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November 2025 © 2025International Bank for Reconstruction and Development / The World Bank 1818 H Street NWWashington DC 20433Telephone: 202-473-1000 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 HealthCare 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 reflect 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 the Nothing herein shall constitute or be construed or considered to be a limitation upon or 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, for 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- 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 Debebe 1Economist, East Asia and the Pacific Region,World Bank2Consultant, East Asia and thePacificRegion, World Bank;Geospatial Consultant, Medecinssans Frontieres UK/Ireland 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 Government 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, 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, itsExecutive 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; Table of Contents Acknowledgments........................................................................................................................v Abbreviations...............................................................................................................................vi Executive Summary.....................................................................................................................vii Model Component 1: Determining Seasonal Access Times.....................................................6Model Component 2: Incorporating Population Demand into the Access Model.............10 Physical Inaccessibility and Quality Gaps in Health Care Pose a Double Burden forRemote Areas..............................................................................................................................16 While densely populated provinces generally do better, accessibility challenges are notlimited to remote and rural provinces.....................................................................................18 7.Policy Implications of the Comprehensive Accessibility Analytics...........................20 References..................................................................................................................................22 Acknowledgments This discussion paper was developed by Lander Bosch (Economist,Health, World Bank),Andries Heyns (Consultant, World Bank), and Zelalem Debebe(Senior Economist, Health,World Bank) as part of the analytical work for the World Bank’s Health, Nutrition,and Moritz Meyer (Senior Economist,Poverty & Equity, West Africa,World Bank,) and KojoNimako (Consultant, World Bank) acted as peer reviewers, while overall guidance wasreceived from Somil Nagpal (Lead Health Specialist,South Asia Region, World Bank) and The team would like to express its gratitude to the staff of the Indonesian Ministry of Health Finally, the team would like to thank the Gates Foundation,the Government ofAustraliathroughtheAdvance Universal Health Coverage Multi Donor Trust Fund and the Japan Policy Abbreviations HNPHealth, Nutrition, and PopulationJKNNational Health Insurance (Jaminan Kesehatan Nasional)km/hkilometers per hour Executiv