Strategies to improve health service quality in Indonesia: a qualitative study

BACKGROUND: Improving the quality of health services remains a significant challenge in Indonesia, particularly due to variations in workforce capacity, uneven adoption of digital health systems, and limited stakeholder engagement. Understanding how these factors influence service quality from the perspectives of key stakeholders is essential to inform effective and sustainable improvement strategies. METHODS: This study employed a qualitative descriptive design across multiple healthcare settings in Indonesia, including primary health centers, clinics, and district hospitals. Data were collected through in-depth, semi-structured interviews with healthcare providers, facility managers, policymakers, and community representatives. Participants were selected purposively based on their involvement in service delivery and quality improvement activities. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. An inductive coding approach was applied to identify recurring patterns and themes. Analytical rigor was enhanced through peer debriefing, source triangulation, and member checking. RESULTS: The analysis identified several interconnected themes influencing health service quality. Workforce capacity emerged as a central challenge, characterized by limited access to continuous training, high workloads, and gaps in clinical and managerial competencies. Digital health implementation varied widely across facilities, with barriers including low digital literacy, poor infrastructure, and limited system integration. Participants also highlighted gaps in policy implementation at the facility level, often related to bureaucratic constraints and insufficient organizational support. Community engagement was generally limited, with few structured mechanisms for capturing and responding to patient feedback. Participants emphasized that effective quality improvement requires coordinated strategies addressing human resources, digital readiness, governance, and community participation. CONCLUSIONS: Health service quality improvement in Indonesia is shaped by complex interactions between workforce capacity, digital health readiness, organizational support, and community engagement. Sustainable improvement requires integrated, context-sensitive strategies that strengthen human resources, support effective use of digital systems, enhance local policy implementation, and promote patient-centered care. These findings provide practical insights for policymakers and health system leaders seeking to strengthen service quality in resource-constrained settings.