Strengthening Palliative Care Systems in Indonesia: A Strategic Policy Brief to Address Health System Gaps
Keywords:
Cancer, Health System, Healthcare Cost, Indonesia, Palliative Care, Policy Brief, Service AccessibilityAbstract
Background: Cancer is one of the most burdensome diseases in Indonesia, ranking as the second-highest cost contributor in the National Health Insurance (Jaminan Kesehatan Nasional) scheme, with expenditures reaching 3.2 trillion rupiahs (approximately 221 million USD). Palliative care is an essential component of cancer management, aimed at alleviating physical, emotional, and psychosocial suffering. However, access to palliative care in Indonesia is extremely limited, with services available in only seven hospitals across three major islands, leaving most regions underserved.
Objective: This policy brief aimed to analyze existing challenges and propose strategic policy recommendations for strengthening palliative care services to address healthcare system pressures in Indonesia, particularly related to cancer.
Methods: A narrative policy analysis was conducted using secondary data from national healthcare reports, cost analyses, and peer-reviewed literature on palliative care effectiveness. The review assessed service coverage, accessibility, financial burden, and policy frameworks to identify key gaps and opportunities.
Results: The analysis highlighted critical disparities in access to palliative care across Indonesia’s geographically dispersed regions. Despite evidence supporting the cost-saving and quality-of-life benefits of palliative services, implementation remains centralized and fragmented. Lack of national integration, workforce capacity, and public awareness were identified as major barriers.
Conclusion: Developing an integrated, nationwide palliative care strategy is urgently needed to mitigate healthcare costs and improve quality of life for patients with cancer and other life-limiting illnesses. Policy efforts should focus on decentralizing services, expanding training for health professionals, and incorporating palliative care into primary healthcare systems.
References
1. World Health Organization. World Health Organization (WHO) 2020. 2020. Cancer country profiles 2020: Indonesia.
2. Witjaksono MA, Sutandiyo N, Suardi D. Regional support for palliative care in Indonesia. EHospice. 2014.
3. The Ministry of Health of Republic of Indonesia. The Report of National Health Research 2018. 2018.
4. The Ministry of Health of Republic of Indonesia. Indonesia TMoHoRo. 2021. Health Statistics: Profil Kesehatan Indonesia Tahun 2020.
5. Rosenberg K. Palliative Care Improves Quality of Life, Reduces Symptoms. AJN The American Journal of Nursing. 2017;117(4):66.
6. World Health Organization. Geneva. 2002. National cancer control programmes : policies and managerial guidelines. – 2nd ed.
7. The World Bank. Hospital beds (per 1,000 people). 2017.
8. The Ministry of Health of Republic of Indonesia. Distribution of health human resources in hospitals. 2018.
9. Effendy C, Agustina HR, Kristanti MS, Engels Y. The nascent palliative care landscape of Indonesia. European Journal of Palliative Care. 2015;22(2):98–101.
10. Indonesian Central Bureau of Statistics. Indonesia Demographic and Health Survey 2016. 2017.
11. Putranto R, Mudjaddid E, Shatri H, Adli M, Martina D. Development and challenges of palliative care in Indonesia: role of psychosomatic medicine. Biopsychosoc Med. 2017;11:1–5.
12. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S. Early palliative care for patients with metastatic lung cancer: Evidence for and barriers against. N Engl J Med. 2010;42–733.
13. Zimmermann C, Swami N, Krzyzanowska M, Leighl N, Rydall A. Palliative care: Renaming as supportive care and integration into comprehensive cancer care. CMAJ. 2016;77–217.
14. Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, et al. Increased satisfaction with care and lower costs: results of a randomized trial of in‐home palliative care. J Am Geriatr Soc. 2007;55(7):993–1000.
15. Edwar P, Soemantri R, Suyoso S, Budiyono D, Handayani P, Mudiharti. Mimbar RSUD Dr. Soetomo: 25 Tahun Pelayanan Perawatan Paliatif di Indonesia 1992-2017. editor Surabaya. 2017;2–9.
16. The Ministry of Health of Republic of Indonesia. Jakarta. 2015. p. 60 National Guidelines for Cancer Palliative Care Service.
17. The Ministry of Health of Republic of Indonesia. Jakarta. 2016. Formularium Nasional.
18. Kemenkes. RI. Stimulasi, Deteksi dan Intervensi Dini Tumbuh Kembang Anak. 2016.
19. Effendy C, Yodang Y. Establishing Palliative Nursing Organization to Foster Palliative Care Literacy and Services in Indonesia: An Embedded Mixed Methods Study. Journal of Health Literacy. 2024;9(1):22–37.
20. Kosen S. Coverage and implementation of healthcare delivery for cancer under national health insurance, experience of Indonesia. The Lancet Regional Health-Southeast Asia. 2022;6.
21. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine. 2010;363(8):733–42.
22. Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741–9.
23. Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A, Spragens L, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–90.
24. Smith S, Brick A, O’Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliat Med. 2014;28(2):130–50.
25. Afiyah RK. Dukungan keluarga mempengaruhi kemampuan adaptasi (penerapan model adaptasi roy) pada pasien kanker di yayasan kanker indonesia cabang jawa timur. Journal of Health Sciences. 2017;10(1).
26. Kemenkes. LAPORAN TAHUNAN. 2022.
27. Tampubolon NR, Fatimah WD, Hidayati AUN. Hambatan-hambatan implementasi perawatan paliatif di Indonesia: Systematic review. Jurnal Kesehatan. 2021;14(1):1–10.
28. Uligraff DK, Sitorus TO. Home-based Pediatric Palliative Care: A Narrative Review. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2022 Oct 31;8(4).
