Abstract
Indonesia is making significant strides toward achieving universal health coverage, which involves providing free access to essential medicines. This study examines the availability of essential medicine in primary health centres (PHCs) across Indonesia, the reasons why medicines are unavailable, and the extent to which communities have access to alternative dispensing points.
Methods
Enumerators visited each of the 9831 PHCs in all 514 districts to assess the availability of 60 essential medicines and identify reasons for any absent medicines. We correlated the results with the national village census to assess the relationship between availability, poverty, and access to alternative dispensing points.
Findings
Medicine availability varied greatly. The median availability for 17 priority medicines was 82%, while 58% of the broader selection of 60 essential medicines was present. The availability of maternal and childcare medicines was highest (73%) and lowest for mental health (42%). The main reasons for absence were that medicines were deemed unnecessary (46%) or not supplied (38%). The Java/Bali region had the highest medicines availability, and rural areas in Eastern Indonesia had the lowest. In these districts, the population is financially struggling, most dependent on free medicines from public providers, and had the least access to alternative dispensing points.
Interpretation
The availability of priority medicines in PHCs is relatively high, while public-paid prices are low by international standards. To improve availability of all essential medicines, the government should prioritize areas with the highest need, increase funding for PHCs in remote areas, and implement transparent monitoring of medicines availability.
| Original language | English |
|---|---|
| Article number | 100345 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | The Lancet. Regional Health, Southeast Asia |
| Volume | 22 |
| Early online date | 8 Jan 2024 |
| DOIs | |
| Publication status | Published - Mar 2024 |
Funding
In this article, we present the results of the Riset Fasilitas Kesehatan (Rifaskes) study, a national health facility survey for which data about the functioning of all primary health centres in Indonesia was collected, including the availability of essential medicine ( 21 ). The Rifaskes study was funded by the Government of Indonesia and was led by the authors of the present study (HH and YY), working at the Indonesian National Institute of Health Research and Development (Balitbangkes) with technical advice and support from academic experts (LT and RF). We thank study participants and all staff members of the Indonesian Ministry of Health and Balitbankes who contributed to the Rifaskes study. The Rifaskes study was funded by the Indonesian Ministry of Health. RBF received additional funding from Indonesia Endowment Fund for Education (LPDP) to support the analysis and finalize the manuscript. The funding source had no involvement in this study. Indonesian Government.We thank study participants and all staff members of the Indonesian Ministry of Health and Balitbankes who contributed to the Rifaskes study. The Rifaskes study was funded by the Indonesian Ministry of Health. RBF received additional funding from Indonesia Endowment Fund for Education (LPDP) to support the analysis and finalize the manuscript. The funding source had no involvement in this study.
| Funders | Funder number |
|---|---|
| National Institute of Health Research and Development | |
| Indonesian Ministry of Health | |
| Ministry of Health and Balitbankes |