Abstract
Non-communicable diseases (NCDs) represent a rapidly escalating public health challenge in Indonesia, accounting for over 70% of all mortality nationwide. Primary healthcare facilities (Puskesmas) serve as the frontline for NCD screening, diagnosis, and long-term management, yet structural inequities in resource distribution threaten health system efficiency and universal health coverage goals. This study evaluated disparities in health resource allocation for NCD management between rural and urban primary care facilities across Indonesia using data from a national cross-sectional facility survey encompassing 1,420 Puskesmas across 34 provinces. Readiness was evaluated using a standardized World Health Organization Service Availability and Readiness Assessment (SARA) index adapted for NCD management, encompassing essential NCD medications, diagnostic technologies, trained human resources, and health information infrastructure. Urban Puskesmas demonstrated significantly higher overall NCD readiness scores compared to rural counterparts (78.4% vs 51.2%, p < 0.001). Major rural-urban gaps were observed in the availability of essential antihypertensive and antidiabetic pharmaceutical stocks (84.1% urban vs 46.5% rural) and basic diagnostic devices like point-of-care HbA1c analyzers and electrocardiograms. Logistic regression revealed that rural location (OR = 0.31, 95% CI: 0.24-0.41) and location in Eastern Indonesia (OR = 0.22, 95% CI: 0.16-0.30) were strong negative predictors of facility NCD operational readiness. These persistent spatial inequities underscore the urgent imperative for decentralized health resource redistribution policies, targeted supply chain interventions, and incentive structures for healthcare workforce retention in rural Indonesian primary care settings.
