Covered but Not Reached: Unraveling Healthcare Access Barriers Among Students in Islamic Boarding Schools in East Java, Indonesia

Islamic boarding schools (pesantren) accommodate millions of adolescents in Indonesia, yet evidence on barriers to healthcare access among students (santri) remains limited. This study explored barriers to healthcare access experienced by santri in Islamic boarding schools in East Java to inform more responsive health policies. An exploratory qualitative study was conducted at six Islamic boarding schools in East Java. Data were collected through in-depth, semi-structured interviews with 42 participants, including santri, boarding school administrators, and healthcare personnel, selected through purposive sampling. We transcribed interviews verbatim and analyzed them using Braun and Clarke's thematic analysis. Credibility was enhanced through source triangulation, member checking, and investigator discussions. Healthcare access barriers were multidimensional, involving financial, geographical, administrative, institutional, and sociocultural factors. Six major themes emerged: financial constraints, transportation and distance barriers, administrative obstacles to National Health Insurance (JKN), restrictive boarding school regulations, limited health literacy, and inadequate health facilities within boarding schools. Institutional rules, dependence on administrators for permission and transportation, and suboptimal implementation of Pos Kesehatan Pesantren (Poskestren) frequently delayed healthcare utilization. Improving healthcare access for santri requires integrated policies that strengthen Poskestren, enhance collaboration between pesantren and Puskesmas, simplify JKN and referral procedures for students living away from their registered facilities, and improve health literacy among santri and boarding school administrators. These coordinated efforts are essential to reduce financial, administrative, institutional, and sociocultural barriers and promote more timely and equitable healthcare utilization among students in Islamic boarding schools.