Integrated Primary Care in Indonesia's Private Facilities: A Scoping Review

Abstract

Indonesia's Integrasi Layanan Primer (ILP) reform reorganizes primary care around the life course, prevention, and coordinated service networks. Implementation has concentrated on Puskesmas and their public networks, while private first-level health facilities remain major access points within the National Health Insurance system. Objective to synthesize evidence on ILP implementation and identify components that can be realistically adapted for private primary care facilities in Indonesia. This scoping review followed JBI guidance and PRISMA-ScR reporting. PubMed, ScienceDirect, and Google Scholar were searched using keyword combinations including integrated primary care, Integrasi Layanan Primer, Puskesmas, private primary care, FKTP, and BPJS for empirical studies published in 2021-2026. Journal indexing was cross-checked through SINTA for Indonesian sources. Of 87 records initially identified, fifteen studies met the eligibility criteria and were synthesized using inductive thematic narrative analysis. Five themes emerged: institutional readiness, digital information systems, financing and referral governance, private-sector roles and constraints, and international lessons on integrated care. Readiness was uneven, with recurrent gaps in workforce capacity, infrastructure, data interoperability, and financing. The evidence supports four enabling conditions for private-sector participation: fit-for-purpose clinical pathways, interoperable data exchange, aligned incentives, and facility-level clinical leadership. A networked model, with Puskesmas coordinating territorial public-health functions and private facilities acting as connected clinical nodes, appears more feasible than direct replication of the Puskesmas cluster model. Expanding ILP to private facilities is feasible but should be phased and governed as a partnership rather than treated as a simple policy extension. Clear accountability, referral feedback, financing, data standards, workforce support, and patient-centered continuity are necessary to prevent integration from becoming additional administrative burden without meaningful improvement in care.