Identifying Key Health System Components Associated with Primary Health Care Performance under Indonesia's Integrated Primary Health Care (ILP) Reform

Abstract

Background: As part of Indonesia's Health Transformation agenda, the Ministry of Health developed the Integrated Primary Health Care (ILP) as a strategy to strengthen primary health services through life course based service integration, Puskesmas network reinforcement, Local Area Monitoring, and health service digitalization. By 2025, 82.5% of Puskesmas had been declared as implementing ILP based on three administrative indicators, which do not comprehensively reflect actual implementation quality. This study constitutes a further quantitative analysis of TAP findings, aiming to identify which input and process indicators most strongly predict primary health service coverage outcomes under ILP implementation across Indonesia. Methodology: Data were drawn from multiple MOH health information systems covering all 514 districts/cities in Indonesia. Input components included health workforce, essential medicines, medical equipment, and fund utilization. Process components included life-course Posyandu, active Posyandu, and trained community health workers (CHWs). Associations with primary health service output indicators were examined using Pearson correlation analysis. Results and Discussion: All components demonstrated statistically significant positive associations with health service output indicators (p < 0.001). Health workforce availability showed the strongest associations, particularly with vitamin A coverage (r = 0.682), complete neonatal care (r = 0.569), ANC6 coverage (r = 0.540), and facility-based delivery (r = 0.537). Medical equipment and essential medicines also demonstrated moderate-to-strong associations with maternal and child health indicators (r = 0.323–0.510). Among process components, life-course and active Posyandu showed stronger associations with service outputs than trained CHWs. Conclusions: Adequate health workforce, essential medicines, medical equipment, and life course based Posyandu implementation represent the health system components most strongly associated with improved primary health service coverage under ILP. These findings suggest that Primary Health Care Reform success requires reinforcement of health system components beyond administrative indicators alone. Prioritizing essential input strengthening and Posyandu revitalization toward comprehensive and equitable ILP implementation throughout Indonesia.