JAKARTA - Health problems in Indonesia are often perceived as a budget problem, limited facilities, or lack of medical personnel. In fact, behind the achievement of increasing health insurance coverage, there are more fundamental problems that are often overlooked, such as the low involvement of citizens in the health system itself.
Without meaningful participation from the public, various health policies risk only being on paper, administratively broad but fragile in practice.
The lack of participation space makes the voices of residents, especially women, vulnerable groups, and communities in remote areas often not represented in the planning and evaluation of health services.
In this context, entering 2026, the Indonesia Health Development Center (IHDC) published the results of scientific studies and a synthesis of national public discussions entitled Health Participation as a Health Ideology of the Nation.
The Chairman of the IHDC Board of Trustees, Prof. Nila F Moeloek, together with the Head of the Study Team and Executive Director of IHDC, Dr. dr. Ray Wagiu Basrowi, MKK, FRSPH, revealed that Indonesia has actually recorded significant achievements with the participation of the National Health Insurance (JKN) which has penetrated more than 95 percent.
However, various independent studies show that these achievements are not fully in line with access equity, service quality, and public trust.
The inequality in the utilization of health services is still clearly visible, both between regions, gender, socio-economic status, people with disabilities, and based on the type of disease. This condition strengthens the finding that there needs to be a change in approach in building a more inclusive health system.
"The results of the IHDC study show that women, poor people, people with disabilities, patients with chronic and infectious diseases, and people in remote areas still face structural barriers to meaningful involvement in the health system. From the IHDC study, we concluded that health participation in Indonesia is still not inclusive," said Nila F Moeloek, who was also the Minister of Health of the Republic of Indonesia 2014-2019 in Jakarta, recently.
This weak health participation has a direct impact on the community. The phenomenon of delayed treatment and low adherence to therapy is still common. In addition, promotional and preventive behavior is not optimal, while the burden of curative services and health financing continues to increase.
The decline in public confidence is also reflected in the tendency of the public to seek health services abroad.
The Chairman of the IHDC Study Team, Ray Wagiu Basrowi, added that the results of the IHDC's deliberative public discussion identified a number of groups with low levels of health participation. One of them is the group of women who hold more than 70 percent of family health decisions, but their strategic involvement in Musrenbang and health planning is still weak.
"Poor and marginalized groups, with a health forum engagement rate of less than 40%, and only about 25% of proposals accommodated. Even people with disabilities less than 20% have ever been involved in public service forums," said the founder of the Health Collaborative Center (HCC).
In addition, stigma and discrimination against HIV, tuberculosis, and mental health diseases are still serious obstacles to access to tests, therapies, and sustainability of services. Geospatial inequality also exacerbates the situation, where community participation in lagging areas is only around 30-35 percent, with referral time to health services that can reach 2 to 4 hours.
In fact, villages and families have proven to be effective locus of participation. However, this potential is considered not to have been optimally utilized in Musrenbangdes and local health data-based planning.
Through this study, the two conveyed a call for health participation to be placed as the main foundation for the development of the national health system.
In its study, IHDC formulated nine pillars of solutions as the foundation for strengthening national health participation. The proposed approach emphasizes structured participation and is rooted in the spirit of mutual cooperation, by actively involving the community based on everyday life experiences.
Participation is understood not only as formal presence, but a qualitative process that gives real space for citizen voices in planning and evaluating health services.
The importance of a monitoring mechanism directly led by the community through Community-Led Monitoring (CLM), as well as the implementation of evidence-based participatory practices so that the resulting policies remain effective and targeted.
Strengthening trust between the community and service providers is the key, supported by the use of social media and digitalization to expand participation and improve health literacy. The use of geospatial-based access indicators is considered important to more accurately map service gaps between regions.
To strengthen implementation in the field, IHDC recommends five supporting instruments, ranging from strengthening community-based participatory agents such as Posyandu, Puskesmas, and family doctors, to the development of the Health Participation Index as an evaluation tool for policies.
Sustainable community-based financing models, simple and quality work procedure standards, and systemic protection from stigma and discrimination are seen as crucial for health participation to be truly inclusive and sustainable.
Without strong participation, the health system risks being only administratively extensive, but socially fragile.
"If participation is made into a national health ideology, Indonesia is considered to have a great opportunity to build a health system that not only guarantees access, but also builds public trust and strengthens health resilience in Indonesia," said Nila Moeloek.
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