2026-11-25 –, Sutherland Room
Primary health care (PHC) quality is fundamental element towards achieving universal health coverage, yet measuring it remains challenging. PHC quality is multidimensional, reflecting both health system and patient perspectives, and influenced by individual and contextual factors. Routinely collected administrative and survey data provide useful insights, however, they are rarely combined with area-level healthcare data to examine PHC quality across geographic locations. This is particularly challenging in low- and middle-income countries (LMICs), where comprehensive assessments and monitoring PHC quality are often limited. Using Indonesia’s highly decentralised healthcare system as a case study, this presentation demonstrates the usefulness of combining routinely collected datasets measured at different levels through multilevel analysis to provide a more comprehensive assessment of PHC quality and to gain potential avenues for improving equitable PHC quality.
We examined two complementary measures of PHC quality: (1) potentially preventable hospitalisations (PPH), representing the health system perspective, and (2) patients’ perceptions of PHC quality, representing the beneficiary perspective. Our study used three data sources: 1) the 2023 National Health Insurance administrative data, 2) the 2023 Indonesian Health Survey, and 3) district/city healthcare characteristics datasets. Multilevel analyses were used to account for the hierarchical structure of the data, with individuals nested within districts/cities, to describe geographic variation in PHC quality and the contributions of healthcare services characteristics to both measures.
Our study showed substantial geographic variation in PPH across districts/cities in Indonesia. Importantly, our findings suggested that caution is required when interpreting PPH as a measure of PHC quality, particularly in settings where unequal access to hospital services, lower estimates may reflect a lack of hospital accessibility rather than better PHC quality. These findings demonstrated the importance of incorporating contextual healthcare characteristics when interpreting measure of PHC quality. Analysis on the patients’ perceptions of PHC quality using survey data and area-level healthcare datasets is currently underway and will complement these findings.
Beyond the Indonesian case study, this work, using various data sources (administrative and survey data) combined with area-level healthcare data using multilevel analysis, provides a practical approach for researchers and policymakers seeking to improve equitable PHC quality in decentralised and resource-constrained healthcare system, where comprehensive quality monitoring system are often lacking.
Dewi Amila Solikha is a Ph.D. candidate at National Centre of Epidemiology and Population Health (NCEPH), Australian National University (ANU), and an Australia Awards awardee. Prior to commencing her Ph.D. study, she has worked for more than ten years as a health policy planner at the Ministry of National Development Planning Indonesia, where she contributed to the national health policy formulation. Her research focuses on measuring geographic variation in PHC quality in Indonesia, with the aim of generating evidence to inform policies that improve equitable access to high quality PHC services across the country. Her several Ph.D. works have been published in Q1 journal, i.e. BMC Health Service Research and BMJ Open.