Auditing Regional Health Governance Readiness For SDGs Achievement: Evidence From Central Java And North Sulawesi, Indonesia

Abstract

The achievement of the Sustainable Development Goals (SDGs), particularly SDG 3 on good health and well-being, is crucially determined by the capacity of health governance at the regional level. In the context of health decentralization in Indonesia, provincial and district/city governments play a strategic role in ensuring the quality of health services, program planning, resource allocation, provision of health workers, and the use of data for decision-making. Despite a strong national commitment to achieving the SDGs, the reality on the ground shows that regional disparities persist, both in terms of health indicator performance and governance quality. The 2023/2024 Indonesian Nutrition Status Survey (SSGI) showed that stunting prevalence, maternal and child health status, and basic immunization coverage still vary across regions, illustrating differences in governance readiness between provinces. Central Java and North Sulawesi are two regions with distinct geographic, demographic, and health burden characteristics, yet both face similar governance challenges. Central Java, as a large province, faces challenges related to health data integration, distribution of health workers across regions, and consistency in program planning across various levels of government. North Sulawesi, on the other hand, faces geographical challenges in the form of an archipelago, limited primary healthcare facilities in remote areas, and suboptimal data utilization. These differences make the two provinces relevant subjects for comparative studies to assess health governance readiness in the context of achieving the SDGs.

The main questions in this research focus on the readiness of regional health governance in the two provinces, which governance components influence the effectiveness of health program implementation, and the extent to which actual conditions align with the principles of good governance. Furthermore, this research aims to identify gaps between ideal governance and the reality on the ground, and formulate policy directions that can strengthen regional health governance systems in supporting the achievement of the SDGs. This research draws on several globally recognized health governance models, including the WHO Health System Governance Framework, the UNDP Governance Principles, and the Good Governance framework, which encompasses transparency, accountability, effectiveness, participation, and cross-sectoral coordination. Furthermore, previous studies on health governance in Indonesia have focused more on technical evaluations of health programs or assessments of performance indicators. Few studies have used a governance audit approach to comprehensively assess regional readiness, particularly those that integrate routine health data, planning documents, the quality of health information systems, and the alignment between the Regional Medium-Term Development Plan (RPJMD), Strategic Plan (Renstra), and SDGs. This knowledge gap suggests that a health governance audit study using case studies from two different provinces has both academic and practical significance. This state-of-the-art research lies in its approach, which integrates regional planning analysis, SSGI 2024-based health indicators, human resource and health facility capacity, data integration quality, and cross-sectoral coordination mechanisms within a single audit framework. This approach allows for a more objective and in-depth assessment of governance readiness than program evaluation or indicator analysis alone.