Health System Capacity for Chronic Kidney Disease and Dialysis in Indonesia

Executive summary

This report asks whether Indonesia's health system has the capacity to care for people with chronic kidney disease (CKD) and on dialysis: the workforce, the facilities, the essential medicines, the information systems, the financing, and the governance behind that care. It is organised around the six WHO health-system building blocks, with an availability, accessibility, and quality scorecard, and is the supply-side counterpart to the report on how patients use the National Health Insurance scheme.

Capacity is measured against the population that needs care: an estimated 1,080,868 diagnosed CKD patients and around 37,546 people on prevalent dialysis, against a 2025 projected population of 284.4 million across 514 districts and cities. Workforce density is drawn from the Ministry of Health DREAMS and SI-SDMK 2025 records, hospital services from the SIRS facility register, and financing from the BPJS Kesehatan Sample Data for 2015 to 2024. Where routine disaggregated data does not exist, the gap is reported openly rather than assumed away.

Questions this report answers

• Does Indonesia have enough kidney specialists and dialysis facilities for the population that needs them?
• How unevenly are that workforce and those facilities spread across districts, islands, and city against rural areas?
• How much does the insurance scheme spend on CKD and dialysis, and which part of care absorbs it?
• Is the system investing in the capacity to prevent and detect kidney disease early, or only in treating its end stage?

Key findings

• Indonesia has only 181 nephrologists nationally, about 0.64 per million people, to care for an estimated 1,080,868 diagnosed CKD patients, far below what that population needs.
• Specialist kidney care is highly concentrated: 86.4 percent of districts and cities have no kidney and hypertension consultant, a near-monopoly of provision in Java and the large cities reflected in a workforce concentration index of 0.925.
• Dialysis services exist in 981 of 3,275 hospitals (30.0 percent), yet 45.1 percent of districts and cities remain dialysis deserts with no dialysis unit at all, so many patients must travel far for routine treatment.
• Kidney transplantation is almost absent, performed in only 2 hospitals in the whole country, so lifelong dialysis is effectively the only available kidney-replacement therapy.
• CKD care leans on general internal medicine, available in 90.2 percent of hospitals, rather than dedicated kidney units, with hemodialysis services in 478 hospitals and dialysis or CAPD services in 906.
• JKN spending on CKD reached about Rp 9.9 trillion in 2024, of which dialysis procedures absorbed 69.2 percent, with the burden falling heavily on people of working age, from 45 to 59 years; cumulative spending over 2015 to 2024 was about Rp 55.1 trillion.
• The pattern is a system that pays for costly kidney-replacement therapy while lacking the upstream capacity, prevention, early detection, and local kidney workforce, that would reduce the need for it.