BKM Public Health and Community Medicine

Navigating access to Indonesia’s National Health Insurance: determinants and barriers among informal sector workers in West Sumatra

Shelvy Haria Roza — 2025-07-11

Purpose: This study aimed to identify the factors that influence and barriers to the utilization of JKN for informal sector workers in West Sumatra Province.

Methods: The study employed a quantitative cross-sectional design. The data used are secondary data from the 2022 Susenas. The population of this study consisted of informal workers aged 15-64 years, comprising approximately 10,909 people. The sample consisted of informal workers with health complaints and a history of outpatient care, specifically 4,606 individuals. This study uses JKN utilization as the dependent variable. Meanwhile, there are several independent variables: JKN ownership, age, gender, economic status, region of residence, education, and employment. Data were analyzed using the STATA application in univariate, bivariate analyses with the Chi-Squared test, and multivariate analyses with binary logistic regression.

Results: The results showed that most respondents (59.12%) did not use JKN due to various barriers, including a preference for self-medication (76%), lack of knowledge on how to use JKN (10%), and difficulties with procedures (5%). The productive age group was significantly more likely to use JKN (OR 4.653; 95% CI 1.837 - 11.784). The poor are more likely to use JKN than those in the lower-middle income groups (OR 6.955; 95% CI 1.444-33.497).

Conclusion: The wealth status and age had a significant influence on the use of JKN. Expand access to affordable health services for low-income individuals and older adults. Barriers to using JKN are practical and require policy interventions. Insurance subsidies, development of mobile-based services, and strategies for the dissemination of information and benefits of JKN.

Disparities in basic immunization coverage: a case study of supply and demand factors in two community health centers in Bogor, Indonesia

Hermadi — 2025-07-14

Purpose: To identify and analyze the factors influencing complete basic immunization (CBI) coverage at two community health centers (CHCs) with contrasting coverage levels.

Methods: This study employed a qualitative approach with a case study design. Informants were purposively selected and included health workers, community health volunteers, and parents. We collected data through in-depth interviews and document review, then analyzed it using a qualitative thematic approach.

Results: Supply-side factors included the number and competence of health workers, availability of facilities and infrastructure, and funding support. Demand-side factors comprised community knowledge and awareness, sociodemographic characteristics, and trust in vaccines. Ciapus faced shortages of health personnel and community resistance to immunization, while Bojong Nangka demonstrated active collaboration between health workers and the community.

Conclusion: The disparity in CBI coverage between Bojong Nangka and Ciapus CHC is caused by an imbalance between supply and demand factors. In Ciapus, low coverage was driven by limited human resources, inadequate infrastructure, and insufficient funding (supply-side), as well as poor public knowledge, awareness, and trust in vaccines, and the minimal involvement of local leaders (demand-side). In contrast, Bojong Nangka succeeded by strengthening its supply and demand components. Comprehensive interventions are necessary to enhance immunization services, increase public awareness and participation, and thereby achieve equitable CBI coverage.

Mapping the vulnerability of stunting in toddlers based on water, sanitation, and hygiene (WASH) indicators in South Sumatra Province by 2023: descriptive spatial analysis

Prihatini Dini Novitasari — 2025-07-22

Purpose: This study was conducted to map stunting vulnerability in children under five years of age by district/city based on stunting prevalence and WASH indicators.

Methods: The research method employed was descriptive spatial analysis using a Geographic Information System (GIS) application with a scoring method, incorporating natural breaks in QGIS software.

Results: As a result, Empat Lawang and South Ogan Komering Ulu districts are high-priority districts for an immediate response to stunting. Additionally, four districts/cities were classified as high-priority areas, three as medium-priority areas, five as low-priority areas, and three as very low-priority areas.

Conclusion: Therefore, the government and communities are expected to increase efforts to prevent and handle stunting in children under five by prioritizing districts/cities with a very high level of vulnerability through expanding the availability of clean drinking water source and proper sanitation, and promoting clean and healthy living through optimal use of clean water and hand washing with soap.

Scoping review of interventions to increase VIA test uptake in Indonesia

Ardhina Ramania — 2025-07-30

Purpose: Cervical cancer remains a major public health concern in Indonesia. Although the VIA (Visual Inspection with Acetic Acid) screening program has been introduced, the national target of 75% coverage has not yet been achieved. Enhancing public participation requires more effective health promotion strategies. This study reviews public health intervention studies conducted in Indonesia aimed at increasing VIA screening uptake.

Methods: Literature published between 2015 and 2025 in English and Indonesian was searched using PubMed and Google Scholar. Inclusion criteria focused on peer-reviewed intervention studies with transparent methodologies and outcome assessments related to VIA uptake. Qualitative studies and other types of studies not published in peer-reviewed journals were excluded from the analysis. Data were extracted and synthesized narratively based on the target intervention and outcomes.

Results: From the 114 retrieved articles, 22 studies met the inclusion criteria. All were cross-sectional studies conducted across 12 Indonesian provinces, primarily in Java and Sumatra. Sample sizes ranged from 12 to 121 participants, totaling 1,278 individuals. Most studies targeted women (n = 19), while a few involved local women cadres (n = 2) or both (n = 1). Knowledge (n = 14) and attitude (n = 11) were the most frequently measured outcomes. All interventions (n = 22) reported positive results.

Conclusion: These findings highlight a critical gap in health intervention strategies targeting women’s social support, especially husbands. Further research should design intervention research focusing on male partners and employ longitudinal designs to assess the long-term impact of these strategies on VIA test uptake.

Elevated liver transaminase levels prolong hospital stay in dengue patients: retrospective cohort study

Abdelrahman MS Alnweiri — 2025-07-31

Purpose: To evaluate the public health impact of elevated liver transaminases (AST/ALT >35 U/L) on hospitalization duration in adult dengue patients in Indonesia’s resource-constrained settings.

Methods: Retrospective cohort study of 786 confirmed dengue patients at Ummi Hospital, Bogor (2021–2023). We analyzed demographics, comorbidities, hepatoprotective therapy, and AST/ALT levels. Prolonged stay was defined as ≥5 days. Multivariate logistic regression identified predictors of prolonged length of stay (LOS).

Results: 41.9% had elevated transaminases. Patients with enzyme elevations had longer hospital stays than those with normal levels. Non-comorbid patients with elevated enzymes were significantly more likely to experience prolonged hospitalization. Comorbidities markedly increased the risk of extended stays, while hepatoprotective therapy reduced it. Nationally, this could save ~105,000 bed-days annually.

Conclusion: Elevated transaminases independently predict prolonged dengue hospitalization. Routine liver monitoring and hepatoprotective therapy may optimize bed utilization in Indonesian hospitals.