{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:59:42Z","timestamp":1790791182462,"version":"4.1.0"},"reference-count":30,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Ronda Stryker and William Johnston MMSc Fellowship in Global Health Delivery"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>In many low- and middle-income countries, comprehensive, first contact primary health care is fragmented by the delivery of centralized programs focused on specific health conditions. Indonesia\u2019s 2023 primary health care reform restructured community health services to provide integrated rather than condition-specific services, representing one of the broadest primary health care integration efforts in a middle-income country to date. We sought to understand the outcomes, barriers, and facilitators of early implementation of this reform.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a convergent mixed-method study in one of the first areas to implement primary health care reform. We used descriptive statistics to quantify service delivery outcomes from a survey of 14 village health facilities and data extracted from monthly reports from two village health facilities and 11 community health posts. We sought to understand barriers and facilitators to implementation via 24 patient interviews, seven key informant interviews, and four focus group discussions with healthcare providers. We used deductive-inductive qualitative analysis guided by the Consolidated Framework for Implementation Research. Findings were integrated to understand factors that impacted service delivery outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the initial months of implementation, both health facilities and health posts offered integrated services to all patients simultaneously, but neither introduced new screening services (e.g., mental health) immediately. At health facilities, patient visits substantially increased across all age groups, with more modest changes seen at health posts. The convenience of getting services at community health posts increased patient visits, but scheduling incompatibility and a low sense of belonging were barriers to attendance for teenagers and working adults. Insufficient training, staff, and resources posed barriers to introducing new services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>It is possible for a middle-income country to move from condition-specific community health programs toward integrated primary health care. Doing so requires investment in human resources, intersectoral collaboration, and outreach to less engaged segments of the population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13558196261489144","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T12:27:47Z","timestamp":1790598467000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated primary healthcare reform in Indonesia: Lessons learned from early community-level implementation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6655-1396","authenticated-orcid":false,"given":"Marwatunnisa Al","family":"Mubarokah","sequence":"first","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5965-0460","authenticated-orcid":false,"given":"Hannah N.","family":"Gilbert","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3171-5271","authenticated-orcid":false,"given":"Ari","family":"Probandari","sequence":"additional","affiliation":[{"name":"Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Sebelas Maret"},{"name":"Disease Control and Research Group, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0497-6107","authenticated-orcid":false,"given":"Havivi Dwi","family":"Anggraeni","sequence":"additional","affiliation":[{"name":"Independent Researcher"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahayu Seffy","family":"Oktavia","sequence":"additional","affiliation":[{"name":"Independent Researcher"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5219-2599","authenticated-orcid":false,"given":"Courtney M.","family":"Yuen","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"issue":"1","key":"e_1_3_8_2_2","first-page":"e010","article-title":"Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care","volume":"13","author":"Valentijn PP","year":"2013","unstructured":"Valentijn PP, Schepman SM, Opheij W, et al. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care [Internet] 2013; [cited 2025 Jun 24];13(1): e010. Available from. https:\/\/doi.org\/10.5334\/ijic.886","journal-title":"Int J Integr Care [Internet]"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-018-0288-z"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540120802310957"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1096\/fba.2020-00145"},{"key":"e_1_3_8_6_2","volume-title":"Integrating family planning into primary health care in Ghana: a case study","author":"Rowan A","year":"2019","unstructured":"Rowan A, Gesuale S, Husband R, et al. 2019 Integrating family planning into primary health care in Ghana: a case study. 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