The impact of health system responsiveness on tuberculosis treatment adherence in public primary healthcare facilities in Indonesia

<h2>Abstract</h2><h3>Background</h3> Tuberculosis (TB) has reemerged as the leading cause of mortality from a single infectious agent globally. Adherence to treatment is essential for patient recovery, controlling infection transmission, and reducing the emergence of drug resistance. This research aimed to investigate the influence of health system responsiveness on tuberculosis treatment adherence among patients in public primary care in Indonesia. <h3>Methods</h3> This is a cross-sectional quantitative research conducted in 25 government-operated primary healthcare facilities. In addition, 491 people with TB receiving treatment at public primary care facilities were selected as respondents. Independent variables included health system responsiveness consisting of eight domains such as attention, dignity, communication, autonomy, confidentiality, quality of basic amenities, social support, and access to healthcare. The Morisky Medication Adherence Scale (MMAS-8) was used to measure tuberculosis medication adherence as a dependent variable. The data was analyzed using SPSS version 27.0, and an ordinall logistic regression was used to examine the responsiveness of healthcare to tuberculosis medication adherence. <h3>Results</h3> Over 95% of respondents reported that the health system exhibits strong responsiveness in the domains of attention, dignity, and communication. The autonomy and quality of basic amenities received the lowest responsiveness score. The results showed that patients who reported having experienced good prompt attention and autonomy were approximately two times as likely to have higher medication adherence (AOR: 2.7 and 2.1, respectively). <h3>Conclusion</h3> Non-medical dimensions, particularly those related to attention, autonomy, and physical quality, should be considered and improved in order to increase medication adherence among people with TB.