Policy Brief 2024

Executive Summary : The provision of raw materials for medical devices is a crucial factor in developing the medical device industry to achieve a resilient health system. One of the instruments used by the government in this effort is the Domestic Component Level (TKDN) policy. The TKDN assessment provides the largest portion of the calculation for manufacturing aspects, particularly direct materials (raw materials). Raw materials for medical devices are a crucial factor in ensuring the safety, quality/performance, and availability of medical devices. Based on the largest purchases of medical devices by value and by volume, there are three main raw materials required by the medical device industry: rubber, plastic, and stainless steel. However, several issues remain, such as the availability of domestic raw materials, such as specifications that do not meet medical grade standards, limited testing laboratory capabilities, and limitations in upstream and intermediate industries in meeting the needs of the domestic medical device industry. Several strategies that need to be implemented by the Directorate General of Pharmaceuticals and Medical Devices, Ministry of Health, include developing the medical device industry to products that predominantly use rubber, plastic, and stainless steel as raw materials, improving medical device raw material testing capabilities, and conducting research on rubber, plastic, and stainless steel raw materials used in the medical device industry to ensure competitiveness in terms of quality and price with imported products.

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Executive Summary : Meeting the need for essential medicines is a crucial factor in achieving independence and resilience in domestic pharmaceutical supplies. The success rate of drug supply is measured by the number of districts/cities with at least 80% of community health centers (Puskesmas) with at least 80% availability of 40 domestically produced essential medicines. This indicator aims to reduce morbidity rates in primary healthcare facilities and optimize disease control programs. This study aims to identify challenges in essential medicine supply and provide policy recommendations needed to strengthen the supply and availability of essential medicines in primary healthcare facilities. Several issues in the essential medicine supply chain that affect the availability of essential medicines include: a) production side: repeated bioequivalence tests for products resulting from substitution of imported raw materials to local raw materials that require time and costs, reformulation of products resulting from substitution of local raw materials that requires time, the number of Drug Requirement Plans (RKO) is often different from the number of drugs ordered causing raw material planning in the industry to be incompatible, finished drug products resulting from substitution of local raw materials are given a Distribution Permit Number (NIE) with a shorter validity period so that it requires time for renewal, b) procurement and distribution side: the number of pharmaceutical wholesalers (PBF) is very limited and geographical and transportation challenges in certain areas, especially Eastern Indonesia, cause the distribution process to be not smooth/impeded, tenders through e-purchasing that take a long time, the expiration date of drugs received by health facilities is often less than 2 years, not all provincial health offices have succeeded in implementing drug procurement contracts for programs through DAK and not all contracts can be fulfilled by providers, c) consumption side: limited number of pharmacists and TTK and limited HR capacity in drug management, inaccurate formulation of RKO by FKTP and Health Office so that the national RKO is inaccurate, d) implementation side program: not all regions have been socialized with the drug procurement regulations for the program and there are shortages of some program drugs, and e) budget side of drug procurement: not all regions have received APBD for drug procurement and distribution. The government (Ministry of Health and Health Office) needs to prioritize areas with the highest needs in mapping for drug control and distribution, especially in Eastern Indonesia, and integrate the systems that have been developed to become a more optimal system for more accurate planning and monitoring of real stocks.

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Executive Summary : Medical device resilience is the ability of a health system to ensure the continued availability, usefulness, and accessibility of medical devices, both under normal circumstances and when facing disruptions such as health crises, natural disasters, supply chain disruptions, and other disruptions. Law Number 17 of 2023 and Government Regulation Number 28 of 2024 mandate the Government to develop a structured National Medical Device Needs Plan (RKA) using information technology integrated with the National Health Information System (SIKN). Health facilities have developed and reported drug need plans, thus providing national drug need data. This has not yet been implemented for medical devices as part of the national RKA. The Ministry of Health currently has several reporting information systems, but these have not been utilized for national medical device needs planning. The lack of uniform nomenclature for medical devices is another obstacle faced in recording and reporting the health logistics system. The proposed policy recommendation is to prepare the RKA based on proposals from health facilities and programs using ASPAK. The RKA is prepared by health facilities and health offices using the KFA code. This recommendation is addressed to the Directorate General of Advanced Health Services as the manager of ASPAK and the Data and Information Center (Pusdatin) as the manager of KFA.

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Executive Summary :The success of health development is largely determined by the availability of medical personnel, healthcare workers, and professional supporting human resources (HR) who possess the skills, expertise, competence, and global competitiveness in sufficient numbers and distribution to optimally carry out their roles and functions. To increase motivation, innovation, and retention of healthcare HR in their respective areas of service, medical personnel and healthcare workers who demonstrate exceptional dedication and performance deserve recognition in the form of awards.

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Executive Summary : The COVID-19 pandemic has become a crucial momentum for the Indonesian nation to enter the genomics era, particularly with humans as its subjects. The government anticipates this genomics era through Ministry of Health Decree No. HK.01.01/MENKES/505/2024 by establishing a genomics technology platform through Biomedical Genome Science Initiative (BGSI) which is clarified in PP Number 28 of 2024. The BGSI program refers to ISO 20387 which involves 10 vertical hospitals to conduct analysis of several types of diseases in humans, so that it is hoped that the results of this genomic analysis can be used as a reference in providing precision treatment (Precision Medicine) according to their genomic profiles. Currently, several private sectors have also begun to offer genomic services. The purpose of this study is to propose policy recommendations related to the governance of genomic services in healthcare facilities in Indonesia. This study discusses the types of genomic services in 10 vertical hospitals and the private sector; the scope of genomic services; analysis of genomic services in Indonesia and the challenges in implementing genomic service governance. Based on the results of the data analysis, recommendations can be made: providing a government genomic service roadmap (BGSI) as a model for private sector genomic services; providing a centralized genetic database platform within the government; certifying all genomic service providers; providing certified genetic/molecular biology consultants at each genomic service facility; and regulations sharing genomic profiling. This study is expected to serve as a reference for Indonesia in regulating the management of genomic services in both the government and private sectors. Full Text Request

Executive Summary: Whole Genome Sequencing (WGS) is the latest technology in genomics, used to read the entire DNA sequence of an organism. This technology has developed rapidly in recent decades and is widely used in the health sector. The use of WGS technology for health in Indonesia was implemented through the establishment of the Biomedical and Genome Science Initiative (BGSI) based on Ministerial Decree No. HK.01.07/MENKES/1141/2022 and the Indonesian Human Genome Project. However, the use of WGS data and technology in Indonesia still faces several major challenges related to the absence of a committee to handle the implementation of WGS; limited laboratory infrastructure and genomics/bioinformatics experts; the still high cost of WGS services and genomics research; limited digital infrastructure and the absence of specific regulations for genomics information management; and minimal public awareness of the benefits and applications of this technology for the health sector. Based on the problem identification and data analysis results, policy recommendations that can be provided to optimize the use of WGS data and technology include the establishment of a committee to handle the implementation of WGS in Indonesia; equalization and capacity building of WGS providers and training for related experts; standardization of testing protocols, data analysis, and storage; designing a subsidy scheme with BPJS to reduce the cost of WGS services; increasing data storage capacity and establishing strict regulations for the use of genomic data; and establishing a national genomic literacy program to increase active public participation in this program. policy brief It is hoped that this will encourage the use of WGS data and technology for the development of genomics-based medical research and precision medicine in Indonesia in an effort to improve national health. Full Text Request

Executive Summary: The Ministry of Health launched the Primary Care Integration Program (PLI) as an implementation of Law No. 17 of 2023. With lifecycle service development and village and hamlet-level networks, the ILP program's effectiveness depends on collaboration among all parties. A Primary Care Integration Consortium was subsequently formed with 27 foreign development partners, the private sector, associations, and universities. Following the collaborative process, the involvement and support of these foreign development partners is expected to continue to grow. These policy recommendations are intended to serve as a guide for the government and development partners in developing the consortium.

There are 5 (five) potential areas for increasing support from foreign development partners and the private sector, namely: development of infrastructure and technology, health cadres, competency of heads of Community Health Centers, Community Health Center business as a Regional Public Service Agency, and integration of central and regional government policies. The consortium can also be maintained and strengthened through strong leadership, clarity of policy and direction, open communication, coordination of resource mobilization and opportunities to share good practices. The consortium also has the potential to become intensive coordination space between ministries/institutions and regional governments as well as global policy advocacy space.

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Executive Summary: The minimum service standards in the health sector have been stipulated by the Minister of Health Regulation Number 4 of 2019 concerning Technical Standards for Fulfilling Basic Service Quality in the Minimum Service Standards in the Health Sector. This regulation is stipulated based on Law Number 23 of 2014 concerning Regional Government as amended several times, most recently by Law Number 9 of 2015 and the provisions of Article 6 Paragraph (6) of Government Regulation Number 2 of 2018 concerning Minimum Service Standards. The minimum service standards based on Article 16 of Government Regulation Number 2 of 2018 have been stipulated by the Minister of Home Affairs Regulation Number 100 of 2018 which has been amended by the Minister of Home Affairs Regulation Number 59 of 2021 concerning the Implementation of Minimum Service Standards. Based on the Minister of Home Affairs Regulation, it has been regulated that the calculation of SPM Achievement is carried out using the SPM Achievement Index.

The SPM Achievement Index includes the achievement of Basic Service Quality and the achievement of Basic Service recipients. Basic Service Quality Achievement is the achievement of the minimum quality of basic services obtained from the average of the sub-Performance Indicators for achieving the minimum quality of goods, services, and human resources in accordance with Technical Standards. Basic Service recipient achievement is the achievement obtained through Targets and Performance Indicators. To increase the achievement of SPM in the health sector to 100%, it is necessary to immediately revise Minister of Health Regulation Number 4 of 2019 in accordance with Minister of Home Affairs Regulation Number 59 of 2021.

The achievement of minimum service standards is also supported by the policy/regulation of 14 (fourteen) indicators of SPM in the health sector with the existence of Law Number 17 of 2023 concerning Health which revokes several laws in the health sector, a Draft Government Regulation is also being prepared as its implementation which will also revoke previously stipulated Government Regulations, as well as various implementing regulations regulated by the Regulation of the Minister of Health.

The Minimum Service Standard Indicators are determined based on Government Regulation Number 2 of 2018, for adjustments in accordance with Law Number 17 of 2023, further analysis is needed regarding these indicators as a proposal for revising Government Regulation Number 2 of 2018.

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Executive Summary: Digital transformation is a crucial step to improve the accessibility and quality of healthcare services. SatuSehat-connected Electronic Medical Records (EMR) must be implemented in all healthcare facilities by the end of 2023. According to the SatuSehat dashboard, in 2024, 24% of the total 34.967 Independent Practices (TPM) were connected to SatuSehat¹. The TPMs that have begun connecting are Independent Doctor Practices (TPMD) and Independent Dentist Practices (TPMDG). Cirebon City is one of the cities in West Java where 19% (24 TPMs out of a total of 129 TPMs) of TPMD and TPMDG have been connected to SatuSehat². This situation has the potential for unnecessary repeat examinations, cost wastage, and delays in diagnosis, which can lead to a decline in the quality of continuity of care. Field findings indicate that the implementation of Satu Sehat in TPMD and TPMDG in the admission aspect is considered to provide benefits, such as increased effectiveness of patient services, ease of access to patient data, efficient paper use, and potential sustainability if the cost of EMR is more affordable. However, obstacles encountered in the field include user trust in data security, complex connectivity processes, and cost adjustments. Compliance aspects, including regulations and the active role of professional organizations (OPs), vendors, and the Health Office, are supporting factors for the implementation of Satu Sehat (One Health) in the TPMD and TPMDG. Meanwhile, inhibiting factors identified include limited assistance and feedback, a lack of infrastructure, user guidelines, rewards, and regulatory consequences. To address these challenges, a comprehensive strategy is needed, including regular assistance and feedback, performance-based incentives, and regulatory enforcement to encourage effective implementation of EMR. These steps are expected to accelerate the digital integration of health services and support the sustainability of the Satu Sehat program. Full Text Request

Executive Summary : ACPHEED (ASEAN Center for Public Health Emergencies and Emerging Diseases) was established based on the mandate of the ASEAN Ministers of Health, where this center serves as a center that will be able to strengthen ASEAN's capabilities in preparing, detecting, and responding to public health emergencies and emerging diseases. ACPHEED is divided into three centers and one secretariat. The centers are Prevention and Preparedness (PM) organized by Vietnam, Detection and Risk Assessment (DM) organized by Indonesia, and Response and Risk Communication (DM) organized by Thailand. In preparing for the operationalization of ACPHEED in Indonesia, preparation is needed in selecting a working mechanism, and a collaboration system for ACPHEED with other ASEAN centers in Indonesia. Therefore, to provide policy recommendations related to this, a study was conducted. The study was conducted using several methods, namely benchmarking, literature review, expert discussions, and Focus Group Discussions (FGD). The resulting policy recommendation is an expertise-based approach recommended for the operationalization concept, ACPHEED in Indonesia will collaborate in an interconnected function with other ASEAN centers in Indonesia such as the ASEAN BioDiaspora Virtual Center (ABVC) and the ASEAN Institute for Disaster Health Management (AIDHM), ACPHEED must have Standard Operating Procedures (SOPs) and guidelines in building a collaborative mechanism for disseminating information between the expertise of each pillar which is managed independently by the host country, and simulations are still needed for the roles and relationships between the 3 host countries in each phase of prevention and control of public health emergencies (PHE).

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Executive Summary: The 2024 Amendments to the International Health Regulations (IHR), adopted at the 77th World Health Assembly, affirm the obligation of each State Party to designate a National IHR Authority (NIA) as the national coordinator for IHR implementation and to maintain a National Focal Point (NFP) as the official point of communication with WHO, as stipulated in Articles 1 and 4 of the IHR Amendments. This need has become even more pressing following the COVID-19 pandemic, which exposed poor cross-sectoral coordination, delayed reporting, and gaps in emergency response capacity. Indonesia faces similar challenges, including limited command flow, a lack of integration of cross-ministerial information systems, and suboptimal sectoral coordination in the prevention and response to public health emergencies. In order to strengthen the implementation of the 2024 IHR Amendments in Indonesia through the institutional arrangement of the NIA and NFP, the proposed recommendations include the Establishment of the NIA at the national level with coordinating authority over all related sectors to the Coordinating Ministry for Human Development and Culture (Kemenko PMK), maintaining the NFP in the Directorate General of Disease Prevention and Control (P2P) as the official communication point and main technical implementer, and strengthening the capacity of the NFP through the formation of a special team, ongoing training, and integration of health emergency information systems. These steps are expected to improve Indonesia's preparedness in dealing with cross-border health threats while ensuring the fulfillment of international obligations under the 2024 IHR. Full Text Request

Executive Summary : The increase in health spending reflects the government's commitment to improving health services and ensuring better access for all. Despite the increase in health spending and high social capital, it is important to consider the long-term challenges related to sustainability, innovation, and health financing policies, to improve spending efficiency, reduce costs, and expand health service coverage. The results of the Public-Private Partnership (PPP) mapping in the Health sector indicate that all regencies/cities have implemented PPPs in the Health sector. However, regencies/cities with low and very low fiscal capacity need to be encouraged and assisted in implementing partnerships and further encourage the private sector to develop partnerships in their regions. At the central level, there are difficulties in inventorying PPP data, both from domestic and international sources. Challenges in PPP implementation in the Health sector include unequal access due to poor governance; regulatory compliance; and doubts about sustainable financing. At the regional level, the problem arises. The lack of partnership regulations at the local government level is a challenge faced by related sectors. Differing perceptions and understanding of regulations regarding public-private partnerships persist. Based on the identification of the problems above, cooperation in the Ministry of Health must be carried out through a one-gate policy, so it is recommended to optimize the role and function of the Ministry of Health's donors office to regulate the governance of partnerships with the domestic and foreign private sectors. Full Text Request

Executive Summary: International trade forums can expand market access and the competitiveness of Indonesian health goods and services, but they also need to be continuously monitored and evaluated to protect domestic products and markets. Currently, the Ministry of Health lacks a negotiating position and strategy in various international trade negotiation forums, resulting in international trade cooperation not optimally safeguarding national interests. The Ministry of Health's strategy and position in various international negotiation forums are needed to optimally provide market access for health goods and services, as well as improve Indonesia's competitiveness and healthcare services. The strategies and positions the Ministry of Health can implement to achieve these goals are as follows: Ministry of Health Strategy

1. Establishing the Ministry of Health's position in international trade negotiation forums.
2. Utilization of the economic cooperation committee in order to fulfill export provisions and health product standards in partner countries, as well as increasing the competitiveness of domestic health products and improving the competency standards of Indonesian health human resources (HRK).
3. Establishment of a Negotiating Team for Trade in Health Goods and Services at the Ministry of Health.
4. Review and alignment of Indonesian legislation related to the health sector with the position of the Ministry of Health.

Ministry of Health Position (Request and Offer)

1. Health Goods Trade Negotiations:

• Categorization of health sector openness positions (offers): offensive, moderate, and defensive.
• Priority arrangement of health sector request positions: priority 1, priority 2, and priority 3.

2. Health Services Trade Negotiations:

• Determination of sub-sectors and human resources whose market access is opened to partner countries (offer).
• Preparation of sub-sectors and human resources for which market access will be requested to partner countries (request).

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Executive Summary : Indonesia is currently striving to transform its healthcare services by strengthening national genomics services. The need for genetic counseling is increasing rapidly with the development of precision medicine technology, but the capacity of genetic counselors remains far from adequate. Ideally, the National Society of Genetic Counselors (NSGC) recommends a ratio of approximately one genetic counselor per 75.000 people. With only approximately 100 counselors per 270 million people, Indonesia faces a gap that hinders the utilization of genomic test results, widens disparities in services, and risks inappropriate medical decisions. Without professional recognition, competency standards, and clear certification mechanisms, genetic counseling services cannot be optimally integrated into the healthcare system. Consequently, healthcare facilities face a shortage of specialized personnel, the public misses opportunities for early detection, and the potential for genomic technology to be applied in health policy is diminished. Therefore, measures are needed to strengthen genetic counseling by establishing professional recognition and establishing a collegium, accelerating training and certification, integrating genetic counseling in healthcare facilities, including through telecounseling, and strengthening public literacy. These interventions will accelerate the national genomics transformation and ensure its benefits are shared equitably. Full Text Request

Executive Summary :

The utilization of specialist doctors in Indonesia is a crucial issue in efforts to improve access and quality of national healthcare services. Currently, the shortage of specialist doctors remains a major challenge, particularly with the ratio of doctors in Indonesia at only 0,47 per 1.000 residents, far below the WHO minimum standard of 1 doctor per 1.000 residents. The availability of specialist doctors and subspecialists also remains very minimal. This problem is exacerbated by the uneven distribution of specialist doctors and subspecialists, with the majority of doctors concentrated on the island of Java, while remote and underdeveloped areas experience limited medical services. This situation impacts public access to quality healthcare and is expected to persist until 2032 if no concrete action is taken. The increasing need for specialist doctors, disproportionate to the availability of medical personnel, further underscores the urgency of policy improvements in this sector.

One solution that can be implemented is faster and more efficient recognition of specialist doctors who are Indonesian citizens (WNI) or foreign nationals (WNA) who graduated from abroad. Based on Government Regulation Number 28 of 2024, doctors and specialists who graduated from abroad are required to take a competency test before practicing in Indonesia. However, there are exceptions for Indonesian citizens who graduated from recognized foreign educational institutions and have at least two years of practice experience abroad or foreign nationals (specifically for specialist doctors and subspecialists) who have practiced abroad for five years. This aims to quickly integrate qualified doctors, specialists, and subspecialists into the Indonesian healthcare system.

One proposed policy is to recognize foreign educational institutions based on the criteria and list of institutions in scholarship schemes (such as LPDP). The government can adopt the stages, criteria, and list of recognized foreign universities benchmarked in regulations in Singapore and Malaysia. Furthermore, clear and comprehensive regulations are needed to provide a legal basis for strengthening the role of the College, working with the Ministry of Health to conduct ongoing monitoring and evaluation to maintain healthcare standards in Indonesia.

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Executive Summary :

There has been a significant increase in foreign grant commitments for the health sector in Indonesia, with total commitments reaching 11,4 trillion rupiah from various international partners between 2021 and 2025. However, grant management policies, particularly Minister of Health Regulation No. 55 of 2017, do not fully accommodate the need for optimal grant reporting and monitoring and evaluation (M&E). Governance limitations result in many grants going unreported or underdocumented, hampering the transparency and effectiveness of grant fund use.

Minister of Health Regulation No. 55 of 2017 regulates grant management procedures, including various types of reporting. However, implementation in the field faces several obstacles, including:

1. Mismatches between reporting policies and practices, with no obligation for partners to report activities, resulting in incomplete grant data.

2. Variations in monitoring and evaluation (monev) systems between units, lead to duplication of reporting and additional burdens for development partners.

3. The limitations of the report's substance do not adequately describe the achievement of targets.

4. Lack of partner understanding of policies and reporting, which hinders the effectiveness of grant management.

Target Policy:

1. Ministry of Health

2. Health Development Partners

Recommendation:

1. Revise the grant reporting policy by regulating the roles and obligations of partners in reporting and evaluation.

2. Development of monitoring and evaluation guidelines for development partners that clarify stakeholder roles and responsibilities to ensure coordination and accountability.

3. Developing integrated real-time monitoring and evaluation instruments that are accessible to all relevant parties, enabling efficient monitoring and analysis of achievements.

4. Increased regular coordination between technical units, development partners, and grant recipient work units to strengthen understanding and response to problems.

Follow-up:
Conducting cross-sectoral workshops to disseminate proposed policies, guidelines, and monitoring and evaluation instruments. Integrating monitoring and evaluation instruments into the Ministry of Health's digital information system.

This summary highlights the need for policy updates to ensure that grant funding supports Indonesia's health sector transformation goals more effectively and accountably.

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Executive Summary: The Indonesian government is currently refining its imported drug registration policy as part of its efforts to safeguard national health interests while ensuring compliance with international trade regulations. A review of Minister of Health Regulation No. 1010/MENKES/PER/2008 is being conducted to avoid potential discrimination against imported pharmaceutical products and ensure alignment with the National Treatment and Most-Favored Nation principles within the WTO framework. Although intended to support the independence of the national pharmaceutical industry through prioritizing local drugs and technology transfer requirements, the provisions of Minister of Health Regulation 1010/2008 are viewed by partner countries as a potential Technical Barrier to Trade (TBT). Thailand has raised objections since 2012, which opens the risk of a trade dispute at the WTO if regulatory adjustments are not made. Indonesia's main challenge is to design a policy that continues to protect public health and encourages the strengthening of the domestic pharmaceutical industry, while not creating unnecessary trade barriers. The regulatory strategy must prioritize access to safe, high-quality, and affordable drugs, while maintaining an investment climate and international cooperation in technology transfer. The Ministry of Health, together with the Ministry of Trade, the Food and Drug Monitoring Agency (BPOM), the Ministry of Foreign Affairs, and the Indonesian Permanent Mission in Geneva, have formulated a new policy direction focused on balancing market access and supporting local production. Two policy recommendations are available:

• The Ministry of Health has adjusted the narrative in the RPMK for Health Supplies by not using statements containing technical barriers to trade.

or

• BPOM, as the technical body implementing drug registration and supervision, creates technical regulations governing the implementation of the RPMK for Medical Supplies by considering aspects of public health protection and immediately notifies the WTO after the issuance of new regulations regarding the registration of imported drugs.

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Executive Summary: As mandated by Law Number 17 of 2023 concerning Health, the Central and Regional Governments are responsible for ensuring quality, safe, efficient, equitable, and affordable healthcare services for the community. The driving force behind healthcare services is medical and health personnel, so the availability of equitable, competent, and appropriate medical and health personnel is essential to support quality and affordable healthcare development. However, the decentralization of healthcare human resource management based on Law Number 23 of 2014 currently still faces challenges, including regional fiscal constraints, high realization of regional employee spending, low planning capacity, and variations in regional conditions. To address this, healthcare human resource planning is needed based on a standardized workload analysis to calculate the need for medical and health personnel in healthcare facilities, especially in community health centers (Puskesmas) and assistant community health centers (Puskesmas) as the healthcare facilities closest to the community. Considering that Indonesia is a country with diverse regional characteristics, including varying types and services of community health centers, the resulting policy recommendations will include rationalization of planning for medical and health personnel needs according to regional typology and identification of implementation obstacles, supported by cross-stakeholder coordination and accurate data, to ensure equitable distribution of health services throughout Indonesia. Full Text Request

Executive Summary: Indonesia faces a chronic health human resource distribution crisis, particularly in Remote, Border, and Island Regions (DTPK). Data shows that only a small number of provinces (DKI Jakarta, Aceh, and Yogyakarta) meet their targets for the availability of medical and health workers. The roots of this problem are systemic, ranging from fragile planning and misalignment of health human resource production to the low attractiveness of DTPK regions due to a lack of incentives, facilities, and career certainty. A Mixed Strategy, combining integrated national policies and interventions based on regional typologies (islands, interior, and conflict areas), is recommended as the most appropriate solution to ensure sustainable health worker retention. Full Text Request

Summary: The disparity in the availability and distribution of specialist doctors in Disadvantaged, Border, and Island Regions (DTPK) remains a major problem in Indonesia's healthcare system. The concentration of specialist doctors in the Java-Bali region means that many hospitals in DTPK lack the seven basic specialist services, thus suboptimal specialist healthcare services. Various policies have been implemented to meet these needs, but their effectiveness remains limited, particularly in terms of retention due to inequities in the remuneration system and limited regional fiscal capacity. This study aims to assess the urgency of providing special incentives for specialist doctors in DTPK and to formulate sustainable policy recommendations. This study used a rapid assessment method through literature review, expert judgment, focus group discussions, and in-depth interviews with stakeholders. The results indicate that the need for specialist doctors in DTPK will reach 1.187 doctors by 2027, with significant variation in incentives across regions. Modeling analysis indicates that the ideal incentive amount ranges from IDR 19,4 million to IDR 39,7 million per month. This study concludes that a standardized special incentive scheme supported by joint central and regional financing is essential to increase specialist doctor retention and strengthen specialist healthcare services in DTPK areas. Full Text Request

Executive Summary: In an effort to reduce maternal and infant mortality rates, the Ministry of Health continues to make various efforts to improve the quality of health for pregnant women and newborns, one of which is by replacing Iron Tablets (TTD) with Multi Micronutrient Supplements (MMS). According to the results of studies conducted by WHO and several universities in Indonesia, it can be proven that MMS can provide improvements in the quality of pregnant women. Therefore, the Ministry of Health will begin implementing changes to the supplement for pregnant women in 2025. Before implementation, a technical guideline (juknis) is needed for implementation that will be used by health workers in the Provincial and Regency/City Health Offices, as well as Community Health Centers. However, before the MMS technical guideline is used for the implementation of MMS, a socialization of the technical guideline will be carried out to health workers in the Provincial and Regency/City Health Offices, as well as Community Health Centers. This study aims to determine whether the technical guideline has been made on target or not, and what improvements are needed in the technical guideline. Field confirmation was conducted in 3 (three) provinces and 6 (six) districts/cities in Indonesia, by conducting Focus Group Discussions (FGD) and in-depth interviews with Health Service Officials, Nutrition Officers, Health Promotion, Pharmacy Section, regional midwives/village midwives at Community Health Centers with 124 informants consisting of 40 informants in West Java Province (Bogor Regency and Sukabumi City), 31 informants in Gorontalo Province (Gorontalo City and Bone Bolango Regency), 53 informants in East Kalimantan Province (Bontang City and West Kutai Regency). Full Text Request

Executive Summary: The high rate of under-reporting of TB in children under 15 (23,5%) worsens TB control in Indonesia. Key factors include difficulty in diagnosis, suboptimal reporting in healthcare facilities, stigma, and low public awareness. This situation hinders the achievement of the 2030 TB elimination target. Various approaches are important to reduce the burden of childhood TB, including: increasing the involvement of private hospitals, healthcare facilities to implement a proactive approach in Pediatric Clinics, strengthening household contact tracing, family education and communication, and expanding the coverage of TPT. Full Text Request

Executive Summary: As of 2022, Indonesia accounts for 10% of global TB cases, with the number of cases estimated to increase annually. In 2023, there are an estimated 1.090.000 TB cases (387 per 100.000 population), far from the target of 65 per 100.000 by 2030. various Government efforts have significantly reduced under-reporting over the past five years; however, this positive progress is still insufficient to reduce TB incidence and mortality, given that 2 out of 10 cases remain undetected and treatment initiation is suboptimal. Indonesia has the second-highest estimated death rate in the world, despite TB being a treatable infectious disease. For this reason, Indonesia needs to strengthen efforts to find TB cases using various approaches; among them by increasing diagnostic capacity, expanding access to TB services, increasing active case finding, expanding case tracing to close contacts, empowering cadres and communities, continuous training, accelerating integration efforts with the private sector, and strengthening COLLABORATIONS cross-sector. Full Text Request