Analyzing Primary Healthcare Governance in Indonesia: Perspectives of Community Health Workers

Mubasysyir Hasanbasri; Ahmad W Maula; Bayu S Wiratama; Aufia Espressivo; Tiara Marthias

doi:10.7759/cureus.56099

Analyzing Primary Healthcare Governance in Indonesia: Perspectives of Community Health Workers

Cureus. 2024 Mar 13;16(3):e56099. doi: 10.7759/cureus.56099. eCollection 2024 Mar.

Authors

Mubasysyir Hasanbasri^{1

2}, Ahmad W Maula¹, Bayu S Wiratama¹, Aufia Espressivo³, Tiara Marthias^{4

5}

Affiliations

¹ Department of Biostatistics, Epidemiology, and Population Health, Universitas Gadjah Mada, Yogyakarta, IDN.
² Center for Health Policy and Management (CHPM), Universitas Gadjah Mada, Yogyakarta, IDN.
³ Research and Policy Division, Centre for Indonesia's Strategic Development Initiatives (CISDI), Jakarta, IDN.
⁴ Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, AUS.
⁵ Department of Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, IDN.

Abstract

Background Community-integrated health posts (Posyandu) are crucial for extending primary healthcare across diverse geographical and demographic landscapes in Indonesia. Community health workers (CHWs) currently function as the main service delivery actors for Posyandu. However, Posyandu's performance remains below the standards set by the Ministry of Health. This study examines health system determinants that explain the poor performance of Posyandu and, in particular, examines the roles of village and township governance and community health center management in supporting the effectiveness of primary healthcare programs. Methodology We analyzed 638 Posyandus across 13 Indonesian provinces, utilizing data from the 2014 Indonesia Family Life Survey. We evaluated eight health system determinants based on the perceptions of CHWs concerning challenges encountered in Posyandus. These factors were ranked and analyzed to determine the variables that affected Posyandu's poor performance. Both unadjusted and adjusted odds ratios were calculated. Results This study revealed that nearly half of the Posyandus in Indonesia are underperforming, particularly in rural areas. Common challenges include insufficient funds, inadequate equipment, and a lack of permanent buildings. Although only a small percentage mentioned minimal support from village and Puskesmas authorities, the weak governance roles of village heads are reflected in all the concerns mentioned by CHWs. Conclusions The absence of village heads from governance roles has contributed to Posyandu's operational problems as perceived by CHWs. Community health centers (Puskesmas), responsible for providing technical support to Posyandu, should be part of CHW teams and networks. Further discussions are needed to choose a workable governance model to ensure practical, accessible, and sustainable primary healthcare services at the grassroots level.

Keywords: community health; community health posts; community health workers; governance roles; health system determinants; posyandu; primary healthcare; village heads.