Reconfiguring National Health System Governance for Non-Military Threats: A Threat-Based Integrated Management Framework for Indonesia
https://doi.org/10.33860/bpk.v54i1.4383
Keywords:
Crisis preparedness, Health system governance, Health system resilience, Integrated resilience framework, Workforce sustainabilityAbstract
Background: Emerging public health crises expose structural vulnerabilities within national health systems, particularly in governance coordination, workforce sustainability, supply chain stability, and digital integration. Indonesia’s COVID-19 experience revealed gaps between regulatory design and operational implementation across these domains. Strengthening governance alignment is therefore essential to enhance preparedness for future systemic shocks. Methods: This study employed systematic document analysis and triangulated synthesis of national regulatory instruments, administrative records, and peer-reviewed studies published between 2019 and 2025. Using iterative cross-domain coding, four analytical domains were examined: crisis governance architecture, workforce resilience, strategic supply chain capacity, and digital health integration. Results: Findings indicate regulatory completeness but operational fragmentation. Temporary dual coordination structures during the pandemic reflected governance misalignment between central and subnational authorities. Persistent psychosocial strain among healthcare workers signals risks to long-term workforce sustainability. Structural dependence on imported pharmaceutical inputs and uneven logistics infrastructure exposed supply chain vulnerabilities. Although digital integration initiatives have progressed, subnational analytic capacity remains uneven. Cross-domain synthesis suggests that institutional alignment gaps, rather than policy absence, constitute the primary systemic challenge. Conclusion: Enhancing Indonesia’s health system resilience requires structural integration across governance, workforce protection, supply chain strategy, and digital capacity. The proposed Integrated Resilience Management Framework offers a policy-oriented pathway to improve institutional coherence and preparedness for future public health crises. This study contributes to health policy scholarship by translating cross-domain structural gaps into actionable system reform strategies.
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References
Acharya, A. (2021). ASEAN and regional order: Revisiting security community in Southeast Asia. Routledge. https://www.routledge.com/ASEAN-and-Regional-Order-Revisiting-Security-Community-in-Southeast-Asia/Acharya/p/book/9780367641528
Babar, S. I., & Fatima, S. (2024). Regional Dialogue on Infectious Diseases in South Asia. UW Journal of Social Sciences, 7(1). https://uwjss.org.pk/index.php/ojs3/article/view/136
Indra, M., Nasution, B., Ismandianto, I., & Handoko, T. (2025). Post-Pandemic Governance: Evaluating Emergency Communication Regulatory Policies in Local Government Responses to COVID-19 in Indonesia. International Journal of Sustainable Development & Planning, 20(4). https://doi.org/10.18280/ijsdp.200433
Jafari, M., Nassehi, A., Jafari, J., & Jafari-Oori, M. (2025). Severity and associated factors of moral injury in healthcare workers during the coronavirus pandemic: a comprehensive meta-analysis. Archives of Public Health, 83(1), 37. https://doi.org/10.1186/s13690-025-01518-2
Juanamasta, I. G., Aungsuroch, Y., Gunawan, J., Dino, M. J., & Polsook, R. (2024). Prevalence of burnout and its determinants among Indonesian nurses: a multicentre study. Scientific Reports, 14(1), 31559. https://doi.org/10.1038/s41598-024-63550-6
Kruk, M. E., Myers, M., Varpilah, S. T., & Dahn, B. T. (2015). What is a resilient health system? Lessons from Ebola. The Lancet, 385(9980), 1910–1912. https://doi.org/10.1016/S0140-6736(15)60755-3
Kuik, C.-C. (2022). Hedging via Institutions: ASEAN-led Multilateralism in the Age of the Indo-Pacific. Asian Journal of Peacebuilding, 10(2), 355–386.
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/https://doi.org/10.1016/j.cpr.2009.07.003
Minampati, V. R. R., Mangani, D. Y., Mallik, P., & Kiyala, J. C. K. (2026). Strengthening BRICS in Areas of Internal Security, Public Health, Disaster Management and the Role of Media. Taylor & Francis. https://www.routledge.com/Strengthening-BRICS-in-Areas-of-Internal-Security-Public-Health-Disaster-Management-and-the-Role-of-Media/Minampati-Mangani-Mallik-Kiyala/p/book/9781041219316
Ministry of Health of the Republic of Indonesia. (2019). Regulation of the Minister of Health Number 75 of 2019 concerning Health Crisis Management. Ministry of Health of the Republic of Indonesia. https://peraturan.bpk.go.id
Ministry of Health of the Republic of Indonesia. (2025a). Regulation No. 13 of 2025 on Health Human Resource Management. Ministry of Health of the Republic of Indonesia. https://peraturan.go.id
Ministry of Health of the Republic of Indonesia. (2025b). Regulation of the Minister of Health Number 12 of 2025 concerning the Strategic Plan of the Ministry of Health for 2025–2029. Ministry of Health of the Republic of Indonesia. https://peraturan.bpk.go.id
MoH Indonesia. (2025). Minister of Health Regulation of the Republic of Indonesia Number 12 of 2025 concerning the Ministry of Health Strategic Plan for 2025–2029.
Observer, I. D. (2025). Indonesia needs healthcare workforce planning, aligned with epidemiological and demographic changes. https://observerid.com/indonesia-needs-healthcare-workforce-planning-aligned-with-epidemiological-and-demographic-changes/
Pacific, T. L. R. H. (2023). The end of zero-COVID-19 policy is not the end of COVID-19 for China. The Lancet Regional Health: Western Pacific, 30, 100702.
Pazirandeh, A. (2011). Sourcing in global health supply chains for developing countries: Literature review and a decision making framework. International Journal of Physical Distribution & Logistics Management, 41(4), 364–384. https://doi.org/10.1108/09600031111131931
Rasouli, A., Ketabchi, K. M. H., Saraee, F., & Ahmadi, F. Z. (2020). The importance of strategic planning and management in health: A systematic review. https://jhmi.sums.ac.ir/article_46622.html
Security, U. N. C. on H. (2003). Human Security Now. United Nations. https://www.un.org/humansecurity/reports/
Tadjbakhsh, S., & Chenoy, A. (2007). Human security: Concepts and implications. Routledge.
Weichselgartner, J., & Pigeon, P. (2015). The Role of Knowledge in Disaster Risk Reduction. International Journal of Disaster Risk Science, 6(2), 107–116. https://doi.org/10.1007/s13753-015-0052-7
Wijayanti, S. P. M., Suratman, Rejeki, D. S. S., Aji, B., & Jayanti, R. D. (2025). Adaptation and validation of the Van Rie tuberculosis stigma scale in healthcare workers in Indonesia. Frontiers in Public Health, Volume 13-2025. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1592191
World Bank. (2025). National Health Compacts: Indonesia. https://thedocs.worldbank.org/en/doc/0273f33ab6ee48c5d842108b9b55c789-0140022025/related/National-Health-Compacts-Indonesia.pdf
World Health Organization. (2024). Country cooperation strategy 2023-2027: Indonesia continuity and change. In Country cooperation strategy 2023-2027: Indonesia continuity and change. https://www.who.int/publications/i/item/9789290211181
World Health Organization (WHO) Indonesia. (2024a). Strategic priority 3: Health security preparedness. https://www.who.int/indonesia/activities/strategic-priority-3-health-security-preparedness
World Health Organization (WHO) Indonesia. (2024b). Strengthening health security: International experts assess Indonesia’s International Health Regulation (IHR) core capacities. https://www.who.int/indonesia/news/detail/11-01-2024-strengthening-health-security--international-experts-assess-indonesia-s-international-health-regulation-(ihr)-core-capacities
Youvan, D. C. (2024). The US Pharmaceutical Supply Chain: Risks, Dependencies, and Mitigation Strategies. https://doi.org/10.13140/RG.2.2.19351.38565
