One of the functions of the Health Development Policy Agency (BKPK) is to provide evidence-based policy recommendations. The Policy Center (Pusjak) has compiled policy brief strategic programs throughout 2024. Policy Briefs This is the result of a collaborative study between the Policy Center and universities and research institutions. On this page, we present an executive summary. policy brief The study, which has been prepared and reviewed, reflects the Ministry of Health's policy focus on crucial issues such as digital health transformation, strengthening primary care, health resilience, and developing health human resources. The results of the study have been submitted to the program's implementing unit, and we hope they can serve as a reference for policymakers and stakeholders in designing appropriate and effective interventions to realize a resilient and responsive national health system. Executive summary list policy brief can be accessed below.
Summary : Integrated health post (Posyandu) cadres are at the forefront of screening and assisting toddlers in addressing nutritional issues. To this end, the Ministry of Health is striving to provide anthropometric equipment at Posyandu and conducting training on 25 basic competencies for cadres, including toddler growth monitoring, which is crucial for assessing nutritional status. The study was conducted to assess the implementation of the policy to increase cadre capacity in toddler growth monitoring in West Bandung Regency, South Tangerang City, Gianyar Regency, and Metro City.
The study was conducted using a mixed-methods approach. Data related to knowledge and skills will be collected quantitatively. Meanwhile, data related to the implementation of cadre training, cadre empowerment, utilization of BOK funds, and supporting and inhibiting factors for policy implementation will be collected qualitatively. Qualitative data was obtained through in-depth interviews starting from the integrated health post (Posyandu), community health centers (Puskesmas), district/city health offices, provincial health offices, and the central level (Directorate of Health Promotion and Nutrition for Children and Children), while Focus Group Discussions (FGDs) were conducted with cadres.
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The study was conducted using a mixed-methods approach. Data related to knowledge and skills will be collected quantitatively. Meanwhile, data related to the implementation of cadre training, cadre empowerment, utilization of BOK funds, and supporting and inhibiting factors for policy implementation will be collected qualitatively. Qualitative data was obtained through in-depth interviews starting from the integrated health post (Posyandu), community health centers (Puskesmas), district/city health offices, provincial health offices, and the central level (Directorate of Health Promotion and Nutrition for Children and Children), while Focus Group Discussions (FGDs) were conducted with cadres.
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Summary : Indonesia faces health challenges with high rates of non-communicable diseases (NCDs) and a double burden of disease. Health services through Primary Care Integration (PCLI) play a crucial role in improving public health. The Ministry of Health is transforming the primary care system, focusing on: a) a lifecycle approach as a platform for integrating health services and strengthening promotion and prevention; b) bringing health services closer to the village and hamlet level through networks, including strengthening promotion and prevention, as well as resilience to pandemics; and c) strengthening Local Area Monitoring (PWS) through monitoring with a village-by-village health situation dashboard.
Health services in the ILP are carried out through a cluster system that is intervened by all programs. The clusters are: 1) Cluster 1: Management; 2) Cluster 2: Mothers and Children; 3) Cluster 3: Productive Age and Elderly; 4) Cluster 4: Infectious Disease Control; 5) Cross-Cluster. The ILP evaluation aims to assess the effectiveness of program implementation, identify barriers and enablers, and provide policy recommendations for the expansion and improvement of ILP implementation throughout Indonesia.
The evaluation was conducted using the CIPP (Context, Input, Process, Product) model at three selected Community Health Centers (Puskesmas Kebonsari, Jereweh, and Plantungan). The evaluation results showed that the cluster system can be implemented at the Puskesmas, with improvements in several aspects of health services related to health screening and a decrease in referral rates, although not yet significant. The obstacles faced include budget limitations, increased workload, difficulties in reporting, and suboptimal regulations. Therefore, strengthening resources, improving coordination systems, strengthening monitoring and evaluation, and allocating incentives for cadres by both the central and regional governments are needed to support better implementation in the future.
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Health services in the ILP are carried out through a cluster system that is intervened by all programs. The clusters are: 1) Cluster 1: Management; 2) Cluster 2: Mothers and Children; 3) Cluster 3: Productive Age and Elderly; 4) Cluster 4: Infectious Disease Control; 5) Cross-Cluster. The ILP evaluation aims to assess the effectiveness of program implementation, identify barriers and enablers, and provide policy recommendations for the expansion and improvement of ILP implementation throughout Indonesia.
The evaluation was conducted using the CIPP (Context, Input, Process, Product) model at three selected Community Health Centers (Puskesmas Kebonsari, Jereweh, and Plantungan). The evaluation results showed that the cluster system can be implemented at the Puskesmas, with improvements in several aspects of health services related to health screening and a decrease in referral rates, although not yet significant. The obstacles faced include budget limitations, increased workload, difficulties in reporting, and suboptimal regulations. Therefore, strengthening resources, improving coordination systems, strengthening monitoring and evaluation, and allocating incentives for cadres by both the central and regional governments are needed to support better implementation in the future.
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Summary : Mental health services in Indonesia still face various challenges. Research on the implementation of a pilot project for community-based mental health services (Keswamas) in Manado City indicates that implementation is suboptimal due to weak cross-sectoral coordination, insufficient human resource availability and capacity, unclear funding allocation, limited infrastructure such as medication and rehabilitation facilities, inadequate family involvement, and a lack of standardized recording and reporting systems.
Five key strategies are recommended to address these challenges: strengthening governance, increasing the capacity of health workers and the role of families, optimizing financing, ensuring the availability and adequacy of infrastructure, and strengthening the recording and reporting system. With this strategy, the implementation of community-based mental health services can be strengthened to realize inclusive and sustainable mental health services.
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Five key strategies are recommended to address these challenges: strengthening governance, increasing the capacity of health workers and the role of families, optimizing financing, ensuring the availability and adequacy of infrastructure, and strengthening the recording and reporting system. With this strategy, the implementation of community-based mental health services can be strengthened to realize inclusive and sustainable mental health services.
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Summary : The implementation of the Cancer, Cardiovascular, Stroke and Heart (KJSU) service network policy in order to equalize access and quality of health services has not been carried out optimally due to gaps in the fulfillment of resources between hospital levels and between regions, the implementation of guardianship duties has not been appropriate, and the ability to provide services is not yet adequate.
Therefore, in order to achieve the program target, it is necessary to optimize the implementation of the KJSU guardianship network policy by: 1) Accelerating the fulfillment of resources by strengthening the supply side, increasing HRK competency and budgeting, especially in middle and main level hospitals; 2) Strengthening the implementation of guardianship duties by increasing managerial capacity and assistance in planning the implementation of guardianship as well as systematic monitoring and evaluation; and 3) Increasing service capabilities by fulfilling essential resources, harmonizing technical regulations between the Ministry of Health, BPJS, BAPETEN and BPOM.
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Therefore, in order to achieve the program target, it is necessary to optimize the implementation of the KJSU guardianship network policy by: 1) Accelerating the fulfillment of resources by strengthening the supply side, increasing HRK competency and budgeting, especially in middle and main level hospitals; 2) Strengthening the implementation of guardianship duties by increasing managerial capacity and assistance in planning the implementation of guardianship as well as systematic monitoring and evaluation; and 3) Increasing service capabilities by fulfilling essential resources, harmonizing technical regulations between the Ministry of Health, BPJS, BAPETEN and BPOM.
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Summary : The National Health Insurance (JKN) Standard Inpatient Class (KRIS) is mandated by Law No. 40 of 2004 concerning the National Social Security System. (2004) with the hope that the community will get better service quality and equity in hospital services. The government through Presidential Regulation No. 59 of 2024 and Decree of the Director General of Health Services No. Hk.02.02/I/2995/2022 has established 12 KRIS JKN Criteria. All hospitals collaborating with BPJS are targeted to have implemented KRIS JKN by June 30, 2025. However, in reality, there are still obstacles faced by hospitals in implementing KRIS JKN. Data from online surveys, monitoring and evaluation and studies show that of the 12 KRIS criteria, there are criteria that are difficult for hospitals to fulfill, namely the provision of oxygen outlets, completeness of standard curtains/partitions, completeness of TT (nurse call), bathrooms inside and accessible bathrooms. The results of the root cause analysis found that the concept of KRIS JKN is still unclear; the amount of funds needed for the implementation of KRIS JKN; Some criteria are too rigid; lack of support from hospital owners/government, still lack of socialization and advocacy internally and externally in hospitals, the lack of implementation of a reward and punishment system; and the absence of norms, standards, procedures and provisions (NSPK) for tiered and integrated monitoring and evaluation. Several study data show the impact of the KRIS policy on service indicators, especially the number of beds (TT), Bed Occupancy Rate (BOR), and hospital revenue in the period before and after KRIS was implemented in hospitals. However, from all of these data, the implementation of the JKN KRIS does not have the potential to have a negative impact on hospital service and revenue indicators, but continuous mitigation of changes in these indicators is still needed so that JKN patient satisfaction is satisfied/very satisfied with the KRIS policy does not experience a decline.
In order to achieve the 2025 target of all hospitals implementing KRIS JKN, an optimization strategy needs to be implemented through (1) accelerating the preparation of various regulations/NSPK containing: the KRIS concept, single class, implementation stages, technical descriptions of 12 criteria, monitoring and evaluation, advocacy, funding assistance schemes and reward and punishment; (2) Strengthening the role and active involvement of the Health Service, Hospital Management, Hospital Owners, Supervisory Boards and related cross-sectors in: socialization, continuous advocacy, funding assistance and tiered and integrated monitoring and evaluation.
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In order to achieve the 2025 target of all hospitals implementing KRIS JKN, an optimization strategy needs to be implemented through (1) accelerating the preparation of various regulations/NSPK containing: the KRIS concept, single class, implementation stages, technical descriptions of 12 criteria, monitoring and evaluation, advocacy, funding assistance schemes and reward and punishment; (2) Strengthening the role and active involvement of the Health Service, Hospital Management, Hospital Owners, Supervisory Boards and related cross-sectors in: socialization, continuous advocacy, funding assistance and tiered and integrated monitoring and evaluation.
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Summary : Stunting is a significant global nutritional problem, including in Indonesia. One effort to address this issue is through supplementary feeding (PMT) interventions made from locally sourced foods for toddlers with nutritional problems (underweight, wasting, and poor weight gain) to prevent stunting. However, the implementation of local PMT in the field faces various challenges that need to be addressed for its continued effectiveness.
The results of this study indicate that several problems in the implementation of the Local PMT program include 31,3 percent of PMT recipients who do not meet the target criteria, the distribution of portions and duration of PMT provision that do not match the nutritional conditions of toddlers, monitoring of PMT consumption and nutritional status that is not optimal and a lack of education for target families.
Quick wins that can be applied to improve program implementation involve multiple sectors, including: The Ministry of Health must improve technical guidelines and simplify data entry for monitoring and evaluation. District/City Health Offices must increase mentoring and facilitation in program implementation. Community health centers must strengthen the commitment and capacity of staff, and village governments must empower communities and allocate village funds for local PMT implementation.
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The results of this study indicate that several problems in the implementation of the Local PMT program include 31,3 percent of PMT recipients who do not meet the target criteria, the distribution of portions and duration of PMT provision that do not match the nutritional conditions of toddlers, monitoring of PMT consumption and nutritional status that is not optimal and a lack of education for target families.
Quick wins that can be applied to improve program implementation involve multiple sectors, including: The Ministry of Health must improve technical guidelines and simplify data entry for monitoring and evaluation. District/City Health Offices must increase mentoring and facilitation in program implementation. Community health centers must strengthen the commitment and capacity of staff, and village governments must empower communities and allocate village funds for local PMT implementation.
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Summary : Identifying tuberculosis (TB) patients as the source of infection and providing prompt and appropriate treatment to these sources is a crucial strategy for breaking the chain of TB transmission. Furthermore, to achieve TB elimination, this strategy must be accompanied by preventative measures such as vaccination and TB preventive therapy (TPT) for high-risk individuals.
Various efforts to control TB have been made, but the achievement of TB case detection in Indonesia has never reached the specified target, even experiencing a decline during the COVID pandemic (2020-2021). However, in 2022, TB case detection increased to 68% and in 2023 reached 72%. However, this figure still does not reach the target of 90%. This indicates that there are still many unrecorded cases or missing cases, namely people with TB who have not been recorded in the national TB program. This may be because TB patients have not been examined at health service facilities (faseks), patients have been examined but not diagnosed with TB, patients have been diagnosed with TB but have not received treatment, or patients have been diagnosed and treated but have not been reported to the national TB program.
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Various efforts to control TB have been made, but the achievement of TB case detection in Indonesia has never reached the specified target, even experiencing a decline during the COVID pandemic (2020-2021). However, in 2022, TB case detection increased to 68% and in 2023 reached 72%. However, this figure still does not reach the target of 90%. This indicates that there are still many unrecorded cases or missing cases, namely people with TB who have not been recorded in the national TB program. This may be because TB patients have not been examined at health service facilities (faseks), patients have been examined but not diagnosed with TB, patients have been diagnosed with TB but have not received treatment, or patients have been diagnosed and treated but have not been reported to the national TB program.
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Summary : Along with the transformation of the health system in Indonesia, the national policy of the National Action Plan (NAP) for Cervical Cancer Elimination (EKLR) in line with the Global Strategy launched by the World Health Organization in controlling cervical cancer is very appropriate. The gap in cervical cancer services in the implementation of the national strategy can be addressed through the readiness of health facilities, starting from the primary care setting (health centers and regional health laboratories) to tertiary care (hospitals) in providing promotive, preventive, curative and rehabilitative services such as immunization, screening, management of pre-cancerous lesions and invasive cancer. Improving the readiness of equipment/materials, human resources (HR), and procedures, as well as service capabilities (especially hospitals) will support the implementation of the first pillar of the RAN for cervical cancer elimination. Through concrete steps to prepare and improve all aspects of the available equipment/materials, HR, and procedures, Indonesia will be able to achieve the target of cervical cancer elimination by 2030.
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Summary : In an effort to improve maternal and child health, the Indonesian Government has set standards for antenatal care services, including two ultrasound examinations by a doctor in the first and third trimesters. By 2, approximately 1% of PKM will have an ultrasound in good condition, and 3% will have ANC services accompanied by an ultrasound.
During the 3-year USG service program at the Community Health Center, there has been an increase in service coverage, from approximately 31% of K1 in 2022, to 41% in 2023, and 50% by October 2024. USG services for K5 also increased from 29% in 2022, to 44% in 2023, and 49% in 2024. A total of 84% of PKM that have USG, have trained doctors with ASN status. Most PKM (56%) provide services 1-2 days a week, with an average of 32 pregnant women served per month (15 K1, and 17 K5). A total of 89% of PKM that have performed ANC with USG, reported having referred cases detected by USG.
Several obstacles exist in terms of regulations and policies, logistics, human resources, infrastructure, and monitoring and evaluation that need to be addressed to ensure smooth program implementation. Required steps include developing more detailed regulations and technical guidelines on the use, utilization, and maintenance of ultrasound, as well as monitoring and evaluation mechanisms. Coordination regarding pre-service training for doctors, certification training, refresher training, or mentoring by obstetrician/gynecologists (OBGYNs) is also needed. Mapping the readiness of community health centers and meeting the human resources and infrastructure needs for quality ANC services with ultrasound is also necessary to improve quality ANC with ultrasound in efforts to detect early and improve maternal health.
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During the 3-year USG service program at the Community Health Center, there has been an increase in service coverage, from approximately 31% of K1 in 2022, to 41% in 2023, and 50% by October 2024. USG services for K5 also increased from 29% in 2022, to 44% in 2023, and 49% in 2024. A total of 84% of PKM that have USG, have trained doctors with ASN status. Most PKM (56%) provide services 1-2 days a week, with an average of 32 pregnant women served per month (15 K1, and 17 K5). A total of 89% of PKM that have performed ANC with USG, reported having referred cases detected by USG.
Several obstacles exist in terms of regulations and policies, logistics, human resources, infrastructure, and monitoring and evaluation that need to be addressed to ensure smooth program implementation. Required steps include developing more detailed regulations and technical guidelines on the use, utilization, and maintenance of ultrasound, as well as monitoring and evaluation mechanisms. Coordination regarding pre-service training for doctors, certification training, refresher training, or mentoring by obstetrician/gynecologists (OBGYNs) is also needed. Mapping the readiness of community health centers and meeting the human resources and infrastructure needs for quality ANC services with ultrasound is also necessary to improve quality ANC with ultrasound in efforts to detect early and improve maternal health.
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Dengue Hemorrhagic Fever (DHF) is a major health problem in Indonesia, with a high incidence. Wolbachia technology offers an innovation to overcome the challenges of dengue vector control, which currently relies on insecticides. Wolbachia is a bacterium that can reduce the ability of the Aedes aegypti mosquito to transmit the dengue virus, with proven results in various regions.
This study aims to evaluate the implementation of Wolbachia technology in three pilot project areas in Indonesia: Kupang, Bontang, and Semarang. It considers the level of community acceptance of the implementation, supporting and inhibiting factors, and government support and commitment in the implementation areas. Quantitative data were collected through random surveys of communities in the Wolbachia implementation areas (where larvae buckets were placed), while qualitative data were obtained through in-depth interviews with stakeholders, including local government officials, community leaders, and program implementers at the Health Office.
The majority of residents in the cities of Semarang, Bontang, and Kupang support the implementation of Wolbachia technology to control Dengue Hemorrhagic Fever (DHF). This support is influenced by an understanding of the technology's benefits, such as a 77% reduction in DHF cases in previous pilot locations. The spread of hoaxes and disinformation that influence public perception, as well as logistical constraints in the distribution of Wolbachia-infected mosquito eggs, are challenges that remain to be overcome in this program. This study confirms that the program's success is greatly influenced by the quality of public communication, the readiness of local infrastructure, and multi-sectoral support. Recommendations as a follow-up to the study results to increase public understanding and acceptance of the Wolbachia program include the development of national-level regulations and technical guidelines that can be implemented down to the smallest community level, conducting post-implementation impact evaluations, strengthening regional laboratory capacity, and developing adaptive communication strategies through a cultural approach to combating hoaxes—by involving community leaders and utilizing digital platforms.
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This study aims to evaluate the implementation of Wolbachia technology in three pilot project areas in Indonesia: Kupang, Bontang, and Semarang. It considers the level of community acceptance of the implementation, supporting and inhibiting factors, and government support and commitment in the implementation areas. Quantitative data were collected through random surveys of communities in the Wolbachia implementation areas (where larvae buckets were placed), while qualitative data were obtained through in-depth interviews with stakeholders, including local government officials, community leaders, and program implementers at the Health Office.
The majority of residents in the cities of Semarang, Bontang, and Kupang support the implementation of Wolbachia technology to control Dengue Hemorrhagic Fever (DHF). This support is influenced by an understanding of the technology's benefits, such as a 77% reduction in DHF cases in previous pilot locations. The spread of hoaxes and disinformation that influence public perception, as well as logistical constraints in the distribution of Wolbachia-infected mosquito eggs, are challenges that remain to be overcome in this program. This study confirms that the program's success is greatly influenced by the quality of public communication, the readiness of local infrastructure, and multi-sectoral support. Recommendations as a follow-up to the study results to increase public understanding and acceptance of the Wolbachia program include the development of national-level regulations and technical guidelines that can be implemented down to the smallest community level, conducting post-implementation impact evaluations, strengthening regional laboratory capacity, and developing adaptive communication strategies through a cultural approach to combating hoaxes—by involving community leaders and utilizing digital platforms.
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Summary : Implementation research on the Biomedical and Genome Science Initiative (BGSi) program was conducted to determine the acceptability and feasibility of BGSi implementation using the Consolidated Framework for Implementation Research (CFIR) conceptual framework. Initial data collection was conducted through an online survey across all Hubs and BB Binomika. Qualitative data collection was conducted through online focus group discussions and face-to-face interviews during visits and observations at the three hub locations. In-depth interviews were also conducted with representatives from the Ministry of Health, the BKPK, and BB Binomika.
Direct observations indicate that the implementation of BGSi's three areas of activity—biobanking (BB), genome sequencing (GS), and data management (MD)—remains in need of capacity building and enhancement at the individual, organizational, and institutional levels to produce optimal healthcare products and services. The primary challenge is how to translate genome sequencing results, which consist of genetic DNA information coupled with personal information (demographic and clinical), into more accurate and precise healthcare services.
There are two main categories supporting the implementation of BGSi: the perception of the usefulness of BGSi innovations for institutions and the community, and behavioral changes in the implementation of service/research tasks. On the other hand, 69 inhibiting factors were identified, most of which were organizational in nature (39 challenges), compared to aspects referring to other components of BGSi (30 challenges).
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Direct observations indicate that the implementation of BGSi's three areas of activity—biobanking (BB), genome sequencing (GS), and data management (MD)—remains in need of capacity building and enhancement at the individual, organizational, and institutional levels to produce optimal healthcare products and services. The primary challenge is how to translate genome sequencing results, which consist of genetic DNA information coupled with personal information (demographic and clinical), into more accurate and precise healthcare services.
There are two main categories supporting the implementation of BGSi: the perception of the usefulness of BGSi innovations for institutions and the community, and behavioral changes in the implementation of service/research tasks. On the other hand, 69 inhibiting factors were identified, most of which were organizational in nature (39 challenges), compared to aspects referring to other components of BGSi (30 challenges).
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Summary : The implementation of Electronic Medical Records (EMR) in healthcare facilities as of September 2023 has only reached 62,5% of the target of 100% by the end of December 2023, in accordance with Circular Letter HK.02.01/MENKES/1030/2023 concerning the implementation of Electronic Medical Records in Healthcare Facilities. Of that figure, only 44,5% have been connected to SatuSehat. SatuSehat was built as a health data exchange ecosystem with the vision of connecting various information systems in the digital health realm in the country, with the main goal of creating synergistic integration between healthcare facilities, regulatory entities, insurers, and digital service providers.
The implementation of SatuSehat, particularly the RME, varies considerably across regions, influenced by specific challenges such as infrastructure variability, resource availability, and the level of technological readiness across regions. Therefore, it is essential for the government, stakeholders, and healthcare providers to understand the variations in implementation and identify barriers to SatuSehat implementation in order to realize Indonesia's vision of integrated and sustainable digital health. This research examines SatuSehat implementation in the regions, exploring variations in compliance and acceptability, and assessing barriers and support for SatuSehat implementation in the regions.
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The implementation of SatuSehat, particularly the RME, varies considerably across regions, influenced by specific challenges such as infrastructure variability, resource availability, and the level of technological readiness across regions. Therefore, it is essential for the government, stakeholders, and healthcare providers to understand the variations in implementation and identify barriers to SatuSehat implementation in order to realize Indonesia's vision of integrated and sustainable digital health. This research examines SatuSehat implementation in the regions, exploring variations in compliance and acceptability, and assessing barriers and support for SatuSehat implementation in the regions.
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Summary : The decline in SatuSehatMobile (SSM) users, previously known as PeduliLindungi, raises questions about whether the SSM app will still be needed after the COVID-19 pandemic has passed. PeduliLindungi users reached over 105 million on March 1, 2023. In 2024, data as of September showed that only 20 users had completed KYC/verification, 2,5 million had not completed KYC, and 100 million users were inactive/deleted from their devices. In addition to vaccine certificates, SSM has been connected to the SATUSEHAT Platform (SSP) as a personal health record (PHR) for personal health monitoring through health records, medical resumes, early detection of disease risks, child health monitoring, health promotion and education, and health service searches.
SSM, the official health application of the Indonesian Ministry of Health, should ideally provide integrated and personalized services within a single application. The declining number of users indicates several challenges to SSM implementation in the community that need to be identified to improve the benefits of integrated health services in Indonesia.
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SSM, the official health application of the Indonesian Ministry of Health, should ideally provide integrated and personalized services within a single application. The declining number of users indicates several challenges to SSM implementation in the community that need to be identified to improve the benefits of integrated health services in Indonesia.
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Executive Summary: The Health Operational Assistance (BOK) program, which has been implemented since 2010, still faces challenges in terms of budget realization. The remaining BOK funds for the five-year period (2019-2023) reach trillions of rupiah, with the largest remaining budget in 2023, amounting to 2,9 trillion rupiah. A study of the implementation of the BOK fund policy for 2019-2023 was conducted in 15 districts/cities to identify obstacles and challenges in BOK program implementation and determine the performance achievements of national priority programs.
The study results indicate that there are obstacles from the policy, administrative and operational side. Among them are the menu that always changes every year, technical instructions that are received late by regions, late disbursement of BOK funds, the unavailability of BOK management personnel in accordance with regulations and the lack of integration of the Ministry of Health's BOK fund planning and reporting system with the Ministry of Home Affairs' SIPD. To optimize BOK funds, it is necessary to involve the main unit of the BOK-funded program holder to propose a long-term BOK menu so as to minimize changes to the BOK menu, as well as the flexibility of budget shifts according to local regional needs. In addition, it is also necessary to integrate the recording and reporting systems at the Ministry of Health and the Ministry of Home Affairs so that regions do not make repeated inputs that can reduce performance and reporting effectiveness.
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The study results indicate that there are obstacles from the policy, administrative and operational side. Among them are the menu that always changes every year, technical instructions that are received late by regions, late disbursement of BOK funds, the unavailability of BOK management personnel in accordance with regulations and the lack of integration of the Ministry of Health's BOK fund planning and reporting system with the Ministry of Home Affairs' SIPD. To optimize BOK funds, it is necessary to involve the main unit of the BOK-funded program holder to propose a long-term BOK menu so as to minimize changes to the BOK menu, as well as the flexibility of budget shifts according to local regional needs. In addition, it is also necessary to integrate the recording and reporting systems at the Ministry of Health and the Ministry of Home Affairs so that regions do not make repeated inputs that can reduce performance and reporting effectiveness.
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Summary : The WHO has launched "The End TB Strategy" with a target of reducing TB deaths by 95% and reducing TB incidence by 90% globally by 2035. One scheme is through vaccine development with international cooperation. The Ministry of Health has created policies and MoUs for involvement and implementation of TB vaccine clinical trials in Indonesia. The vaccine used is M72/ASO1E, one of the vaccines that has shown quite high efficacy (54%) and successfully entered phase III clinical trials. In collaboration with BMGF, this phase III clinical trial is multicenter and is expected to increase opportunities for Indonesia to obtain a TB vaccine relevant to conditions in Indonesia. This phase III clinical trial was conducted at 5 sites including UI Hospital, Persahabatan Hospital, Jakarta Islamic Hospital Cempaka Putih, Faculty of Medicine UI, and Research Center for Care and Control of Infectious Disease (RC3ID) Padjadjaran University, where currently all requirements for phase III TB vaccine clinical trials have been met, namely (i) appointment of ORK by the sponsor, (ii) research team, recruitment and training of additional staff (iii) compliance with regulations including approval from the Ethics Commission, BPOM, MTA Committee, laboratory assessment by external auditors, (iv) site infrastructure/facilities, a central laboratory for testing in South Africa and a specimen delivery expedition company, (v) management (vi) document system, (vii) availability of test vaccines at the site, and (viii) socialization to local Health Service Agencies/Facilities. Urgent matters for accelerating clinical trials and efforts to achieve Indonesian vaccine independence are (i) Increasing the readiness of human resources with qualifications, integrity and track records according to international clinical trial needs/standards (managers, researchers, clinicians, pharmacists, laboratory technicians, administrative staff), as well as regular training GCP, MTA, and basic science according to the scientific field/disease group to improve the skills, knowledge and expertise of the research team; (ii) Provision of supporting infrastructure (central laboratory and biobank) that is internationally accredited and a support system from the institution; (iii) Ease of bureaucracy in managing permits and coordination between institutions (MTA Committee, Health Research Ethics Committee, BPOM, Ministry of Finance/Customs, Sponsors, Clinical Trial Centers); (iv) Providing or improving epidemiological data on diseases that are a problem in Indonesia; (v) The need for public education about the threat of TB and the benefits of the TB vaccine through effective socialization.
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Summary : Since the implementation of the freeze-unfreeze policy in July 2022, Indonesia continues to face significant challenges in reducing its dependence on imported drugs and medical devices. Although Minister of Health Regulation No. 1314 of 2023 aims to encourage the use of domestic products, more than 52% of medical devices are still sourced from abroad, with 90% of raw materials for drugs and 70% of medical devices dependent on imports. Factors contributing to this dependence include low domestic production capacity, negative perceptions of the quality of local products, and uncertainty surrounding the freeze-unfreeze policy. Business Matching (BM) activities have also been ineffective due to time constraints and a lack of accurate information. Recommendations to increase industrial independence and reduce import dependence include Optimizing the Freeze-Unfreeze Policy by building a real-time notification system to provide sufficient preparation time for providers, Increasing the Effectiveness of Business Matching Activities by increasing the frequency and duration of BM and providing training for providers, Standardizing and Verifying Drug and Medical Device Needs Plans by adopting standard guidelines for accuracy of needs, increasing Production Capacity and Raw Material Availability by implementing training programs and establishing partnerships with local raw material providers, strengthening the Price and Product Quality Monitoring System: Increasing transparency and accountability in the e-Catalog, and Optimizing Domestic Product Quality Surveillance by increasing public trust in local products through continuous quality monitoring. The implementation of these recommendations is expected to strengthen the domestic drug and medical device industry, reduce import dependence, and create a more sustainable health ecosystem.
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Summary : Minister of Health Regulation No. 13 of 2022 concerning Amendments to Minister of Health Regulation No. 21 of 2020 concerning the Ministry of Health's Strategic Plan for 2020-2024 encourages increased pharmaceutical resilience and independence by strengthening domestic production of medicinal raw materials (BBO). The policy of changing the source of imported BBO to local BBO aims to overcome transitional obstacles, especially amidst uncertainty regarding market guarantees, supply, and prices. Implementation research was conducted with the aim of exploring the extent of the implementation and stakeholder acceptance of the BBO change source policy, as well as to identify supporting and inhibiting factors in policy implementation. A qualitative research design was used by conducting in-depth interviews (IDI) or focus group discussions (FGD) with 20 stakeholders to obtain a field overview from various perspectives.
The research results show a low level of interest from the pharmaceutical industry in producing and using local BBO, resulting in minimal uptake of locally sourced drugs in healthcare facilities. Recommendations include facilitating imports, harmonizing regulations, accelerating the certification process, clarifying the auction process for drugs using local BBO, and promoting and monitoring implementation as quick-win recommendations to strengthen the change-source BBO policy.
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The research results show a low level of interest from the pharmaceutical industry in producing and using local BBO, resulting in minimal uptake of locally sourced drugs in healthcare facilities. Recommendations include facilitating imports, harmonizing regulations, accelerating the certification process, clarifying the auction process for drugs using local BBO, and promoting and monitoring implementation as quick-win recommendations to strengthen the change-source BBO policy.
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