<![CDATA[Introduction: Islamic boarding schools (IBS) in the Special Region of Yogyakarta continue to show gaps between daily practice and the national guidelines for Islamic Boarding School Health Posts (Pos Kesehatan Pesantren; Poskestren) and Clean and Healthy Living Behaviour (CHLB). This study assessed institutional compliance with the national guidelines and developed an advocacy agenda based on the observed implementation gaps.Methods: A cross-sectional study was conducted in eleven IBS across all five districts and the municipality of Yogyakarta. The assessment instrument was derived from Regulation of the Minister of Health No. 1 of 2013 on Poskestren implementation and development. It covered five domains: human resources, facilities and infrastructure, service processes, financing and health insurance, and partnerships. Each indicator was scored as fulfilled (1) or not fulfilled (0). Domain scores were calculated as the mean of the relevant indicators, and the Poskestren Index was calculated as the mean of the five domain scores for each IBS. Findings were summarized using unweighted proportions and student-weighted coverage.Results: The eleven participating IBS served 4,890 students. Facilities and infrastructure had the highest mean compliance score (81.8%), followed by human resources (69.7%) and financing and health insurance (68.2%). Service processes and partnerships each scored 63.6%. Nine IBS had an operational Poskestren, seven conducted periodic health checks, and five had active student health cadres. In the student-weighted analysis, periodic health checks reached 85.1% of students. Two IBS fulfilled all criteria, whereas three recorded the lowest Poskestren Index scores because they lacked student health cadres, had limited educational materials, and delivered services inconsistently.Conclusion: The availability of facilities did not consistently translate into well-functioning service processes. Strengthening student health cadres, establishing scheduled supervision by primary health centers (PHCs), and formalizing partnerships are necessary to embed CHLB as a sustained practice. More consistent service processes, stronger organizational arrangements, and sustained financing for promotive and preventive activities are required to close the implementation gap. The Poskestren Index provides a measurable baseline for advocacy and periodic monitoring of health services in IBS]]>
