Setting priorities for healthcare interventions in Indonesia: a comprehensive conceptual framework

Health priority setting is a fundamental aspect of public health decision-making in Indonesia, a country characterized by its vast geographic diversity, large population, and evolving healthcare challenges. Given the complex and varied health needs across the country, effective prioritization of healthcare interventions is essential for optimizing resource allocation and improving health outcomes. This study aims to explore the current healthcare priority-setting strategies in Indonesia and identify opportunities to enhance their implementation to support the achievement of universal health coverage (UHC). We conducted a narrative review of relevant literature using the medical databases PubMed and EMBASE, supplemented by a manual review of reference lists and key policy documents. Key findings reveal that the criteria for health intervention prioritization in Indonesia include disease burden, intervention effectiveness, cost, acceptability, and fairness. However, challenges persist in the consistent application of these criteria across Indonesia’s diverse regions, further compounded by disparities in infrastructure, governance, and data availability. In terms of healthcare priority setting, Indonesia combines technical approaches like Health Technology Assessment and Programme Budgeting and Marginal Analysis with value-based methods such as the Delphi Technique and Multi-Criteria Decision Analysis, focusing on equity, fairness, and stakeholder engagement. Limitations in current approaches for healthcare priority setting further complicate the process. Additionally, ethical and social considerations sometimes conflict with economic or technical priorities, underscoring the need for continuous evaluation and adaptation of health priority setting practices. These complexities highlight that while Indonesia has made significant strides, areas for improvement remain to ensure equitable and effective healthcare allocation. Using Indonesia as a reference case, this paper emphasizes the importance of integrating evidence-based priority setting within the framework of UHC to improve healthcare access and equity in Indonesia. This analysis equips stakeholders with the knowledge necessary to navigate Indonesia’s complex healthcare landscape and drive initiatives aimed at achieving better health outcomes and the well-being of its population.