From Cooperatives to Health Providers: Implementation Challenges of Indonesia's Red-and-White Village Cooperative Clinics
https://doi.org/10.53770/medica.v8i10.1165
Keywords
Cooperative Health Policy Primary Health Care Regulatory Barriers Village ClinicAbstract
The Red-and-White Village Cooperative (Koperasi Desa Merah Putih, KDMP) is an Indonesian government initiative that mandates village cooperatives to provide primary health services alongside economic activities. More than one year after its launch, however, KDMP clinics have not operated independently, and the reasons remain poorly understood. This study aimed to explore the implementation challenges that prevent KDMP from functioning as a health service provider. A qualitative implementation research design guided by the Consolidated Framework for Implementation Research (CFIR) was used. In-depth interviews were conducted with four purposively selected informants (two cooperative chairpersons, one secretary, and one clinic manager) from two pilot KDMPs in the Special Region of Yogyakarta between January and April 2026. Data were analysed thematically and triangulated with regulatory documents and field notes. Six themes emerged within two domains. Regulatory and policy constraints comprised incomplete technical regulations from the Ministry of Health, restrictions on collaboration beyond community health centres, and limited inter-ministerial coordination. Technical and operational challenges comprised difficulties in recruiting medical personnel, financial constraints combined with a preference for faster-return businesses, and demanding infrastructure and licensing requirements. Together, these barriers formed a “chicken-and-egg” cycle in which regulatory uncertainty deterred investment while detailed regulation awaited evidence of readiness. The stalled implementation of KDMP clinics appears to be driven more by outer-setting and process factors than by internal capacity. Transitional regulations, legally protected pilot mechanisms, and flexible collaboration schemes are needed for KDMP to become a partner within Indonesia’s primary healthcare system.
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