Fanda Relmbuss Biljers, Probandari Ari, Yuniar Yuyun, Hendarwan Harimat, Trisnantoro Laksono, Jongeneel Nikki, Kok Maarten Olivier
Center for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.
Lancet Reg Health Southeast Asia. 2024 Jan 8;22:100345. doi: 10.1016/j.lansea.2023.100345. eCollection 2024 Mar.
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.
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.
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.
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.
Indonesian Government.
印度尼西亚在实现全民健康覆盖方面正取得重大进展，全民健康覆盖包括提供免费基本药物。本研究调查了印度尼西亚各地基层医疗中心（PHC）基本药物的可获得性、药物无法获得的原因，以及社区获得替代配药点的程度。
调查员走访了所有514个地区的9831家基层医疗中心，以评估60种基本药物的可获得性，并确定任何缺失药物的原因。我们将结果与全国村庄普查数据相关联，以评估可获得性、贫困与获得替代配药点之间的关系。
药物可获得性差异很大。17种优先药物的中位可获得率为82%，而60种基本药物的总体可获得率为58%。孕产妇和儿童保健药物的可获得性最高（73%），精神卫生药物的可获得性最低（42%）。药物缺失的主要原因是被认为不必要（46%）或未供应（38%）。爪哇/巴厘地区的药物可获得性最高，印度尼西亚东部的农村地区最低。在这些地区，居民经济困难，最依赖公共机构提供的免费药物，且获得替代配药点的机会最少。
基层医疗中心优先药物的可获得性相对较高，而按国际标准公共支付价格较低。为提高所有基本药物的可获得性，政府应优先考虑需求最高的地区，增加对偏远地区基层医疗中心的资金投入，并对药物可获得性实施透明监测。
印度尼西亚政府
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