Fanda Relmbuss Biljers, Probandari Ari, Kok Maarten Olivier, Bal Roland A
Center for Health Policy and Management, Universitas Gadjah Mada, Medika, Sendowo, Sinduadi, Mlati, Sleman, Yogyakarta, Special Region of Yogyakarta, 55281, Indonesia.
Healthcare Governance Department, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, South Holand, 3062 PA, The Netherlands.
Health Policy Plan. 2025 Mar 7;40(3):346-357. doi: 10.1093/heapol/czae114.
In Indonesia, primary health centres (PHCs) are mandated to provide essential medicines to ensure equal access to medication for all Indonesians, as stated in the national medicine policy. However, limited information is available regarding the actual practices of health workers within the context of decentralized governance. This paper investigates the discrepancies between national policies and local practices in two Indonesian districts, shedding light on coping mechanisms employed in each phase of medicine management within PHCs. The mixed-method study began by identifying pertinent policies addressing medicine management in PHCs. Subsequently, panel data on patient visits to tuberculosis, maternal and neonatal health (MNH), and noncommunicable disease (NCD) services were collected from 2019 to 2022. After analysing the panel data, interviews were conducted with 56 health workers including physicians, nurses, pharmacists, midwives, and public health programme managers regarding their views on fluctuations in medicine stocks and the patient visit data. These participants included pharmacists and programme managers specializing in tuberculosis, MNH, and NCD care and were affiliated with PHCs and district health offices. Our findings highlight the occasional unavailability of essential medicines in PHCs, with stockouts being attributed to supplier shortages at provincial and national levels and to variations in the capacity of the local health system. Low-skilled pharmaceutical staff are a contributing factor in each phase of medicine management. Additionally, health workers employ coping mechanisms, such as deviating from policy on the use of capitation funds to purchase medicines, to manage temporary stockouts. To tackle systemic stockouts, central government should prioritize capacity-building among health workers, by establishing a continuous and easily accessible local learning system.
在印度尼西亚，正如国家药品政策所规定的，初级卫生保健中心（PHC）被要求提供基本药物，以确保所有印度尼西亚人都能平等获得药物治疗。然而，关于权力下放治理背景下卫生工作者的实际做法，可获取的信息有限。本文调查了印度尼西亚两个地区国家政策与地方实践之间的差异，揭示了初级卫生保健中心药品管理各阶段所采用的应对机制。这项混合方法研究首先确定了与初级卫生保健中心药品管理相关的政策。随后，收集了2019年至2022年期间患者前往结核病、孕产妇和新生儿健康（MNH）以及非传染性疾病（NCD）服务机构就诊的面板数据。在分析面板数据之后，对56名卫生工作者进行了访谈，这些卫生工作者包括医生、护士、药剂师、助产士和公共卫生项目管理人员，询问他们对药品库存波动和患者就诊数据的看法。这些参与者包括专门从事结核病、孕产妇和新生儿健康以及非传染性疾病护理的药剂师和项目管理人员，他们隶属于初级卫生保健中心和地区卫生办公室。我们的研究结果凸显了初级卫生保健中心基本药物偶尔缺货的情况，缺货原因包括省级和国家级供应商短缺以及地方卫生系统能力的差异。低技能的药学人员是药品管理各阶段的一个促成因素。此外，卫生工作者采用应对机制，例如偏离人头费资金用于购买药品的政策，来管理临时缺货情况。为了解决系统性缺货问题，中央政府应通过建立一个持续且易于使用的地方学习系统，将卫生工作者的能力建设作为优先事项。
