Health Care In Indonesia Research Articles

Quality of maternal health care in Indonesia

Maternal Mortality Ratio (MMR) in Indonesia remains high, 190 per 100,000 live births in 2013. World Bank emphasizes that 60% of maternal death is contributed by poor quality of care. Lack of attitude, competence and compliance of midwives were found in Indonesia, which indicate poor quality of maternal health care. The objective of this study is to analyze factors influencing the quality of maternal health care in Indonesia. The literatures from 2004-2014 were selected and reviewed. The latest framework of 2014 on quality maternal health care by Renfrew et al. was used as a guide. The quality of maternal health care in Indonesia is influenced by lack of midwives’ competence, inadequate supervision and monitoring, lack of drugs and equipment supply, lack of community involvement in health services. In order to address the gaps in quality of maternal health care in Indonesia, six effective interventions are proposed; namely: maternal health audit and feedback, cultural competence, education, educational outreach visit, optimizing the role of lay health workers, group prenatal care and ensure adequate supply of drugs and equipment. The interventions needs to be carried out through a collaborative approach, policy change, pilot study and strengthen activities in implementation level.

Social Determinant Factors of Elderly as an Input in Enhancing Primary Health Care in Indonesia

Objective: To analyze the differences of social determinant factors among elderly according to gender, in urban and rural areas in Indonesia. Indonesia is one of the most populated countries in the world, faces an increased number of elderly. This situation leads to the increase of degenerative diseases and demands of caregivers as well. The identification of social determinant factors of elderly has an important role in enhancing primary health care. Methods: A comparative study was carried out in 33 provinces in Indonesia using secondary data from Statistics Indonesia 2013. The variables included in this study were percentage of elderly according to education, marital status, occupation, income and living arrangements, divided in gender, urban and rural areas. The normally distributed data were analyzed using unpaired T test and not normally distributed data were analyzed using Mann-Whitney test. Results: This study showed that there were differences in education, occupation and income between urban and rural areas. In urban area, most of the elderly worked in industry and trade and in rural area they worked in agricultural, indicated huge risks of occupational haxards. Most of them were poor, still married, lived with spouses and family of three generations. Conclusions: It can be concluded that there were differences of social determinant factors (education, occupation and income) in elderly who live in urban and rural areas that can contribute to the risks of disease in elderly and these situations must be considered as an input to enhance the primary health care. Keywords: Elderly, gender, rural, social determinants, urban

Primary care physicians\u2019 satisfaction after health care reform: a cross-sectional study from two cities in Central Java, Indonesia

BackgroundIn 2014, Indonesia launched a mandatory national health insurance system called Jaminan Kesehatan Nasional (JKN). The reform introduced new conditions for primary care physicians (PCPs) that could influence their job satisfaction. This study assessed PCPs’ satisfaction and its predictors in two cities in Central Java, Indonesia, following the reform.MethodsIn this exploratory, cross-sectional study, we recruited 276 PCPs from the selected area. The data were all collected in 2016 using self-report questionnaires and interviews. PCPs’ satisfaction was measured using a modified version of the Warr-Cook-Wall Job Satisfaction Scale which contains 19 items and uses a Likert-type response scale. Analysis of variance, the Kruskal-Wallis H test, both with Bonferroni corrections for post hoc testing, and Cochran–Mantel–Haenszel tests were used to compare overall job satisfaction between participant groups. We used simple and multiple linear regression analyses to identify the predictors of PCP satisfaction. Furthermore, a logistic regression analysis for binary outcome was applied to model the PCPs intention to leave practice.ResultsPCPs’ mean overall satisfaction level was 3.19 out of 5. They tended to be very satisfied with their relationship with colleagues, working hours, and physical working conditions. However, the PCPs were dissatisfied with the new referral system, the JKN health services standards, and JKN policy. The factors significantly associated with job satisfaction (p < 0.001) included type of practice, performance of managerial tasks, and PCPs’ perceptions of and experiences with patients. PCP satisfaction was negatively associated (p = 0.004) with PCPs’ intention to leave their practice.ConclusionsThe PCPs investigated in these two cities in Central Java had moderate satisfaction after the Indonesian health care reform. PCPs who worked in solo practices, performed managerial tasks, and had good experiences with patients tended to have higher satisfaction scores, which in turn prevented them from developing an intention to leave their practice. The three aspects that PCPs with which most dissatisfied were related with the JKN reform. Because of that, the government and BPJS for Health should aim to improve the JKN system in order to increase PCPs’ satisfaction.

Validation of the Indonesian version of the Safety Attitudes Questionnaire: A Rasch analysis.

IntroductionSafety climate, which provides a snapshot of safety culture, is rarely measured in Indonesian healthcare organisations because there are no validated surveys that can be administered in its native language, Bahasa Indonesia. The objectives of this study were to translate and linguistically adapt the Safety Attitudes Questionnaire into Bahasa Indonesia, and investigate the internal construct validity and reliability of the translated survey.MethodsThe Safety Attitudes Questionnaire was translated into Indonesian language through forward and backward translation. The internal construct validity and reliability of the translated survey was assessed using Rasch analysis which examines overall model fit, unidimensionality, response format, targeting, internal consistency reliability and item bias.ResultsA total of 279 nurses (response rate 82%) completed the Indonesian version of the Safety Attitudes Questionnaire. Most respondents were Division 2 registered nurses (n = 209; 75%), female (n = 174; 62%), and aged less than 30 years (n = 187; 67%). All six domains of the Indonesian version of the Safety Attitudes Questionnaire demonstrated unidimensionality (t-test less than 0.05 threshold value). However, suboptimal targeting (ceiling effect) was observed in all domains, and had at least one misfitting item (item fit residual beyond ±2.5) Item bias was also evident in most domains.ConclusionThis study has translated and validated an Indonesian version of the Safety Attitudes Questionnaire for the first time. Whilst there was general support to sum items to obtain domain scores, further work is required to refine the response options as well as the wording and number of items in this survey to improve its overall measurement properties.

Comprehending Mental Health in Indonesian’s Adolescents through Mental, Emotional, and Social Well-Being

ABSTRACTMany problems occur at the age of adolescence, especially mental health disorders. Teens experiencing life changes could be at risk for mental health disorders. Adolescents with flourishing/good mental health can become adults who are optimistic, independent, creative, and able to adequately contribute to their surroundings by optimally using their capacities. This study aims to describe an overview of the psychological, emotional, and social well-being of adolescents; thus, it can be used to create a national picture of adolescents’ mental health in Indonesia. This is a descriptive study with a cross-sectional design. The study sample included 972 adolescents in grades 7 and 8 in public and private junior high schools in Depok, Jakarta, Tangerang, and Denpasar who were selected by stratified random sampling. Adolescents possess a high degree of psychological, emotional, and social well-being, and 46.3% of the adolescents were discovered to have flourishing mental health while the others had moderate and languishing/weak mental health. It is necessary to maintain and enhance the involvement of adolescents’ support systems to maintain their mental health. Moreover, adolescents should explore their potential in order to learn adaptive coping mechanisms to help them solve problems appropriately.

Cost Effectiveness Analysis of Rivaroxaban Compared to Warfarin and Aspirin for Stroke Prevention Atrial Fibrillation (SPAF) in the Indonesian healthcare setting

Main drugs used in the prevention of stroke among atrial fibrillation (AF) patients are antiplatelets (aspirin) and oral anticoagulants (OAC). OAC therapy can be difficult to administer due to drug and food interactions, adds the burden of required blood monitoring, narrow therapeutic window, and requirements for dose titration. Rivaroxaban is a single-dose oral anticoagulant which does not require blood monitoring, dose titration or has dietary interactions. Phase III clinical data from the ROCKET trial have recently been reported the non-inferiority of rivaroxaban over warfarin for the prevention of strokes in AF patients. To develop an economic model evaluating the clinical and cost-effectiveness of rivaroxaban for the prevention of stroke in non-valvular AF patients in the Indonesian health care settings. We conducted cost effectiveness analysis from the perspective of payer (national health insurance). Effectiveness data used the international data from previous RCT and network metaanalysis studies. Costs data used local data of Indonesia from national health insurance’s reimbursement tariffs. Markov model was used, comprised of health and treatment states describing the management and consequences of AF. The main analysis was based on data from the phase III trials. Three months was used as cycle length. The time horizon was set at patients’ lifetime (20 years). Costs and outcomes were discounted at a 3% annual rate. Subgroup analysis and extensive sensitivity analysis was conducted. Willingness to pay (WTP) threshold in Indonesia was set as 3 times GDP of Indonesia in 2015, equal about IDR 133,375,000 per quality-adjusted life year (QALY). Base case rivaroxaban vs warfarin has ICER of IDR 141,835,063per QALY at the current cost of rivaroxaban IDR 23,500 and ICER of 130,214,687 per QALY at the proposed cost of rivaroxaban IDR 22,000. One-way sensitivity analysis showed that the key drivers of cost-effectiveness were the utility decrement applied to stable warfarin patients, discontinuation/subsequent discontinuation rates for rivaroxaban, and discontinuation/subsequent discontinuation rates for warfarin. The probabilistic sensitivity analysis suggested that rivaroxaban was cost-effective compared to warfarin in about 45% of cases at the WTP per QALY. Rivaroxaban with the proposed price of IDR 22,000 was considered to be more cost-effective when compared to warfarin.

A Tool to Help or Harm? Online Social Media Use and Adult Mental Health in Indonesia

The effect of online social media use on individual mental health remains contested. This study examines the effect of online social media (Facebook, Twitter and chat) on adult mental health in Indonesia. Instrumental variable analysis was used to address reverse causality issues. Data come from the Indonesia Family Life Survey (IFLS) 2014, which polled 22,423 individuals age 20 years and older in 9987 households and 297 districts in Indonesia. The findings show that social media use harms adult mental health; an increase of one standard deviation in adult use of social media is associated with 9% increase in CES-D score. The effect is robust with respect to an extensive set of individual, household, community and district covariates. The findings suggest that policies offering advice to wise use of online social media are needed to protect adults from the harmful effects of online social media on their mental health.

Health Referral Enterprise Architecture Design in Indonesia.

ObjectivesIn this study an enterprise architecture (EA) was developed for a health referral information system (HRIS) for individual healthcare in Indonesia with reference to the Open Group Architecture Framework (TOGAF) 9.1. The HRIS includes patient referrals for vertical and horizontal references (internal and external), specimen referrals, and health personnel referrals.MethodsThis research was a qualitative study that used the interview and observation method of the Primary Health Care Information System (SIMPUS) application developed by the Agency for Assessment and Application of Technology (BPPT). The interviews were conducted at South Tangerang City Government Health Office with five resource persons who were responsible for conducting health referral processes.ResultsThe EA of the HRIS includes the principles of architecture, business, application, data, and technology architecture. Twelve principles, four referral processes, and three application reference modules and centralized applications comprise the architecture of the HRIS. The HRIS is a centralized integrated application that uses application program interface (API) to integrate with SIMPUS.ConclusionsThe proposed architecture was developed in an integrated and comprehensive manner for the individual healthcare referral process, which can be implemented by regulators and healthcare facilities. This architecture can also help regulators and healthcare facilities to standardize and integrate health referral data and related processes.

AN UPDATE REVIEW: THE USE OF WET CUPPING THERAPY AGAINST VERTIGO

Vertigo is one of common complaints in the primary health care in the world. The common modern therapy for vertigo is using chemical pharmacological therapy yet having unwanted side effect. One of the wellknown complementary medicine that has been proven for relieving and curing many diseases is cupping therapy, especially wet cupping therapy. However, wet cupping therapy is not commonly applied in Indonesia healthcare. The causes may be due to the scarcity of the high quality scientific sources of the cupping therapy use for vertigo as well as the boundary between complementary and modern medicine in Indonesia. This review aimed to find out the use of wet cupping therapy against vertigo. A systematic review was obtained from NCBI and Google Scholar database (1999-2017) according to topic of interest. Yet Yunani, Persia, and China medicines recommend this therapy for treating vertigo as it had high level safety and effectivity. Wet cupping therapy has a potential effect in treating vertigo which the mechanism using negative pressure from vacuum cupping thus opening the skin barrier and removing causative pathology substances (CPS). Researchers and health practitioners essentially need to improve research in large scale towards the use of wet cupping against vertigo so the effectivity will be more optimal.Â

Mini Health Technology Assessment of Urban and Rural Health Care in Indonesia

Background: Health Technology Assessment (HTA) is a program to evaluate the use of technology in healthcare. HTA proposed by World Health Organization (WHO) will affect the government’s decision-making in the development of healthcare technology. The use of technology should be assessed from its cost-effectiveness to its potential ethical problems. HTA Unit – a division who organizes HTA in government in Indonesia – has emerged in ministry of health in 2003 and focused in drugs and vaccines problems. However, HTA in Indonesia has not been formally effective until today.Objectives: To evaluate the usage, supply, and demand of the health technology and the spread of health technology in urban and rural areas.Methods: This study is a cross-sectional study using questionnaire to gather quantitative and qualitative data. The respondents of this study are medical doctors in Indonesia, and the selection of the respondents is done consecutively. We divide respondents’ area into urban and rural areas, and health practitioners as field executors (general practitioners or GP and specialists) and head of healthcare facilities.Results: The total samples are 48 health practitioners and 14 head of healthcare facilities. Statistical analysis shows that the two settings (urban and rural) are not significantly different (p=0.478), while descriptive analysis shows that the inadequacy of health technology is higher in rural than that in urban areas (70% VS 52.63%). The relationship between the field of health practitioners (GP and specialist) and the adequacy of health technology is not significant. More GP than specialists complain about the inadequacy of health technology in giving the health service to the patients. About 92.8% head of health facility said that technology is needed to support the health service, while only 35.71% agreed that their health facilities still have inadequate health technology.Conclusion: The use of health technology in Indonesia is still inadequate. The spread of health technology is not equal in urban and rural areas. The lack of health technology in rural areas, especially for GP, affect in diagnosing and giving therapy to patients. The poor spread of technology in healthcare also make gap between health research and health clinical practice.

Good Governance and Anti-Corruption: Responsibility to Protect Universal Health Care in Indonesia

The establishment of universal health care marks a new momentum for the progressive realization of the right to health in Indonesia. The problem of corruption in health sector endangers the sustainability of effective and quality health care, therefore, Indonesia established an anti-fraud system to protect the universal health insurance fund. This research seeks to analyze the current anti-fraud system in universal health insurance through the lens of international law and principles of good governance. The sociolegal approach is chosen to study the relationship between the State party obligations to international law and the implementation of international law concerning universal health care and anti-corruption in the designated anti-fraud system. Good governance principles are essential in designing an effective anti-fraud system due to the correlation between human rights and anti-corruption that both areas emphasize good governance principles as guiding principles for the realization of human rights and the making of potent anti-corruption strategy.

Narrative Navigation: HIV and (Good) Care in Aceh, Indonesia

In this article, I elaborate the concept of narrative navigation to analyze the subjective and intersubjective ways in which people struggle through experiences of illness by constructing multiple, ambiguous and non-linear narratives that may continuously change, as they reposition themselves within changing circumstances. Drawing on ethnographic material on HIV care in Aceh, Indonesia, I show how subjunctivity and open-endedness are crucial narrative ways in which people living with HIV, their relatives, medical doctors and support group workers adjust to possibilities and limitations of care over time, thereby continuously negotiating what good care may be. Unfolding within a changing Indonesian healthcare system, their narrative navigations reveal caregiving to be a complex and contradictory process, thereby problematizing boundaries between good care and neglect.

On the road to universal health care in Indonesia, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

SummaryBackgroundAs Indonesia moves to provide health coverage for all citizens, understanding patterns of morbidity and mortality is important to allocate resources and address inequality. The Global Burden of Disease 2016 study (GBD 2016) estimates sources of early death and disability, which can inform policies to improve health care.MethodsWe used GBD 2016 results for cause-specific deaths, years of life lost, years lived with disability, disability-adjusted life-years (DALYs), life expectancy at birth, healthy life expectancy, and risk factors for 333 causes in Indonesia and in seven comparator countries. Estimates were produced by location, year, age, and sex using methods outlined in GBD 2016. Using the Socio-demographic Index, we generated expected values for each metric and compared these against observed results.FindingsIn Indonesia between 1990 and 2016, life expectancy increased by 8·0 years (95% uncertainty interval [UI] 7·3–8·8) to 71·7 years (71·0–72·3): the increase was 7·4 years (6·4–8·6) for males and 8·7 years (7·8–9·5) for females. Total DALYs due to communicable, maternal, neonatal, and nutritional causes decreased by 58·6% (95% UI 55·6–61·6), from 43·8 million (95% UI 41·4–46·5) to 18·1 million (16·8–19·6), whereas total DALYs from non-communicable diseases rose. DALYs due to injuries decreased, both in crude rates and in age-standardised rates. The three leading causes of DALYs in 2016 were ischaemic heart disease, cerebrovascular disease, and diabetes. Dietary risks were a leading contributor to the DALY burden, accounting for 13·6% (11·8–15·4) of DALYs in 2016.InterpretationOver the past 27 years, health across many indicators has improved in Indonesia. Improvements are partly offset by rising deaths and a growing burden of non-communicable diseases. To maintain and increase health gains, further work is needed to identify successful interventions and improve health equity.FundingThe Bill & Melinda Gates Foundation.

Brokers and citizenship: access to health care in Indonesia

Faced with unresponsive and intimidating bureaucracies, citizens across particularly the global south regularly rely on intermediaries to gain access to public services. Focusing on how such brokers arrange access to health care in Indonesia, this essay discusses the impact of brokered state–citizen interaction on the character and experience of citizenship. On the basis of extensive fieldwork in both urban and rural Java we argue that brokers not only enable the realization of citizen rights, they also transform the experience and interpretation of these rights. Brokers ‘vernacularize’ citizenship, in the sense that citizenship comes to be experienced and interpreted not just in terms of a formal relationship with a national state, but also in terms of the character of personal relationships and attendant obligations that exist between citizens, brokers and power holders.

Women's choice of maternal healthcare in Parung, West Java, Indonesia: Midwife versus traditional birth attendant

BackgroundIn the 1990s, the Indonesian government launched programmes to train traditional birth attendants (TBAs) and increase the number of midwives. AimTo identify and compare the factors that influence women's choice of a midwife or a TBA for maternal healthcare in Indonesia. MethodsThis study used a descriptive design for comparing women's choice of maternal healthcare. The participants were (1) married women, (2) experienced birth within two years, (3) living in a rural or urban village, and (4) capable of communicating in the Indonesia language. Three instruments were used: (1) traditional belief questionnaire, (2) preference for caregiver questionnaire, and (3) women-centered care (WCC) questionnaire which measured women's perceptions of care that they received during pregnancy. FindingsA total of 371 women participated in this study. All these subjects answered based on their most recent birth within the last two years. Of the 371 women, 207 (55.8%) chose a midwife and 164 (44.2%) chose a TBA for giving birth. Women choosing midwives were generally satisfied and perceived receiving WCC. Factors determining choice were (1) women's background, (2) perception of WCC, (3) satisfaction, (4) choice of antenatal care (ANC), (5) family encouragement, and (6) traditional beliefs. DiscussionThe choice of caregivers was determined by not only education, parity, usual source of healthcare payment, and family encouragement but also traditional beliefs. ConclusionIndonesian women's choice of a midwife instead of a TBA for their maternal healthcare resulted in a higher satisfaction of care and more ANC visits.

Nurses challenging to terminate irrelevant treatment prior to end of life patient

Observations were done since 2008 in hospital, community concluded that end of life patients, and families did not understand how to respond to advance treatment. Besides, there were no similar standard of procedure applied into patients. There were some doctors told the families about patients' conditions and some did not. Moreover, some families understood that patients' condition could not be cured, but in dying process, the physicians suggested to be treated in an intensive care unit. In this situation, the families did not have any choice instead of to follow the physician suggestion. Indonesian's health care system that embrace doctor's domination over decision-making on patient treatment exists, although nurse has their own skills, function and knowledge that need to be incorporated in the treatment plan. On the other hand, nurses do not have initiatives to challenge this system in health care structure. This study refers to a Philosophical Carol Gilligan Theory, and Bakker & Zubair Qualitative Method of Philosophical Research. The results were divided into 2 groups: firstly were the nurses who were mostly women had their limitation to raise up their profession, and secondly, the basic nurses education was insufficient to encounter the doctors.

Multiple Regressions of a Malcolm Baldrige's Patient Safety Models

This research proposed to develop patient safety models in primary health care and provide a possible model to implementated. Primary health care in Indonesia battling in assessment of risk reduction strategy because difficulty in identifying adverse event and there are no model or guidance for patient safety in primary health care yet. The patient safety model can be framed with Baldrige Health Care Criteria for performance excellence. Basic Emergency Obstetric Care was an critical health care in Indonesia for reduce maternal death by early detection of maternal complication. So, this study focus to develop patient safety model in basic emergency obstetric care bases on Baldrige criteria. We conducted a cross sectional study, data collected through a likert scale questionnaire from 194 respondent, there were doctors, nurses, midwifes, pharmacist, and medical report officer from six basic emergency obstetric care. Data analysis by linear regression and multiple regression to determined the most suitable variable to the models. The result shows that incident detection, mitigation, health workers workload and commitment, internal audit are variables for a patient safety model development. It is recommended to futher researcher to developed module for patient safety training in primary health care.

Health System Strengthening: Adopting WHO Building Blocks- Comparison between India and Indonesia

Background: The objective of this review was to review and compare between Indian and Indonesian health systems. It attempted to understand the health system strengthening activities adopted by both the countries. Subjects and Method: This was a systematic review using qualitative method. The internet-based search strategy extended the traditional approach of using biblio­graphic data­bases, journals, citations to include grey literature, abstracts, web­sites, reports and documents from WHO, World Bank, Ministry of Health Indonesia, and Ministry of Health and Family Welfare India. Results: The concept of designating house­hold meeting requisite health standards as a healthy home is something which can be successfully implemented in India as social recognition plays a vital part in encouraging people to move towards healthier lifestyles. India is in the process of upgrading 150,000 Sub Centres into health and wellness centers. Compre­hensive health care will be provided in these centers, including for mother and child health and noninfectious diseases. Essential drugs and diagnostic services will be provided free of cost at these centers. Another notable feature from India is the concept of ASHA which is an acronym and stands for Accredited Social Health Activist. ASHAs are locally selected and trained women who performed the duties of health promoters and educators in communities. The ASHA is trained to work as an intermediary between the public health system and the community. Medical Insurance coverage for Primary Care and the concept of VVIP Rooms at differential pricing is some­thing which can be tried in Indian context while, the latest Government funded medical insurance for Secondary and Tertiary care and Strategic purchase from Private sector is something Indonesia can emulate. For tackling the rural health care problems : schemes like National Rural Health Mission (NRHM) and mandatory service in rural areas by doctors if they want government job can be looked at by Indonesian Health care professionals. The concept of Posyandu (Maternity Hut) and the registered midwife clinics is a unique concept which can be tried in Indian Context. Conclusion: The Indian and Indonesian health care systems have been compared and contrasted. Keywords: health care system, India, Indonesia Correspondence: Shikha Gill. International Institute of Health Management Research, New Delhi, India. Email: shikhaparttapgill@gmail.com Journal of Health Policy and Management (2018), 3(2): 101-107 https://doi.org/10.26911/thejhpm.2018.03.02.06

The Change in Mental Health Status of Indonesian Health Care Migrant Worker in Japan

Under the Japan – Indonesia Economic Partnership Agreement, more than 1,000 of Indonesian health care workers have migrated to Japan. Social adjustment during the process of migration is linked to mental health changes. This study aimed to figure out the strongest predictor that influences the change in mental health status as a result of migration. Baseline data were collected in Jakarta in 2013 during pre-departure orientation. Follow-up study was conducted one year after the study participants migrated to Japan in 2014. Using longitudinal design, this study employed 92 participants consisting of nurse and certified care worker candidates. The multiple linear regression analysis was conducted to figure out the predictors that influence the change in mental health status. The prediction model expected to explain 39.9% of the change in mental health status, p value &lt; 0.01, while sex (b = 0.201, p value &lt; 0.05), economic conditions in pre-migration (b = -0.200, p value &lt; 0.05), and the socio cultural adaptation competency (b = -0.238, p value &lt; 0.05). This finding assumed that female candidates and those who have economic constraint in pre-migration stage, and those who have declining in socio-cultural adaptation competency tend to have lower mental health one year after the migration.

Investigating the impact of the universal healthcare coverage programme on community pharmacy practice.

The introduction of Universal Healthcare Coverage (JKN) in 2014 has changed the landscape of the Indonesian healthcare and affected the community pharmacy sector. This paper investigates perceptions of healthcare and pharmacy stakeholders about the impact of JKN on the practice of pharmacists and pharmacy in both public (Puskesmas) and private (Community or Retail pharmacy) settings. In-depth, semi-structured interviews were conducted from February to August 2016 involving 29 participants representing key stakeholders from different provinces in Indonesia. While JKN was actually designed with good policy objectives for pharmacy integration within primary care network, it has created some unintended and unanticipated distortion in the healthcare system which may be detrimental to the community pharmacy sector. In fact, community pharmacy practice is still limited to dispensing and continued to be hampered by ongoing challenges mainly pharmacists' absence, lack of clinical competence and limited support from regulation changes. It is a missed opportunity for pharmacists to play a greater role in primary care services indicating the need for an overhaul to pharmacy education and policy system.