Understanding Health Information Systems Utilisation across Public Health Centres in Indonesia: A Cross Sectional Study (Preprint)
Authors: Aisyah Dewi Nur , Setiawan Agus Heri , Mayadewi Chyntia Aryanti , Lokopessy Alfiano Fawwaz , Kozlakidis Zisis , Manikam Logan 
Published: November 2024

BACKGROUND

The primary healthcare service in Indonesia consists of 10,260 Public Health Centres (Puskesmas), which play a major role in providing health care in the community, recording and reporting health data, using digital Health Information Systems (HIS) and/or manual reports. The utilisation of HIS across Puskesmas is crucial to capture the dynamic evolution of health problems and monitor interventions, thus providing effective primary healthcare services for the community.

OBJECTIVE

This paper provides a comprehensive overview of HIS utilisation in Indonesian Puskesmas. It evaluates the number of HIS used, factors influencing the HIS implementation, and challenges faced by health care personnel at primary care services in the country.

METHODS

A cross-sectional survey was carried out covering all Puskesmas across 34 Indonesian provinces between January and February 2022. The questionnaire covered a list of health information systems used by Puskesmas, who developed the HIS, the utilisation and challenges during HIS implementation. The data were analysed and presented in a descriptive format.

RESULTS

A total of 2,606 (25·5%) Public Health Centres across 34 provinces participated in this study. This research shows that, on average, there are 30 different HIS used by Puskesmas for data reporting. The numbers of HIS used varies between provinces, ranging from 13 to 54. Most of the HIS (72·94%) utilised by Public Health Centres in Indonesia are provided by the National Government. It is found that HIS is already aligned with Puskesmas’ needs (91·54%) and the data is utilised for decision-making (90%). However, 49% of HIS has too many data input variables, 33% of the systems experience frequent downtime, 21% of HIS are not user-friendly, and 29% of HIS cannot generate automated data analysis. In terms of the infrastructure supporting HIS implementation, 9·45% of Puskesmas has no access to the internet, while only 31% have access to robust and efficient internet connections. As for the human resources, the study reveals that each health personnel manages up to six different HIS for data reporting tasks, 74.30% of Puskesmas only received training at the initial system's implementation stage, and 80.51% of respondents report the existence of an informal knowledge transfer process among the staff.

CONCLUSIONS

Health information systems are crucial for policy-making at all levels of the healthcare system. To optimise their implementation, as demonstrated by this study on public, primary healthcare centres of Indonesia, efficient management at the grass-roots level, supported by competent, trained human resources and infrastructure, is essential. Simplified and integrated HIS can ease data recording pressures for healthcare workers, enabling better clinical decisions and program development. Addressing these factors can improve the overall healthcare system's effectiveness and benefit the community.