Abstract
Background: The high number of COVID-19 cases in Indonesia, with 6,811,201 people affected and 161,844 deaths up to June 2023, was influenced by regional governments' varying approaches to disease control. This study aimed to analyze regional government preparedness in response to the COVID-19 pandemic and the factors that influenced their preparedness.
Methods: We conducted a qualitative research study using purposive sampling. We collected data from September 2023 to April 2024 via semi-structured interviews with staff at health and disaster agencies in Bali and West Java. The interview guide was developed using the Six Building Blocks of World Health Organization (WHO)’s Health Systems Framework and Practical Actions in Cities to Strengthen Preparedness. We validated and analyzed data using content analysis.
Results: When assessing regional government preparedness, we identified the following themes: leadership and policy; cross-sector collaboration; communication and coordination; human resources; supplies; information management; budget adequacy; funds availability; facilities and infrastructure availability. Almost all informants said that cross-sector collaboration and coordination between regional and central government influenced pandemic preparedness.
Conclusion: Initial challenges in the handling of the pandemic health crises included supply shortages and limited resources. However, with central support, regional governments prioritized cross-sector collaboration and secured budgets to manage effectively. The COVID-19 pandemic enhanced Indonesia’s health governance, shifting from reactive to proactive planning and strengthening national-regional cooperation. This experience bolstered the resilience and readiness of Indonesia's health system for future challenges.
Keywords: Preparedness, Pandemic, COVID-19, Regional Government, Indonesia
Recommended Citation
Sitepu E, Ayuningtyas D, Junadi P, Satibi S.
Regional Government Preparedness in Response to the COVID-19 Pandemic in Indonesia.
J Health Res.
2025;
39(1):-.
DOI: https://doi.org/10.56808/2586-940X.1126
References
[1] Ministry of Health of the Republic of Indonesia. Concerning Guidelines for the Prevention and Control of Coronavirus Disease 2019. Jakarta: Ministry of Health of the Republic of Indonesia; 2020.
[2] World Health Organization [WHO]. IHR Emergency Committee on Novel Coronavirus (2019-nCoV). Geneva: WHO; 2020.
[3] President of the Republic of Indonesia. Concerning Determination of Coronavirus Disease 2019 Public Health Emergency (COVID-19). Jakarta: Presiden of the Republic of Indonesia; 2020.
[4] Huang X, Yu D. Assessment of Regional Health Resource Carrying Capacity and Security in Public Health Emergencies Based on the COVID-19 Outbreak. Int J Environ Res Public Health. 2023 Jan 23;20(3):2068. doi: 10.3390/ijerph20032068.
[5] Johns Hopkins University and Medicine. COVID-19 MAP: Baltimore: John Hopkins University and Medicine; 2023 [cited 2024 Jul]. Available from: https://coronavirus.jhu.edu/map.html.
[6] Kata Data Media Network. Indonesia's total COVID-19 deaths are 2nd in ASIA. Jakarta: Kata Data Media Network; 2023. [cited 2024 Jul]. Available from: https://databoks.katadata.co.id/datapublish/2023/08/14/total-kematian-covid-19-indonesia-urutan-ke-2-di-asia
[7] Ministry of Health of the Republic of Indonesia. Phase 8 COVID-19 Intra Action Review Monitoring Report. Jakarta: Ministry of Health of the Republic of Indonesia; 2023.
[8] Kurhayadi. Policy Analysis of The Government of the Republic of Indonesia in Facing the COVID-19 Pandemic. AKSELERASI: Jurnal Ilmiah Nasional. 2021; 3(3): 93-102. https://doi.org/10.54783/jin.v3i3.617.
[9] President of the Republic of Indonesia. Law Number 23 Year 2014 on Regional Government. Jakarta: President of the Republic of Indonesia; 2014.
[10] National Development Planning Agency (Bappenas). White Book on National Health System Reform. Jakarta, Indonesia: National Development Planning Agency; 2022.
[11] Khan Y, O'Sullivan T, Brown A, Tracey S, Gibson J, Généreux M, et al. Public health emergency preparedness: a framework to promote resilience. BMC Public Health. 2018 Dec 5;18(1):1344. doi: 10.1186/s12889-018-6250-7.
[12] Kluge H, Martín-Moreno JM, Emiroglu N, Rodier G, Kelley E, Vujnovic M, et al. Strengthening global health security by embedding the International Health Regulations requirements into national health systems. BMJ Glob Health. 2018 Jan 20;3(Suppl 1):e000656. doi: 10.1136/bmjgh-2017-000656.
[13] Nuzzo JB, Meyer D, Snyder M, Ravi SJ, Lapascu A, Souleles J, et al. What makes health systems resilient against infectious disease outbreaks and natural hazards? Results from a scoping review. BMC Public Health. 2019 Oct 17;19(1):1310. doi: 10.1186/s12889-019-7707-z.
[14] Hossain A, Akter S, Rashid AA, Khair S, Alam ASMRU. Unique mutations in SARS-CoV-2 Omicron subvariants' non-spike proteins: Potential impacts on viral pathogenesis and host immune evasion. Microb Pathog. 2022 Sep; 170:105699. doi: 10.1016/j.micpath.2022.105699.
[15] Meyer D, Bishai D, Ravi SJ, Rashid H, Mahmood SS, Toner E, et al. A checklist to improve health system resilience to infectious disease outbreaks and natural hazards. BMJ Glob Health. 2020 Aug;5(8):e002429. doi: 10.1136/bmjgh-2020-002429.
[16] Harvard Global Health Institute. Global monitoring of disease outbreak preparedness: preventing the next pandemic. Cambridge, MA: Harvard University; 2018.
[17] McDarby G, Reynolds L, Zibwowa Z, Syed S, Kelley E, Saikat S. The global pool of simulation exercise materials in health emergency preparedness and response: a scoping review with a health system perspective. BMJ Glob Health. 2019 Jul 29;4(4):e001687. doi: 10.1136/bmjgh-2019-001687.
[18] Mounier-Jack S, Griffiths UK, Closser S, Burchett H, Marchal B. Measuring the health systems impact of disease control programmes: a critical reflection on the WHO building blocks framework. BMC Public Health. 2014 Mar 25;14:278. doi: 10.1186/1471-2458-14-278.
[19] World Health Organization [WHO]. Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. Geneva : WHO; 2010.
[20] Manyazewal T. Using the World Health Organization health system building blocks through survey of healthcare professionals to determine the performance of public healthcare facilities. Arch Public Health. 2017 Aug 31;75:50. doi: 10.1186/s13690-017-0221-9.
[21] Abagero A, Ragazzoni L, Hubloue I, Barone-Adesi F, Lamine H, Addissie A, et al. A Review of COVID-19 Response Challenges in Ethiopia. Int J Environ Res Public Health. 2022 Sep 4;19(17):11070. doi: 10.3390/ijerph191711070. PMID: 36078785; PMCID: PMC9518440.
[22] World Health Organization [WHO]. Covid-19 Strategic Preparedness and Response Plan Operational Planning Guidelines to Support Country Preparedness and Response. Geneva : WHO; 2020.
[23] World Health Organization [WHO]. Novel Coronavirus (2019-nCoV): Strategic Preparedness and Response Plan. Geneva : WHO; 2020.
[24] President of the Republic of Indonesia. Presidential Regulation No. 82/2020 on the Committee for Handling CORONA VIRUS DISEASE 2019 (COVID-19) and National Economic Recovery. Jakarta: President of the Republic of Indonesia; 2020.
[25] Foroughi Z, Ebrahimi P, Aryankhesal A, Maleki M, Yazdani S. Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis. BMC Public Health. 2022 Feb 12;22(1):287. doi: 10.1186/s12889-022-12496-3.
[26] Saulnier DD, Blanchet K, Canila C, Cobos Muñoz D, Dal Zennaro L, de Savigny D, et al. A health systems resilience research agenda: moving from concept to practice. BMJ Glob Health. 2021 Aug;6(8):e006779. doi: 10.1136/bmjgh-2021-006779.
[27] Haldane V, De Foo C, Abdalla SM, Jung AS, Tan M, Wu S, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med. 2021 Jun;27(6):964-980. doi: 10.1038/s41591-021-01381-y.
[28] World Health Organization [WHO]. Strengthening health-system emergency preparedness: toolkit for assessing health-system capacity for crisis management. Regional Office for Europe. Geneva: WHO; 2012.
[29] World Health Organization [WHO]. Practical actions in cities to strengthen preparedness for the COVID-19 pandemic and beyond an interim checklist for local authorities. Geneva: WHO; 2020.
[30] Zhang XX, Jin YZ, Lu YH, Huang LL, Wu CX, Lv S, et al. Infectious disease control: from health security strengthening to health systems improvement at global level. Glob Health Res Policy. 2023 Sep 5;8(1):38. doi: 10.1186/s41256-023-00319-w.
[31] Zhao L, Jin Y, Zhou L, Yang P, Qian Y, Huang X, et al. Evaluation of health system resilience in 60 countries based on their responses to COVID-19. Front Public Health. 2023 Jan 9;10:1081068. doi: 10.3389/fpubh.2022.1081068.
[32] Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Apr;7(4):e15-e16. doi: 10.1016/S2215-0366(20)30078-X.
[33] Hanefeld J, Mayhew S, Legido-Quigley H, Martineau F, Karanikolos M, Blanchet K, et al. Towards an understanding of resilience: responding to health systems shocks. Health Policy Plan. 2018 Apr 1;33(3):355-367. doi: 10.1093/heapol/czx183.
[34] Aruru M, Truong HA, Clark S. Pharmacy Emergency Preparedness and Response (PEPR): a proposed framework for expanding pharmacy professionals' roles and contributions to emergency preparedness and response during the COVID-19 pandemic and beyond. Res Social Adm Pharm. 2021 Jan;17(1):1967-1977. doi: 10.1016/j.sapharm.2020.04.002.
[35] Henry LA. Navigating Disruptive Times: How Cross-Sector Partnerships in a Development Context Built Resilience During the COVID-19 Pandemic Outbreak. Business & Society. 2023;63(4):745-73. https://doi.org/10.1177/00076503231169.
[36] Cohen J. COVID-19 Capitalism: The Profit Motive versus Public Health. Public Health Ethics. 2020 Sep 20:phaa025. doi: 10.1093/phe/phaa025.
[37] Pettus K, Cleary JF, de Lima L, Ahmed E, Radbruch L. Availability of Internationally Controlled Essential Medicines in the COVID-19 Pandemic. J Pain Symptom Manage. 2020 Aug;60(2):e48-e51. doi: 10.1016/j.jpainsymman.2020.04.153.
[38] Cameron EE, Bushell MA. Analysis of drug shortages across two countries during pre-pandemic and pandemic times. Res Social Adm Pharm. 2021 Sep;17(9):1570-1573. doi: 10.1016/j.sapharm.2020.12.001.
[39] Cohen J, Rodgers YvdM. Contributing factors to personal protective equipment shortages during the COVID-19 pandemic. Preventive Medicine. 2020; 141: 106263. https://doi.org/10.1016/j.ypmed.2020.106263
[40] Maani N, Galea S. COVID-19 and Underinvestment in the Public Health Infrastructure of the United States. Milbank Q. 2020 Jun;98(2):250-259. doi: 10.1111/1468-0009.12463.
[41] Singh A, Deedwania PKV, Chowdhury AR, Khanna P. Is India's healthcare infrastructure sufficient for handling the COVID-19 pandemic? International Archives of Public Health and Community Medicine. 2020;4(2):1-4. https://doi.org/10.23937/2643-4512/1710041