Barriers and enablers in implementing integrated primary health care: A qualitative assessment in West Sumbawa District, Indonesia
8 affiliations
- 1Center for Health Policy and Management, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman, Daerah Istimewa Yogyakarta, Indonesia
- 2School of Medicine and Psychology, College of Science and Medicine, The Australian National University, Acton, The Australian Capital Territory, Australia
- 3Nossal Institute of Global Health, University of Melbourne, Carlton, Victoria, Australia
- 4Public Health Program, Faculty of Public Health, Universitas Halu Oleo, Kendari, Sulawesi Tenggara, Indonesia
- 5Health Systems Insight, Jakarta, Indonesia
- 6Faculty of Public Health, Universitas Indonesia, Depok, Jawa Barat, Indonesia
- 7Health Systems Insight, Washington, District of Columbia, United States of America
- 8Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Sleman, Daerah Istimewa Yogyakarta, Indonesia
Abstract
In 2023, Indonesia introduced an integrated primary health care (IPHC) model called Integrasi Pelayanan Kesehatan Primer (ILP) as part of the national primary care transformation agenda. ILP seeks to strengthen the network of public primary care providers across sub-district, village, and community levels with a five-cluster model organized around a life-cycle approach, replacing the previously fragmented, program-based model. West Sumbawa District (WSD) in West Nusa Tenggara Province was chosen as a national pilot district by the Ministry of Health (MOH), with ILP implementation expanding from one to all ten public primary care clinics (Puskesmas) in 2024. Using a qualitative design, this study aims to evaluate the implementation process, barriers, and facilitators of ILP in WSD. Data were collected through focus group discussions, small group interviews, and individual interviews with health workers, community health workers, and district-level stakeholders across multiple time points between 2023 and 2025. The study found that health system barriers, namely limited human resources availability and capacity across all levels of primary care network, fragmented governance, leadership, and management practices, insufficient financing attributable to limited cross-sectoral support, inadequate physical resources, and a fragmented information system constrained ILP implementation. Despite these barriers, support from local government, community health workers, and the MOH were identified as key enablers. The results demonstrate that establishing IPHC in decentralized settings requires structural and operational redesign as well as recognizing the social, political, and organizational dynamics of the local units where reforms take place. These findings are applicable to broader primary health care (PHC) strengthening initiatives across decentralized contexts.
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BibTeX
@article{widiastuti2026barriers,
title = {{Barriers and enablers in implementing integrated primary health care: A qualitative assessment in West Sumbawa District, Indonesia}},
author = {Mentari Widiastuti and Sandra Olivia Frans and Siti Nurfadilah Hafala and Shita Listyadewi and Ery Setiawan and Ulfathea Mulyadita and Anooj Pattnaik and Mubasysyir Hasanbasri},
journal = {PLOS Global Public Health},
year = {2026},
month = sep,
doi = {10.1371/journal.pgph.0007238},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007238},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Barriers and enablers in implementing integrated primary health care: A qualitative assessment in West Sumbawa District, Indonesia
AU - Mentari Widiastuti
AU - Sandra Olivia Frans
AU - Siti Nurfadilah Hafala
AU - Shita Listyadewi
AU - Ery Setiawan
AU - Ulfathea Mulyadita
AU - Anooj Pattnaik
AU - Mubasysyir Hasanbasri
PY - 2026
DA - 2026/09/11
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007238
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007238
AB - In 2023, Indonesia introduced an integrated primary health care (IPHC) model called Integrasi Pelayanan Kesehatan Primer (ILP) as part of the national primary care transformation agenda. ILP seeks to strengthen the network of public primary care providers across sub-district, village, and community levels with a five-cluster model organized around a life-cycle approach, replacing the previously fragmented, program-based model. West Sumbawa District (WSD) in West Nusa Tenggara Province was chosen as a national pilot district by the Ministry of Health (MOH), with ILP implementation expanding from one to all ten public primary care clinics (Puskesmas) in 2024. Using a qualitative design, this study aims to evaluate the implementation process, barriers, and facilitators of ILP in WSD. Data were collected through focus group discussions, small group interviews, and individual interviews with health workers, community health workers, and district-level stakeholders across multiple time points between 2023 and 2025. The study found that health system barriers, namely limited human resources availability and capacity across all levels of primary care network, fragmented governance, leadership, and management practices, insufficient financing attributable to limited cross-sectoral support, inadequate physical resources, and a fragmented information system constrained ILP implementation. Despite these barriers, support from local government, community health workers, and the MOH were identified as key enablers. The results demonstrate that establishing IPHC in decentralized settings requires structural and operational redesign as well as recognizing the social, political, and organizational dynamics of the local units where reforms take place. These findings are applicable to broader primary health care (PHC) strengthening initiatives across decentralized contexts.
SN - 2767-3375
ER -