Nagiot Cansalony Tambunan (Associate Expert Policy Analyst and Member of the National Association of Policy Analysts (INAKI) at the Center for Health Security System Policy, BKPK, Ministry of Health, Republic of Indonesia)
Photo Illustration: 'Dedication of Health Workers' by Achmad Fazeri from Grobogan, Central Java, as the winner of 1st Place in the 2025 East Java Harmony Photo Competition. Source link: https://www.petrogas.co.id/juaralombafoto2025/
Introduction: The Complexity of Archipelagic State Administration
Indonesia occupies a unique and challenging position in the global public administration landscape. Unlike continental countries with robust land connectivity and relatively high demographic homogeneity, Indonesia is the world's largest archipelagic state. With its expanse of 17.000 islands, hundreds of ethnic groups, and extreme topographic variation, Indonesia presents significant challenges of disparity. The span of government control stretches from the modern business hub of Jakarta to remote health posts in border regions where accessibility is limited to river or sea transportation.
This geographic reality creates asymmetric challenges in the distribution of public services. What is readily accessible in Java is often a luxury in the remote, frontier, and outermost (3T) regions. In this context, health policymakers face a crucial test: how to deliver social justice for all Indonesians through health services that are of equal quality yet adaptable to local conditions.
Development Mandate: From Discourse to Real Impact
Amidst this complexity, strategic direction from national leaders serves as a bureaucratic compass. President Prabowo Subianto has emphasized a development vision that is outcome-based, expeditious, and deliverable—meaning that every government program must truly reach and benefit communities at the grassroots level. There is no longer room for policies that are merely beautiful on paper but ineffective in practice.
Minister of Health Budi Gunadi Sadikin translated this vision into health transformation. The standards set are very high: national health policies must be based on the best scientific evidence and global best practices. However, the success of the policy is not measured by the sophistication of the technology adopted, but rather by how effectively health services reach and protect people across the country fairly and equitably.
For thousands of State Civil Apparatus (ASN), especially those holding the Functional Position of Policy Analyst (Anjaker) and Health Administrator (Adminker), this mandate is a crucial momentum for transforming performance. The bureaucratic paradigm, which has tended to be administrative and rigid, needs to be transformed into a more responsive, strategic, and problem-solving-oriented one.
Photo Illustration: Midwife Ilen (center) is among the Sikerei (Mentawai shamans) while checking on a resident's condition at home in Matektek Hamlet, Matotonan Village, South Siberut, Mentawai, West Sumatra. ANTARA FOTO/Iggoy el Fitra. Source link: https://www.antaranews.com/berita/5114937/dua-pewarta-foto-antara-raih-juara-karya-jurnalistik-bpjs-kesehatan
Deconstructing Urban Bias in Public Policy
The biggest challenge in achieving health equity often stems from cognitive bias in policy formulation, or what is often referred to as urban biasThere is a tendency to generalize that the infrastructure and social ecosystems in Jakarta or other major cities represent the conditions throughout Indonesia.
This fundamental error often leads to a policy approach one size fits allWe often adopt World Health Organization (WHO) standards or imitate the success stories of developed countries without contextualization. For example, a policy of digitizing healthcare services through an integrated application might be very effective at a Community Health Center (Puskesmas) in Menteng District, Jakarta, supported by a high-speed internet network and strong digital literacy. However, the same policy would face fundamental obstacles if implemented raw in a Community Health Center in the interior of Papua or the Maluku Islands, where electricity still relies on solar power and telecommunications signals remain a major obstacle.
Uniform policies across diverse landscapes have the potential to create budget inefficiencies and program failures. Therefore, a national perspective in policy formulation is absolutely essential. Loving Indonesia in the context of technocracy means understanding that justice does not mean providing the "same" interventions for all, but rather providing interventions that are "appropriate" to the needs and capacities of each region.
Global Synergy and Local Wisdom: An Implementation Research Approach
To address the challenges of standardization amidst diversity, the Ministry of Health is pursuing an upstream-downstream collaboration strategy. At the global (upstream) level, strategic partnerships are being established with reputable international institutions such as Institute for Health Metrics and Evaluation (IHME), Vital Strategiesand Aceso GlobalThe role of these global partners is crucial in providing precise disease burden data, cutting-edge analytical methodologies, and references to clinical interventions that have been proven effective in various countries.
However, global data is only raw material. To be implemented, it must be prepared by "chefs" who understand local tastes. This is where the role of local educational and research institutions becomes vital. The Ministry of Health's Health Polytechnics (Poltekkes) and universities throughout Indonesia must be empowered to conduct Implementation Research.
The focus of implementation research is no longer on the question "what is the cure?", as this is already answered by global medical standards. The key question has shifted to "how can this treatment be accepted, accessed, and adhered to by the local community?" This research explores local anthropological, sociological, and logistical aspects. The synergy between accurate, world-standard data and a network of local academics familiar with the field is key to ensuring policies are not only scientifically sound but also operationally feasible in the field.
Role Transformation Anjaker: From Administrator to Knowledge Broker
This changing policy landscape demands a redefinition of the role of Anjaker. Colleagues Anjaker should no longer be trapped as merely an administrative drafter of policy recommendations or regulatory drafts. Anjaker must transform into a Knowledge Broker—a reliable knowledge intermediary.
One Anjaker must have the ability to synthesize complex global data, combine it with local implementation research findings, and then formulate these into asymmetric policy options. This means, Anjaker We must have the courage to offer varied policy recommendations: one set for urban areas with established infrastructure, and another for island or remote areas. The ability to design flexible policies while remaining within quality standards is a core competency needed today.
Role Transformation Adminker: Becoming a Cultural Translator
Cut from the same cloth, colleagues. Adminker also holds a strategic role as a “Cultural Translator” of the health system. Currently, the position Adminker filled with talents with diverse technical backgrounds, ranging from epidemiology, environmental health, to health promotion.
This specific technical expertise should not be marginalized by administrative routines. In fact, it is this technical perspective that adds value. Adminker A sanitarian, for example, has the sensitivity to assess whether global hospital sanitation standards can be applied in tidal areas. An epidemiologist understands the nuances of infectious disease contact tracing in crowded traditional markets. This contextual sensitivity is essential for providing input to leaders so that the services requested by the President can strengthen, rather than conflict with, local wisdom.
Conclusion: Towards a Bureaucracy Based on Evidence-Based Pragmatism
We are now entering an era of evidence-based pragmatism. Geographical challenges and cultural diversity should no longer be used as justifications for slow public service delivery. Instead, this diversity should become a catalyst for bureaucratic creativity, leading to service innovation.
We need a flexible policy architecture: a fully digital system for smart city, but remains humane and manual for the region blank spot; medically advanced treatment, but delivered with a culturally respectful approach.
To all Anjaker and AdminkerOur task is to optimize global data for national health sovereignty. Let's leave our offices for a moment, go into the field with researchers, and listen to the aspirations and real needs of the community. Only with a down-to-earth approach can we ensure that every rupiah of the state budget is converted into tangible benefits for improving the health of the Indonesian people. Effective and dignified policies are policies that respect the geographic and sociological conditions of their citizens.
