Health-System Capacity for Heart Failure in Indonesia

Executive summary

This report asks whether Indonesia's health system has the capacity to care for heart failure, a chronic and progressive condition that depends on sustained outpatient management to keep people out of hospital. It works through the six World Health Organization health-system building blocks, service delivery, workforce, information, essential medicines, financing, and governance, and closes with an Availability, Accessibility and Quality scorecard.

The analysis draws on the DREAMS and SI-SDMK workforce records (2025), SIRS hospital service data covering 3,275 hospitals (October 2025), BPS population projections for 2025, and the BPJS Kesehatan Sample Data for 2015 to 2024 for financing. It is a supply-side companion to the demand-side claims work: rather than asking who is served, it asks whether the workforce, facilities, medicines and financing exist to deliver care, and how unevenly they are spread across regions, islands, and between cities and rural districts. Population figures are denominators from official projections, and cost figures are verified-paid claim values, not budget realisation.

Questions this report answers

• Does Indonesia have enough cardiologists to manage heart failure, and how are they distributed across the country?
• Which hospitals offer heart-failure clinics and cardiac intensive care, and how many districts have none?
• Are guideline-recommended heart-failure medicines available at the primary-care level?
• How large is the financing burden of heart-failure care, and where does the spending go?

Key findings

• Cardiologists are scarce and concentrated: just 1,623 cardiologists serve the whole country (0.571 per 100,000 people), 38.7 percent of districts and cities have none, and 61.9 percent are in Java (Gini 0.767).
• Heart-failure clinics are rare: only 779 hospitals (23.8 percent) run a chronic heart-failure clinic, 52.3 percent of districts have no such clinic, and cardiac intensive care is absent in 64.8 percent of districts.
• There is a medicines gap at the front line: of 71 guideline-directed medical therapy molecules, only 7 are available in primary care, and the newer SGLT2 inhibitor and ARNI pillars are effectively not yet listed for primary heart-failure treatment.
• The financing burden is large and rising: verified-paid hospital spending on heart failure reached about Rp 22.35 trillion cumulatively over 2015 to 2024, and Rp 3.85 trillion in 2024 alone, with 75.9 percent of spending going to inpatient care.
• In 2024, coded heart-failure service contacts ran at 367.61 per 100,000 JKN members, with a proxy in-hospital case-fatality of 0.6 percent.
• Care is highly recurrent: 22.5 percent of admitted patients had two or more admissions, underlining the need to strengthen outpatient management so that repeat hospitalisation falls.