Solikha Dewi Amila, Butler Danielle C, Setiawan Ery, Korda Rosemary J, Kelly Matthew
National Centre for Epidemiology and Population Health (NCEPH), Australian National University (ANU), Canberra, Australia.
Directorate for Public Health and Nutrition, Ministry of National Development Planning, Jakarta, Indonesia.
BMC Health Serv Res. 2025 Jul 2;25(1):898. doi: 10.1186/s12913-025-12955-8.
Indonesia has endeavoured to strengthen primary health care (PHC), a task requiring comprehensive measurement of PHC performance which remains a challenge. This scoping review aims to describe PHC performance measurement pertaining to service delivery in Indonesia and identify what has not been measured.
We conducted a scoping review, following the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews guideline. We mapped the measurement used in the included studies to the WHO/UNICEF PHC measurement framework at the service delivery level. Our analysis involved process (domains: models of care, systems for improving quality, resilient health facilities and services) and output (domains: access and availability, quality care) indicators, 38 in total. These indicators are broadly categorised in the WHO/UNICEF framework based on their feasibility and relevance for measuring PHC performance as either Tier 1 - measurable in most contexts, or Tier 1 global - important for global monitoring, or Tier 2 - difficult to measure or requiring further assessment.
Of the 4,831 studies initially identified, 33 were included in this review. The domains of PHC performance assessed included access and availability, models of care, and quality care. No studies reported on the domains: systems for improving quality, or resilient health facilities and services. Overall, 18/38 of the WHO/UNICEF framework indicators were not measured: 1 of 3 Tier 1 global indicators (admissions for ambulatory care sensitive conditions (ACSC)), 4 of 11 Tier 1 indicators, and 13 of 24 Tier 2 indicators. Few studies utilised instruments that have been designed for national reporting, and time-trend analysis was limited.
This study identified measurement gaps in PHC service delivery performance in Indonesia. Addressing these gaps, by developing a more comprehensive monitoring framework that incorporates unmeasured domains and indicators, adapting relevant global measurement instruments to the Indonesian context, and conducting time trend analyses, may contribute to improve PHC performance monitoring and support Indonesia PHC transformation agenda. These potentially offer insights for other countries with similar setting.
印度尼西亚一直在努力加强初级卫生保健（PHC），而这一任务需要对初级卫生保健绩效进行全面衡量，这仍然是一项挑战。本范围综述旨在描述印度尼西亚与服务提供相关的初级卫生保健绩效衡量情况，并确定尚未进行衡量的方面。
我们按照系统综述扩展版的首选报告项目（PRISMA-ScR）指南进行了范围综述。我们将纳入研究中使用的衡量指标映射到世界卫生组织/联合国儿童基金会初级卫生保健服务提供层面的衡量框架。我们的分析涉及过程（领域：护理模式、质量改进系统、有韧性的卫生设施和服务）和产出（领域：可及性和可得性、优质护理）指标，共38项。这些指标在世卫组织/联合国儿童基金会框架中根据其衡量初级卫生保健绩效的可行性和相关性大致分为3类：第1类——在大多数情况下可衡量；第1类全球指标——对全球监测很重要；第2类——难以衡量或需要进一步评估。
在最初识别出的4831项研究中，本综述纳入了33项。评估的初级卫生保健绩效领域包括可及性和可得性、护理模式以及优质护理。没有研究报告质量改进系统或有韧性的卫生设施和服务领域的情况。总体而言，世卫组织/联合国儿童基金会框架中的38项指标中有18项未被衡量：3项第1类全球指标中的1项（门诊护理敏感病症（ACSC）的住院率）、11项第1类指标中的4项以及24项第2类指标中的13项。很少有研究使用专门为国家报告设计的工具，时间趋势分析也很有限。
本研究确定了印度尼西亚初级卫生保健服务提供绩效衡量方面的差距。通过制定一个更全面的监测框架，纳入未衡量的领域和指标，使相关全球衡量工具适用于印度尼西亚的情况，并进行时间趋势分析来填补这些差距，可能有助于改善初级卫生保健绩效监测，并支持印度尼西亚的初级卫生保健转型议程。这些可能为其他情况类似的国家提供见解。
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