Community Participation in Indonesian Healthcare: Challenges and Opportunities

Despite Indonesia’s healthcare system achieving over 95% coverage under the National Health Insurance (JKN) program, public participation remains suboptimal. With nearly full coverage, Indonesia’s healthcare system faces challenges rooted in both social and economic issues. According to Professor Nila Moeloek, Chair of the Advisory Council for the Indonesian Health Development Center (IHDC), the problems are not just about funding or infrastructure but also about weak public involvement in planning, implementation, and evaluation of healthcare services.

Professor Moeloek highlights that the actual utilization of healthcare services remains unequal across regions, genders, socio-economic statuses, individuals with disabilities, and types of diseases. Women, the poor, and marginalized groups, as well as those with chronic or infectious diseases, face structural barriers that limit meaningful participation in the healthcare system.

One worrying indicator of weak community participation is treatment delays, low adherence to therapy, low preventive behavior, increasing burden on curative and financial sectors of healthcare, and declining trust in the system, illustrated by rising numbers of patients seeking treatment abroad. One of the most vulnerable groups is the female population, responsible for over 70% of family health decisions, yet their formal involvement in health planning and discussion remains limited.

IHDC also provides data from independent studies showing that participation from poor and marginalized groups in health forums is below 40%, with only about 25% of their proposals being accommodated. Persons with disabilities rarely participate in such forums, with less than 20% involvement.

Moreover, stigma and discrimination regarding diseases like HIV, tuberculosis, and mental health issues impede access to testing, therapy, and service retention. Geographical disparities also pose a barrier, as remote areas sometimes experience participation rates of only 30 to 35%, with travel times to healthcare facilities reaching two to four hours.

To achieve fairness and enhance trust in Indonesia’s healthcare system, IHDC emphasizes the need to strengthen inclusive participation across all groups. This is crucial in decision-making and implementing strategies tailored to local population needs and integrating health data.