Indonesia shifts primary care focus from treatment to prevention

Jakarta (ANTARA) - For decades, Indonesians have visited community health centers mainly when they were sick. Now, the government is reshaping primary healthcare to detect risks earlier and prevent disease before it develops.

Located at the sub-district level, community health centers, known as puskesmas, have long been the frontline of Indonesia's healthcare system.

Most people seek treatment there for symptoms such as fever or cough, but rarely visit when they feel healthy.

That mindset reflects a primary healthcare model historically centered on curative care rather than prevention.

Puskesmas guidelines were developed in the 1970s, when Indonesia's main health challenges were malnutrition, maternal and child health issues, and infectious diseases.

The system effectively addressed the country's needs during that period.

Today, Indonesia faces a different reality. Life expectancy has increased, the elderly population is growing, and non-communicable diseases are becoming a larger burden.

The challenge is no longer only treating illness but preventing it before it occurs.

These demographic and epidemiological changes have prompted the Health Ministry to overhaul puskesmas operations and redefine their role.

Rather than responding after illness appears, puskesmas are increasingly expected to identify health risks early.

The shift is reflected in the nationwide Free Health Screening program launched in February 2025.

The initiative is among Indonesia's most ambitious efforts to expand preventive health screening and targets citizens across the country.

Within months, more than eight million people in all provinces underwent health checks through thousands of puskesmas.

Participation expanded sharply throughout 2025, reaching tens of millions through healthcare facilities and schools.

The program has given authorities a clearer picture of the country's health conditions in real time.

Screening results show tooth decay, hypertension, diabetes and obesity are widespread, yet often undetected by those affected.

The findings highlight that many major health problems develop gradually and remain unnoticed in their early stages.

As a result, many patients learn of their condition only after symptoms emerge or complications occur.

The government designed the screening initiative as more than a mass-checkup program.

It is intended to move intervention earlier, when risk factors can still be identified and managed effectively.

Officials say earlier intervention lowers costs and improves treatment outcomes.

Preventive and promotive healthcare have therefore become practical necessities rather than policy aspirations.

Transformation is also underway in how primary healthcare services are delivered.

For years, services for toddlers, adolescents, pregnant women and older adults often operated through separate pathways.

Officials say that approach was not always effective because healthcare needs evolve throughout a person's life.

Through the Integrated Primary Healthcare Services initiative, the government is combining previously separate services.

The approach aims to simplify access and provide continuous healthcare from childhood through old age.

Implementation is progressing gradually, with some regions first establishing pilot puskesmas before broader expansion.

Officials acknowledge that healthcare transformation requires more than regulatory changes.

It also demands organizational adjustments, workforce development and sustained support for smaller facilities, including auxiliary health centers and community health posts.

Persistent challenges

Indonesia has a strong foundation, with more than 10,000 puskesmas operating nationwide.

The country has surpassed the minimum target of one puskesmas in every sub-district.

However, uneven distribution of healthcare workers remains a major challenge.

Health Ministry data show many puskesmas still lack complete staffing that meets national standards.

Shortages persist in key professions, including health-promotion specialists and laboratory technicians.

The gaps directly affect facilities' ability to focus on prevention, early detection and community outreach.

Strengthening the healthcare workforce has therefore become a central element of the reform agenda.

The government and international partners have begun mapping workforce needs, including education, deployment and retention strategies.

Community health volunteers, known as posyandu cadres, also play a crucial role.

Numbering more than one million, most are women who connect healthcare services with communities.

As preventive healthcare expands, these cadres remain closest to residents' daily lives.

Their training and mentoring are considered essential to the success of primary healthcare programs.

Still, national progress does not mean all regions advance equally.

Healthcare disparities remain evident, particularly in eastern Indonesia.

Participation in the screening program remains relatively low in provinces such as West Papua, Central Papua and Highland Papua.

Java continues to account for the largest share of participants.

The gap reflects longstanding challenges, including geography, workforce shortages and limited infrastructure.

As a result, success will be measured not only by participant numbers but also by how effectively reforms reach underserved regions.

The transformation is unlikely to be completed within a few years.

Yet Indonesia's direction is increasingly clear: building a healthcare system focused not only on treating disease, but on helping people stay healthy from the start.

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Editor: Rahmad Nasution

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