Geographic Disparities in Minimum Health Service Standards Implementation across Sub-districts in Kotawaringin Barat Regency, Indonesia
Keywords:
Geographic disparities, health service equity, minimum service standards, public health, rural healthAbstract
Geographic disparities in healthcare service delivery remain a critical challenge in achieving universal health coverage, particularly in rural Indonesian districts. The Minimum Health Service Standards (SPM) framework provides measurable targets for essential health services. This study aimed to analyze geographic disparities in SPM implementation across sub-districts in Kotawaringin Barat Regency, Central Kalimantan, Indonesia. A descriptive analytical study was conducted using secondary data from 94 villages across six sub-districts in Kotawaringin Barat Regency in 2025. Data included 12 SPM health service indicators covering maternal and child health, communicable and non-communicable diseases, and productive age population services. Descriptive analysis examined service target distribution patterns, disparity ratios between urban and rural areas, and service coverage variations. Results of this study was significant geographic disparities were identified across sub-districts. Arut Selatan sub-district, representing urban areas, showed the highest service targets with 381 pregnant women, 13,066 productive age population, and 2,514 hypertension patients in Kelurahan Baru village. In contrast, remote villages like Keraya (Kumai sub-district) recorded minimal targets with only 1 pregnant woman and 90 productive age population. The urban-rural disparity ratio for productive age population services reached 145:1, while hypertension services showed a 251:1 ratio. Non-communicable disease prevalence was concentrated in urban areas, with Arut Selatan accounting for 32% of total hypertension cases and 28% of diabetes mellitus cases. Conclusion of this study was geographic disparities in SPM implementation are substantial, with urban areas showing significantly higher service demands and disease burdens. These findings necessitate differentiated health service strategies, including mobile health services for remote areas and strengthened non-communicable disease programs in urban settings.
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References
Acharya, Y., Yoshino, Y., & Kawakatsu, Y. (2021). Geographic inequalities in maternal healthcare utilization in Nepal: Implications for policy planning. International Journal of Environmental Research and Public Health, 18(13), 7081. https://doi.org/10.3390/ijerph18137081
Ataguba, J. E., Day, C., & McIntyre, D. (2015). Monitoring and evaluating progress towards universal health coverage in South Africa. PLoS Medicine, 12(9), e1001686. https://doi.org/10.1371/journal.pmed.1001686
Fauzi, M. B., Purnama, T. B., & Andarmoyo, S. (2020). Geographic disparity in healthcare access and health outcomes in Indonesia. Asia Pacific Journal of Public Health, 32(4), 171-178. https://doi.org/10.1177/1010539520912192
Gonzalez Block, M. A., Leyva Flores, R., Serván Mori, E., Balandrán, A., & Méndez, E. (2020). Universal health coverage: Assessing service coverage in marginalized populations in Mexico. PLoS ONE, 15(4), e0229876. https://doi.org/10.1371/journal.pone.0229876
Heywood, A. E., & Newall, A. T. (2016). The seasonal influenza vaccination landscape in the Western Pacific Region. Human Vaccines & Immunotherapeutics, 12(8), 2065-2071. https://doi.org/10.1080/21645515.2016.1168954
Ipa, M., Widawati, M., Laksono, A. D., Kusrini, I., & Dhewantara, P. W. (2020). Variation of preventive practices and its association with malaria infection in eastern Indonesia. PLoS ONE, 15(5), e0232909. https://doi.org/10.1371/journal.pone.0232909
Maharani, A., Sujarwoto, Praveen, D., Oceandy, D., Tampubolon, G., & Patel, A. (2019). Cardiovascular disease risk factor prevalence and estimated 10-year cardiovascular risk scores in Indonesia: The SMARThealth Extend study. PLoS ONE, 14(4), e0215219. https://doi.org/10.1371/journal.pone.0215219
Mboi, N., Surbakti, I. M., Trihandini, I., Elyazar, I., Houston, K. A., Bahjuri, A. W., Sofyan, H., Mansyur, M., & Rahardjo, H. (2018). On the road to universal health care in Indonesia, 1990-2016. The Lancet, 392(10147), 581-591. https://doi.org/10.1016/S0140-6736(18)30595-6
Ministry of Health Republic of Indonesia. (2019). Regulation of the Minister of Health of the Republic of Indonesia Number 4 of 2019 concerning Technical Standards for Fulfillment of Basic Health Service Quality in Minimum Service Standards in the Health Sector. Ministry of Health Republic of Indonesia.
Nugraheni, W. P., Utarini, A., & Lazuardi, L. (2021). Barriers and facilitators to the implementation of minimum service standards for health in Indonesia: A systematic review. BMC Health Services Research, 21(1), 1056. https://doi.org/10.1186/s12913-021-07051-8
O’Donnell, O., van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2008). Analyzing health equity using household survey data: A guide to techniques and their implementation. World Bank Publications.
Omran, A. R. (2005). The epidemiologic transition: A theory of the epidemiology of population change. The Milbank Quarterly, 83(4), 731-757. https://doi.org/10.1111/j.1468-0009.2005.00398.x
Quisumbing King, M., Furgeson, J., & Guerrero, N. (2021). Improving access to healthcare in rural and remote areas: A review of telemedicine implementation. Rural and Remote Health, 21(2), 6519. https://doi.org/10.22605/RRH6519
Scheil-Adlung, X. (2015). Global evidence on inequities in rural health protection: New data on rural deficits in health coverage for 174 countries. International Labour Organization.
Sujarwoto, S., Maharani, A., & Tampubolon, G. (2019). Decentralization and access to healthcare: Evidence from Indonesia. Health Policy and Planning, 34(10), 753-762. https://doi.org/10.1093/heapol/czz103
Ulfa, M., Azhar, K., & Mahendradhata, Y. (2022). Urban-rural disparities in diabetes mellitus prevalence and management in Indonesia: Analysis of the 2018 Basic Health Research. BMC Public Health, 22(1), 1456. https://doi.org/10.1186/s12889-022-13842-w
Wahyuni, S., Wilunda, C., Putri, N. K., Suwondo, A., & Astuti, W. D. (2020). Geographic and socioeconomic inequalities in antenatal care utilization in Indonesia. International Journal of Environmental Research and Public Health, 17(23), 8970. https://doi.org/10.3390/ijerph17238970
World Health Organization. (2018). Building the economic case for primary health care: A scoping review. World Health Organization.
