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

Background Community-integrated health posts (Posyandu) are crucial for extending primary healthcare across diversegeographical and demographic landscapes in Indonesia. Community health workers (CHWs) currentlyfunction as the main service delivery actors for Posyandu. However, Posyandu's performance remains belowthe standards set by the Ministry of Health. This study examines health system determinants that explain thepoor performance of Posyandu and, in particular, examines the roles of village and township governanceand 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 FamilyLife Survey. We evaluated eight health system determinants based on the perceptions of CHWs concerningchallenges encountered in Posyandus. These factors were ranked and analyzed to determine the variablesthat 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 ruralareas. Common challenges include insufficient funds, inadequate equipment, and a lack of permanentbuildings. Although only a small percentage mentioned minimal support from village and Puskesmasauthorities, 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 asperceived by CHWs. Community health centers (Puskesmas), responsible for providing technical support toPosyandu, should be part of CHW teams and networks. Further discussions are needed to choose a workablegovernance model to ensure practical, accessible, and sustainable primary healthcare services at the grassroots level.