<![CDATA[The leadership style of community health center (Puskesmas) heads is a determinant of health workers' performance, motivation, and job satisfaction at the primary care level, yet published Indonesian evidence reports inconsistent findings and no systematic synthesis has specifically addressed the classic autocratic-democratic-Laissez-Faire trichotomy in this setting. This study aimed to describe the pattern of leadership styles among Puskesmas heads in Indonesia. A systematic review was conducted following the PRISMA 2020 guideline with an a priori protocol. Google Scholar was searched using eight structured queries covering publications from 2016 to 2026, and study selection followed the four PRISMA stages. Methodological quality was appraised with the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies. Four pre-specified rules governed the determination of the dominant style, particularly for studies testing several styles simultaneously. Of 85 records identified, 10 studies met the eligibility criteria. A democratic style was dominant in three studies, an autocratic style in two, and a Laissez-Faire style in two, while three studies reported multiple significant styles or measured leadership as a single construct and therefore could not be classified into a single category. Methodological quality was moderate across studies, with consistent weaknesses in identifying and handling confounders. Leadership style at the Puskesmas level in Indonesia is heterogeneous and cannot be reduced to a single dominant type, so leadership development for Puskesmas heads should emphasise adaptability to local organisational context rather than the promotion of one prescribed style.]]>
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