This commentary discusses Indonesia's strategic decision to move from the WHO Southeast Asia region (SEARO) to the Western Pacific region (WPRO), which was formally approved at the 78th World Health Assembly in May 2025. This move shows that Indonesia wants to be more active in determining the direction of its global health cooperation, while also revealing power imbalances and limitations in the WHO regional system. The article also compares Indonesia's experience with other countries, such as Mongolia and Israel, that have made similar moves. It concludes that the WHO's regional system needs to be adjusted to be more equitable and flexible, and give all member states an equal voice. Keywords: Global health, Indonesia, multilateralism, regionalism, power asymmetry.

This editorial article highlights the important role of strengthening the maternal and child health system for the overall increase of the nation’s productivity, as well as the achievement of Indonesia Emas 2045. The discussion emphasized accessibility of maternal health services in community health services like Posyandu through readiness of health cadres, especially after the government implemented Integrated Primary Health Services or Integrasi Layanan Primer (ILP). Moreover, the implementation of exclusive breastfeeding was found to be significantly associated with stunting, making it a pivotal program to decrease stunting prevalence and increase infants’ health quality. Although some challenges like geographic barriers, limitation of knowledge and education, as well as low household income existed, investing in the maternal and child health system would solve the problem of the high mortality rate among mothers and infants. As Indonesia Emas 2045 was set as national development goals, the article stands up for better quality of maternal and child health in Indonesia through collaboration across sectors with an inclusive decision-making process. Keywords: Child health, health system, infant health, maternal health.

Background: Stunting negatively impacts children’s growth, cognitive development, and future productivity. A frequently overlooked yet critical risk factor is the absence of exclusive breastfeeding (EBF). Many studies continue to explore and update the critical role and the urgency of EBF. Aims: This research aimed to identify and analyze the previous studies on the relationship between EBF and stunting to capture a comprehensive understanding of EBF’s role in stunting prevention and various associated factors. Methods: A Systematic Literature Review with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) protocol was employed through four steps – identification, screening, inclusion, and eligibility. A total of 865 articles were initially retrieved from electronic databases (Google Scholar and PubMed). Following the inclusion and exclusion criteria, 18 studies resulted in the final review. Results: There was a significant relationship between EBF and stunting incidents. Key contributing barriers are predominantly observed in families with low socioeconomic status and limited educational attainment. In addition, prevailing public perceptions and traditional cultural practices—such as pre-lacteal feeding and CF-were also identified as influential factors. Conclusion: The failure to practice EBF contributes to increased stunting, primarily due to the absence of optimal nutrition and immune protection provided by breast milk. The ignorance of EBF stems from customs and culture that have been applied from era to era. Addressing this issue requires multidimensional interventions, particularly focusing on educational and environmental support. Future research should adopt a multi-sectoral approach to inform evidence-based policy-making for more effective stunting prevention. Keywords: Children aged under 5 years, chronic nutrition, exclusive breastfeeding, stunting, systematic literature review.

Background: Leptospirosis is a public health issue caused by the Leptospira bacterium, leading to significant economic impacts. The cost of illness due to Leptospirosis encompasses hidden costs that significantly affect individuals and society Aims: This study aimed to assess the hidden economic burden (direct and indirect costs) experienced by patients and their families due to healthcare treatment of leptospirosis. Methods: This descriptive cross-sectional study was conducted in Banyumas Regency from February to June 2024. Data were collected from patients who completed leptospirosis treatment in 2023. The variables of cost were categorized into direct treatment cost, treatment cost, and indirect cost, which were analyzed descriptively. Results: Most leptospirosis patients were male, aged 26 – 45 years old, and the majority worked as farmers. Our study reveals that uninsured patients incurred higher out-of-pocket expenses during leptospirosis’ treatment. The productivity loss was estimated at USD 44.75, with significant hidden costs being transportation (USD 31.90), caregiver support (USD 86.38), and hospital treatment (USD 231.40). Conclusion: The significant burden of Leptospirosis in Indonesia highlights the economic impact on individuals and the challenges within the healthcare system. This study calls for enhanced public health strategies focused on prevention, early diagnosis, and improved healthcare access to address the leptospirosis burden effectively. Keywords: Cost of illness, economic burden, financial impact, leptospirosis, productivity loss

Introduction: Effective work motivation among healthcare professionals significantly enhances health service performance and plays a pivotal role in improving service quality. Aims: This study aims to analyze the determinants influencing work motivation among doctors at community health centers in Indonesia. Methods: This study employed a quantitative approach with a cross-sectional design, utilizing secondary data from the 2017 Indonesian Workforce Research in the Health Sector. The study sample comprised 9,988 respondents. Logistic regression was employed for data analysis. Results: In 2017, 55.1% of doctors at community health centers in Indonesia reported high work motivation. Significant correlations were identified between work motivation and various factors: individual characteristics (age, education, marital status, position), intrinsic factors (training and continuing education), extrinsic factors (salary/wages, work area), financial incentives (performance allowances, capitation fund incentives), and non-financial incentives (official vehicles) (p < 0.05). Among these, the type of position was identified as the most dominant factor influencing work motivation (p < 0.05; prevalence ratio (PR) = 1.805 CI 95% [1.608-2.028]). Conclusion: Work motivation among doctors at community health centers in Indonesia is significantly influenced by individual characteristics, intrinsic and extrinsic factors, as well as financial and non-financial incentives, with the type of position being the most dominant factor. To enhance motivation and improve healthcare services, policymakers should strengthen career development, expand training opportunities, improve financial and non-financial incentives, and implement targeted retention strategies, especially in underserved areas. Keywords: Community health center, doctor, Indonesia, work motivation

Background: Patient safety incidents continue to occur in primary health care services despite being 24% to 85% preventable. Promoting and assessing patient safety culture is the primary step to minimize and prevent adverse incidents. Aims: This research examined the level of patient safety culture implementation in Primary Health Centers. Methods: A quantitative descriptive research design was conducted involving 319 employees randomly selected from 11 Primary Health Centers in Jambi province. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire and analyzed descriptively, with an average cut-off point of 75%. Results: The implementation level of patient safety culture in the Primary Health Centers in Jambi Province was 71.5%. Furthermore, seven dimensions of patient safety culture were weakly implemented: staffing, communication openness, organizational learning for continuous improvement, supervisor/manager expectations and actions promoting patients, non-punitive response to error, general perception of patient safety, and frequency of error reporting. Conclusion: Continuous examination should be conducted to ensure better changes in improving patient safety culture. Keywords: Jambi Province, Patient safety culture, Primary health center

Background: Madura Island is often left behind in health development in East Java Province, including in the health sector. Poverty and poor education dominate this region. Aims: The research examined the role of education in National Health Insurance (NHI) membership among Indonesian Madurese. Methods: The study employed 791 respondents. We used NHI membership as an outcome variable, education level as an exposure variable, and seven control variables: regency, residence, gender, employment, age, wealth, and marital status. In the last stage, we employed a binary logistic test. Results: The results showed that 58.2% of Madurese people in Indonesia are members of the NHI. Regarding education level, Madurese with primary education was 1.672 times more likely than those without formal education to be an NHI member (95% CI 1.662-1.683). Meanwhile, Madurese with secondary education was 2.329 times higher than those uneducated to be an NHI member (95% CI 2.306-2.352). Moreover, Madurese with higher education was 4.593 times more likely to be an NHI member than uneducated Madurese (95% CI 4.517-4.669). Conclusions: Education level was associated with NHI membership among Madurese in Indonesia. The higher the education level, the higher the possibility of being an NHI member. Keywords: health insurance, National Health Insurance, Madurese, big data, public health

Background: Remote public health centers (PHCs) have the highest proportion of PHCs without doctors, with Southeast Sulawesi Province ranking fifth in this regard. PHCs serve as the main gateway to health services in rural and remote areas. Despite its high fiscal capacity and provision of support for medical education and incentives, North Konawe District has not succeeded in retaining doctors in its public health centers. Aims: This study aims to analyze factors that influence the retention of doctors in remote PHCs in the North Konawe District. Methods: This qualitative study employed a case study design, involving in-depth interviews with 14 informants and a review of six documents. Results: Factors affecting doctor retention in the North Konawe District include individual factors, work factors, living environment factors, and health system factors. Conclusion: Doctors in remote PHCs in North Konawe District are Ministry of Health placement doctors working on temporary contracts. Strategies to improve the retention of doctors in remote PHCs include improving living conditions in remote areas, supporting job opportunities for doctors' spouses, recruiting doctors early in their careers, implementing government disincentive policies, building PHCs with official housing, requiring mandatory service for recipients of medical education scholarships, and developing doctor attendance information systems. Keywords: Doctor, PHC, remote area, retention.

Background: Exclusive breastfeeding (EBF) is a lifesaving practice for infants in vulnerable conditions. Therefore, it is crucial to ensure the optimization of EBF coverage in disadvantaged areas. One of the barriers to EBF is limited maternal knowledge, and prenatal classes are designed to improve maternal health knowledge and practices. Aims: The study aimed to analyze the role of prenatal classes in supporting EBF in Papua. Methods: The cross-sectional study examined 640 mothers with children aged 0-5 months from the Papua Region. Prenatal classes were an exposure variable, while EBF practice served as an outcome variable. Nine control variables, including age, marital status, education, work, wealth, sex, infant age, and early initiation of breastfeeding (EIBF), were incorporated into the analysis. Binary logistic regression test was used for analysis. Results: The proportion of EBF in Papua is 50.7%. Mothers who participated in prenatal classes were 1.560 times more likely to practice EBF than those who did not (AOR = 1.560; 95% CI [1.476-1.649]). Additionally, the study identified nine control variables related to EBF in the Papua Region: type of residence, maternal age group, maternal marital status, education level, employment status, wealth status, infant age, infant sex, and EIBF. Conclusion: Participation in prenatal classes is positively associated with the achievement of EBF practice in the Papua Region. Additional characteristics associated with a higher likelihood of EBF among Papuan mothers included having a higher level of education and employment, living in rural regions, experiencing poverty, being married, and achieving successful EIBF. Keywords: exclusive breastfeeding, Papua, prenatal classes, public health, public health nutrition

Background: To achieve high and equitable immunization coverage, it is important to understand the access and utilization barriers, as well as the influencing determinants among population groups. Aims: This study aims to identify high-risk regencies and explore the application of spatial analysis to support microplanning in immunization programs. Methods: This study employed an implementation research design conducted in Aceh Province, Indonesia. Secondary datasets on immunization coverage, health human resources, facilities, and socio-economic parameters were analyzed. Focus group discussions (FGDs) and training sessions were conducted with health workers. Results: The average coverage of universal child immunization (UCI) across villages was 24.18%, while complete basic immunization (CBI) reached 55.85%. In general, regencies with low UCI and CBI often had limited human resources, inadequate health facilities, and a high proportion of high-risk populations. This study identified hot spots and cold spots in the study area. Additionally, participants reported that mapping using the application was easier and beneficial for supporting the preparation of immunization micro-planning. Conclusion: Spatial analysis can help address inequalities in immunization services and support resources during immunization. Qualitative approaches provided a deeper understanding of undocumented information. The use of mapping applications facilitated more effective microplanning in immunization programs. Keywords: Child mortality, health risk, immunization, microplanning, vaccine.