ICT Maturity Assessment at Primary Healthcare Services across 9 Provinces in Indonesia: An Evaluation Study (Preprint)

Abstract

BACKGROUND Indonesia has rapidly embraced digital health, particularly during the COVID-19 pandemic, with over 15 million daily health application users. To advance its digital health vision, the government is prioritizing the development of health data and application systems into an integrated healthcare technology ecosystem. This initiative involves all levels of healthcare, from primary to tertiary, across all provinces. In particular it aims to enhance primary healthcare services (as the main interface with the general population) and contribute to Indonesia's digital health transformation. OBJECTIVE This study assesses the information and communication technology (ICT) maturity in Indonesian healthcare services to advance digital health initiatives. ICT maturity assessment tools were utilized, specifically designed for developing countries, to evaluate digital health capabilities in 9 provinces across 5 Indonesian islands. METHODS A cross-sectional survey was conducted in 2022, in 9 provinces across Indonesia, representing the country's diverse conditions on its major islands. Respondents included staff from Public Health Centers (Puskesmas), Primary Care Clinics (Klinik Pratama), and District Health Offices (Dinas Kesehatan Kabupaten/Kota). The survey used adapted ICT maturity assessment questionnaires, covering human resources, software and system, hardware, and infrastructure. It was administered electronically and involved 121 Public Health Centers, 49 Primary Care Clinics, and 67 IT staff from District Health Offices. Focus group discussions were held to delve deeper into the assessment results and gather more qualitative insights. RESULTS In this study, 237 participants represented three distinct categories: 121 Public Health Centers, 67 District Health Offices, and 49 Primary Clinics. These instances were selected from a sample of 9 out of the 34 provinces in Indonesia. Collected data from interviews and focus group discussions were transformed into scores on a scale of 1 to 5, where 1 indicates low ICT readiness, and 5 indicates high readiness. On average, the breakdown of ICT maturity scores is as follows: human resource capability and system management (2.71), software and information systems (2.83), hardware (2.59), and infrastructure (2.84), resulting in an overall average score of 2.74. According to the ICT Maturity level pyramid, the ICT maturity of healthcare providers in Indonesia falls between the basic and good levels. The need to pursue best practices also emerged strongly. Further analysis of the ICT Maturity Scores, when examined by province, revealed regional variations. CONCLUSIONS The maturity of ICT utilization is influenced by several critical components. Enhancing human resources, ensuring infrastructure and the availability of supportive hardware, and optimizing information systems are imperative to attain ICT maturity in healthcare services. In the context of ICT Maturity assessment, significant score variations are observed across healthcare levels in nine provinces, underscoring the diversity in ICT readiness, and need for regionally-customized follow-up actions.