The Indonesian Ministry of Health (MoH), with support from the World Health Organization (WHO), is strengthening data on district-level health spending to improve health budgeting, enhance resource allocation and advance universal health coverage. Between October 2024 and February 2025, district health teams from four provinces in Java mapped spending flows from health facilities to district governments as part of Subnational Health Accounts workshops, helping to inform national health financing decisions.
Stronger local-level data is critical to advancing Indonesia’s national health goals and reducing out-of-pocket payments, which still account for nearly one-third of total health spending. High out-of-pocket spending creates financial pressure for households and limits access to essential services. Article 388 of Law No. 17 of 2023 on health mandates the government to strengthen health financing monitoring at national and regional levels.
In Indonesia’s decentralized health system, responsibility for managing health services and budgets is shared across multiple levels of government. This enables regions to adapt services to local needs; however, fragmented data makes it difficult to track how much is spent at district and facility levels, and whether resources are reaching essential services. This limits policy makers’ ability to monitor financing for key health priorities and ensure that public funds are allocated equitably.
Workshop participants in Banten Province. Credit: WHO/Feby Oldfisra
Throughout the workshops, MoH and WHO helped district health teams in West Java, Central Java, East Java and Banten Province use national technical guidelines and a newly developed District Health Accounts (DHA) module to collect, classify and validate financial data from fiscal year 2024. More than 40 districts – represented by health financing officers and puskesmas treasurers – participated, working directly with facility-level records to map funding sources, programme allocations and service delivery costs. Data from these exercises are now being compiled at provincial level to inform national health accounts and budget planning processes.
“This is the first time we’ve seen our health spending so clearly, broken down in this way,” said drg. Rifanda Bachraini Firdaus, Head of the Health Financing Working Team, Provincial Health Office, East Java. “Now we understand what we can improve – and what we need to fight for in next year’s budget.”
While the pilots showed strong district-level engagement, challenges remain in fully institutionalizing DHA data collection and analysis. Several districts struggled with incomplete data – particularly from puskesmas – due to inconsistent reporting systems, limited staff capacity and weak integration of service delivery and financial data. Disaggregating spending by specific services also remains difficult, and many districts still lack the systems, processes and trained personnel to produce DHA data routinely.
“Building strong subnational health accounts is essential for making public health spending more visible, accountable and aligned with Indonesia’s national priorities,” said Professor Roderick Salenga, Team Lead for Health Systems at WHO Indonesia. “This work helps ensure that resources are reaching the communities and services that need them most.”
Indonesia’s work on subnational health accounts directly supports broader reforms under the Health Transformation Agenda and the National Medium-Term Development Plan (RPJMN) 2025–2029. This includes ongoing efforts to improve budget execution, strengthen strategic purchasing and better align financing with priority health programmes at both national and subnational levels.
WHO will continue to work with MoH and partners to expand subnational health accounts implementation, build institutional capacity and strengthen health spending data for more effective and equitable health resource allocation.
Written by Feby Oldfisra, National Professional Officer (Health Financing), WHO Indonesia