can attract medical professionals to settle in remote areas. In this regard, the Kuningan Axis must provide a roadmap based on accurate data on the precise distribution of healthcare worker needs.
Regents and mayors are obligated to create a humane ecosystem for medical personnel, from ensuring security to providing educational facilities for their families. Without concrete local support, national policies on equitable distribution of healthcare workers will remain mere promises on paper. Accordingly, digital integration through the SatuSehat platform must be positioned as a bridge to simplify bureaucracy, especially in emergency situations where the speed of medical information exchange is crucial for saving lives. Down-to-earth digitalization is an inclusive system that remains reliable even in areas with poor internet signal, and can significantly reduce patient referral times.
Furthermore, national health resilience requires regional participation in strengthening medical logistics independence. Governors must play an active role in coordinating cross-regional collaboration to ensure the availability of medicines and medical devices is not disrupted by geographical barriers. Visionary regional leadership will ensure that every citizen has equal access to the latest medical technology, regardless of location. Innovations born from the Kuningan Axis must be easily operable by health workers in villages, so that sophisticated technology can truly save lives in even the most remote areas.
Health transformation is a long journey that requires leadership stamina and consistency from 552 regional heads. Its success is not measured by the grandeur of the program's launch ceremony, but by the resilience of our health system when tested by a pandemic or unexpected natural disaster. Grounding the policy means breaking down sectoral egos to realize equitable national health sovereignty. We need a national symphony in which 38 governors and 514 regents/mayors move in unison with the conductor at the Kuningan Axis and its BKPK (Investigating Agency for Health Development). When quality health services are evenly and resiliently present in every corner of the country, that is when transformation has truly landed firmly. Let us ensure that the grandeur of this grand narrative is not merely a record of administrative achievements in the capital, but a real protection for every soul in every corner of the earth. In truth, health transformation is the first step from the regions towards future national progress.
*) Published in the Opinion Column of the Lampung Post Newspaper (February 9, 2026)
