Stakeholders’ perspectives of factors that enable primary health center accreditation in eastern Indonesia

Abstract

Background: Puskesmas, or primary health center (PHC) accreditation, is a program that was implemented by the Indonesian Ministry of Health to improve the quality and safety of primary healthcare centers. However, there is very little evidence to either support or criticize the effectiveness of accreditation. Most regions in the eastern part of Indonesia have scant resources, and, as such, PHC accreditation is becoming increasingly challenging in these areas. Therefore, a proper strategy is needed for PHC accreditation to be implemented successfully. Aims: This study aims to identify the factors that enable effective PHC accreditation implementation in eastern Indonesia. Settings and Design: Data were collected in Ambon City, the capital of Maluku Province, in September 2019. Methods and Material: In-depth interviews and focus group discussions were administered with directors of PHCs, sub-district mayors, top managers of the City of Ambon’s health department, and other relevant stakeholders. Strategies for implementing PHC accreditation were explored through data collection. The data were analyzed thematically to extract strategies for effective accreditation implementation. Results: Five factors were identified as essential to the effective implementation of PHC accreditation: (1) accreditation is aligned with other regulations; (2) accreditation is well-planned and uses a set of relevant standards; (3) accreditation is supported by the PHC director’s leadership, thus promoting quality health services; (4) the accreditation program is accepted by health professionals; and (5) the accreditation program is supported by other government bodies. Conclusions: Most PHCs in the City of Ambon have successfully implemented accreditation. The accreditation program’s implementation should focus on the five factors revealed by this study to increase the likelihood that accreditation programs will be implemented successfully.