Revitalization of Community Health Centers

The revitalization of Community Health Centers (CHCs) (Puskesmas) in Bali through transformation into Regional Public Service Agencies (BLUD) demands increased independence, efficiency, and accountability. This study aims to examine the influence of goal alignment, goal commitment, employee engagement, and information technology (IT) strategy on Community Health Center performance using the sustainability balanced scorecard (SBSC) framework. The novelty of this study lies in the integration of the local wisdom of Tri Hita Karana Culture (THK)—specifically the harmony of humans with God, others, and nature—as a moderating variable that aligns the managerial dimension with the philosophy of sustainability. This study was conducted at 120 Community Health Centers in Bali, involving 384 leaders/employees and 384 patients as respondents. Data was analyzed using the structural equation modeling–partial least squares method. The results showed that goal alignment, commitment, employee engagement, and IT strategy had a positive and significant effect on Community Health Center performance. Meanwhile, THK Culture was proven to strengthen the influence of employee engagement on performance improvement. Theoretically, this study contributes to the public sector literature by developing a hybrid SBSC model that integrates Goal Setting Theory with local cultural values. Practically, this research provides a framework for policymakers to operationalize cultural values into measurable administrative performance metrics to improve the quality of primary healthcare services following the BLUD reform.