医疗保健的可及性风雨无阻：印度尼西亚公共初级卫生保健的多因素可及性研究

Lander BoschAndries HeynsZelalem Debebe November 2025 © 2025International Bank for Reconstruction and Development / The World Bank 1818 H Street NWWashington DC 20433Telephone: 202-473-1000Internet: www.worldbank.org ATTRIBUTION Please cite the work as follows: Lander Bosch, A. Heyns, and Z.Debebe. 2025. HealthCareAccess Come Rain or Shine: A Multifactorial Accessibility Study of Public Primary HealthCarein Indonesia. Washington DC: World Bank. This work is a product of the staff of The World Bank with external contributions. Thefindings, interpretations, and conclusions expressed in this work do not necessarily reflectthe views of The World Bank, its Board of Executive Directors, or the governments theyrepresent. The World Bank does not guarantee the accuracy, completeness, or currency of the dataincluded in this work and does not assume responsibility for any errors, omissions, ordiscrepancies in the information, or liability with respect to the use of or failure to use theinformation,methods,processes,or conclusions set forth.The boundaries,colors,denominations, and other information shown on any map in this work do not imply anyjudgment on the part of The World Bank concerning the legal status of any territory or theendorsement or acceptance of such boundaries. Nothing herein shall constitute or be construed or considered to be a limitation upon orwaiver of the privileges and immunities of The World Bank, all of which are specificallyreserved. RIGHTS AND PERMISSIONS The material in this work is subject to copyright. Because The World Bank encouragesdissemination of its knowledge, this work may be reproduced, in whole or in part, fornoncommercial purposes as long as full attribution to this work is given. Any queries on rights and licenses, including subsidiary rights, should be addressed to WorldBank Publications, The World Bank, 1818 H Street NW, Washington DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. Health, Nutrition, and Population Discussion Paper HEALTHCAREACCESS COME RAIN OR SHINE: A MULTIFACTORIALACCESSIBILITY STUDY OF PUBLIC PRIMARY HEALTHCARE IN INDONESIA Lander Bosch1,Andries Heyns2, andZelalem Debebe3 1Economist, East Asia and the Pacific Region,World Bank2Consultant, East Asia and thePacificRegion, World Bank;Geospatial Consultant, Medecinssans Frontieres UK/Ireland3Senior Economist,EastAfrica Region, World Bank Thispaperwasprepared for the World Bank’s Health, Nutrition, and Population GlobalPractice under theAdvisory Services and Analytics (ASA) “Reforms toStrengthenUniversalHealthCoverage in Indonesia” and supported bythe Gates Foundationand the GovernmentofAustralia throughtheAdvance Universal Health Coverage Multi Donor Trust Fund and theJapan Policy and Human Resource Development Fund. ABSTRACT:Geographic disparities in health outcomes persist across Indonesia,fueled inpart byinequities inthephysical accesstoand quality of health services.This note deploysa novel model to assessspatial patterns of accessibility of public primary care in Indonesia.Itfocuseson access to public community health centers, orPuskesmas,integratinglargedatasets on settlement patterns and population density, terrain, land cover, seasonality,road infrastructure and a variety of modes of transportation. Three core findingsemerge: (i)physical inaccessibility and quality gaps in public primary health care pose a double burdenfor vulnerable communities; (ii) accessibility challenges are not limited to remote areas butalso affect pockets of geographic areas across more densely populated islands; and, (iii)accessibility differs not only in space but also in time, with the monsoon season posingadditional challengesformillions of Indonesian patientsin need of care. KEYWORDS:Primary HealthCare, Accessibility, Equity, Indonesia DISCLAIMER:The findings, interpretations, and conclusions expressed in the paper areentirely those of the authors, and do not represent the views of the World Bank, itsExecutiveDirectors, or the countries they represent. CORRESPONDENCE DETAILS:Bosch, Lander, World Bank, 1818 H St., N.W, Washington, DC20433, USA; telephone: 202-458-8707; fax: (202) 522-0050, e-mail:lbosch@worldbank.org;website:www.worldbank.org/hnp Table of Contents Acknowledgments........................................................................................................................vAbbreviations...............................................................................................................................viExecutive Summary.....................................................................................................................vii1.Introduction...................................................................................................................12.Why Understanding Accessibility Is Important............................................................23.Features and Advantages of a Comprehensive Accessibility Methodology..............