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Pande Putu Januraga
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INDONESIA
Primary Care Science and Practice (PCSP)
Published by Pusat Unggulan IPTEKS Center for Public Health Innovation (CPHI) Universitas Udayana
ISSN : -     EISSN : 31243835     DOI : https://doi.org/10.66641/pcsp
Core Subject : Health, Social,
Health Professions Social Sciences
Primary Care Science and Practice (PCSP) seeks to publish high-quality research that seek original research, systematic reviews, guidelines, policy briefs, and case studies that offer substantial novelty and global implications. Every submission must explicitly state its original contribution to existing knowledge and demonstrate how the findings advance primary care practices. Our primary areas of interest include Clinical Primary Care & Family Medicine; Public Health & Community Medicine; Health Policy, Systems, & Management; Digital Health & Innovation; Medical Education.
Arjuna Subject : Profesi Kesehatan - Profesi Kesehatan (Lain-Lain)
Articles 5 Documents
 1 
From Integration to Impact: Immediate Policy Actions to Accelerate HIV Control within Indonesia’s Primary Health Care Reform Pande Putu Januraga
Primary Care Science and Practice (PCSP) Vol. 1 No. 1 (2026): January
Publisher : Center of Public Health Innovation (CPHI), Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66641/pcsp.v1i1.6

Abstract

Background: Indonesia has reduced new HIV infections by nearly half since 2010, yet AIDS-related mortality continues to rise. This paradox reflects persistent gaps in early diagnosis, treatment initiation, retention, and strategic targeting, occurring amid Indonesia’s major Primary Health Care (PHC) reform, which involves integrated primary health care or Integrasi Pelayanan Kesehatan Primer (ILP). Evidence: Joint HIV Programme Review (JPR) 2023–2025 data show strong treatment quality once patients are retained (≈95% viral suppression among those tested), but weak cascade performance overall: only ~64% of people living with HIV (PLHIV) know their status, <50% are on antiretroviral therapy (ART), and fewer than one-third are virally suppressed. The epidemic remains concentrated among key populations nationally, while Tanah Papua exhibits a mixed-to-generalized epidemic with severe service access constraints. Policy Options: Options include maintaining vertical optimization, full facility-based integration under ILP, or a hybrid model that integrates services while preserving community-led delivery and differentiated care (preferred option). Recommendations: We propose an immediate, operational package centered on (1) a prevention shift plus retention fix; (2) accelerated ILP integration with explicit safeguards for key populations; (3) rapid ART decentralization with multi-month dispensing (MMD); (4) strategic information integration for decision intelligence; and (5) a differentiated, community-centered strategy for Tanah Papua. Implications: Acting now can bend both incidence and mortality curves, safeguard reform momentum, and align HIV control with Universal Health Coverage (UHC) goals.
Hesitancy on the Front Line: The Barriers among Primary Healthcare Workers in Bali for Immunizing Children in Special Populations Desak Putu Yuli Kurniati; Komang Ayu Kartika Sari; Ketut Dewi Kumara Wati; Ketut Ariawati; I Made Darma Yuda
Primary Care Science and Practice (PCSP) Vol. 1 No. 1 (2026): January
Publisher : Center of Public Health Innovation (CPHI), Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66641/pcsp.v1i1.14

Abstract

Background: Primary healthcare workers are central to national immunization efforts, yet they face significant challenges in caring for children with special health needs. Clinical hesitancy among front-line workers causes missed opportunities for vulnerable children. This study examines perceptual, competency, and systemic barriers faced by primary healthcare workers in Bali in immunizing children in special cases populations, defined as those needing health services beyond routine care due to underlying conditions. Methods: A qualitative case study was conducted in Denpasar City and Badung District, Bali Province (September 2024 - March 2025). Data were collected through in-depth interviews and Focus Group Discussions with 36 stakeholders, following COREQ guidelines. Thematic analysis was performed using NVivo 12 1. Results: The study reveals that vaccine hesitancy among primary care staff is driven by systemic barriers rather than anti-vaccine sentiment. A critical lack of specific Standard Operating Procedures forces staff into a rigid “zero-risk” bias, causing unnecessary delays for minor ailments. To mitigate liability in the absence of legal protection, staff adopt defensive practices, such as refusing action without written authorization from specialists. This bureaucratic hurdle creates a “referral trap” that fragments care and imposes financial burdens on families, thereby exacerbating health inequities. Provider hesitancy reinforces the misconception that vulnerable children are too fragile for vaccination, validating parents’ “never healthy paradigm”. Conclusion: Hesitancy in primary care stems from insufficient legal protection and guidance. To break this cycle, urgent development of "legally protective" SOPs and consultation pathways is needed to empower frontline workers and avoid excluding vulnerable children.
Holistic Management in Pulmonary Tuberculosis Patients Through Family Medicine Approach: A Case Report Ni Putu Dinda Pramesti Sudastra; Mutiara Anastasia Carmenita; I Putu Yudi Pradnyana; Putu Aryani
Primary Care Science and Practice (PCSP) Vol. 1 No. 1 (2026): January
Publisher : Center of Public Health Innovation (CPHI), Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66641/pcsp.v1i1.16

Abstract

Background: Tuberculosis (TB) remains a major health concern globally and in Indonesia, ranking among the leading causes of death from infectious diseases. The government targets TB elimination by 2030 through primary care and family doctor involvement, emphasizing not only treatment but also health promotion, prevention, and psychosocial support. Purpose: To apply evidence-based family medicine principles to a pulmonary TB patient by identifying risk factors, clinical problems, interventions, and monitoring progress using patient-centered and family approaches. Method: A case report using primary data from history taking, physical examination, home visits, and family folder documentation. Three visits were conducted, covering holistic diagnosis, intervention, and outcome evaluation, assessed qualitatively and quantitatively. Results: A 40-year-old female diagnosed with pulmonary TB was in the continuation phase of therapy. Main complaints were chronic cough and weight loss. Internal risks included limited knowledge and anxiety, external risk was family cigarette smoke exposure. Family function was good (APGAR 10). Interventions included education about TB (definition, symptoms, treatment, prevention), family counseling, adherence monitoring, high-calorie high-protein diet advice, and home ventilation improvement. After the interventions, the patient showed positive progress with weight gain (35 kg to 52 kg), good medication adherence, and improved family knowledge. Conclusion: Family medicine approaches effectively support TB therapy by addressing biological, psychological, social, and environmental factors. Continuous family education, monitoring, and behavioral changes enhance treatment success and prevent transmission.
Travel-Health Behaviour and Self Reported Travel-Related Illness Among International Medical Students In A Tropical Destination: A Cross Sectional Survey From Indonesia Made Ayunda Apti Chandra Apsari; Wayan Citra Wulan Sucipta Putri; A.A. Sagung Sawitri; Ni Luh Putu Ariastuti
Primary Care Science and Practice (PCSP) Vol. 1 No. 1 (2026): January
Publisher : Center of Public Health Innovation (CPHI), Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66641/pcsp.v1i1.17

Abstract

Background: International travelers are at risk of travel-related illness (TRI), particularly when visiting tropical and developing regions such as Indonesia. Bali, as a major international destination, presents increased exposure to infectious diseases and environmental health risks. International medical students are especially vulnerable due to prolonged stays and high levels of social interaction. Objective: This study aimed to describe travel-health behaviour and the occurrence of travel-related illness among international medical students in tropical LMICs. Methods: This study employed a descriptive cross-sectional design conducted from January to September 2025, collected using a structured questionnaire administered through in-person and online interviews. A total 60 participants from international medical students, Udayana University using convenience sampling. The study assessed travel-health behaviour : pre-travel preparation, pre-travel advice–seeking behaviour, preventive practices during travel, and travel-health kit utilization. In addition, travel-related illness was evaluated, defined as any self-reported health problems experienced during travel. Results: Most participants showed good pre-travel health preparation (31-58,3%), including professional consultation, and possession of travel-health kits. Preventive practices during travel were generally good (68,3%) but did not consistently increase with higher preparation levels. Despite this, a high proportion of participants experienced travel-related illness (78,3%), mainly gastrointestinal (55%) and respiratory conditions (31,7%). Professional pre-travel advice and good preventive practices were associated with lower illness proportions. Conclusion: Despite high pre-travel preparation, travel-related illness remained common among international medical students, likely influenced by ongoing environmental exposure and situational behaviours during prolonged stays in tropical settings, reducing the effectiveness of pre-departure preparation.
Policy Analysis of Integrated Antenatal Care in Indonesia: An Application of the Policy Triangle Framework Ni Made Diaris
Primary Care Science and Practice (PCSP) Vol. 1 No. 1 (2026): January
Publisher : Center of Public Health Innovation (CPHI), Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66641/pcsp.v1i1.19

Abstract

Background: Integrated Antenatal Care (ANC) is an important public health intervention to reduce maternal and infant mortality rate. In Indonesia, integrated ANC implementation requires a comprehensive policy analysis to identify gaps between policy design and the implementation. Method: This study uses a descriptive analytical narrative review approach using the Policy Triangle Framework. The analysis was conducted on integrated ANC policies using secondary data obtained from national regulations, technical guidelines, monitoring and evaluation reports, and relevant scientific evidence published since 2020. Policy documents and supporting literature were analysed thematically across four domains: actors, content, context, and processes. Results: The findings show that, in terms of policy content, integrated ANC in Indonesia has developed comprehensively, characterized by an increase in the minimum number of visits from four to six (K6) and the integration of 10T service standards. However, significant challenges still remain in the realm of actors, especially the uneven distribution of health workers, workload and the shortage of general practitioners trained in obstetric ultrasound, especially in Papua. From a contextual perspective, geographical barriers and sociocultural factors remain the main determinants of the sharp differences between provinces in K6 coverage, ranging from 4.77% to 95%. Conclusion: Integrated ANC policies have strong content but are hampered by uneven distribution of actors and geographic access. Policy innovations are needed in the form of task shifting, strengthening telemedicine, equitable distribution of doctors and midwives and strengthening family support systems to overcome sociocultural barriers in remote areas and a more comprehensive antenatal class.

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