Licensing Issues at Primary Clinics Resulting From the Omnibus Law in Indonesia: A Case Study From Surabaya City

Articles in Press

Document Type : Original Article

Authors

1 Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

2 Community Medicine Coordination Bureau, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

3 Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

4 School of Medicine, Western Sydney University, Campbelltown, NSW, Australia

Abstract

Background 
Anecdotal evidence has indicated that Indonesian primary care clinics struggle to meet new licensing requirements under the new Omnibus Law in 2020. This study aimed to analyse the challenges associated with clinic licensing under this Law and identify potential practical solutions.
 
Methods 
This was a sequential exploratory mixed-method case study in Surabaya, the second-largest city in Indonesia. Participants were recruited using convenience sampling from a District Health Office WhatsApp group of 38% of primary clinics in Surabaya (85/223). We used a quantitative survey to assess primary clinics’ compliance with the new requirements. Subsequently, survey participants and key stakeholders were invited to two-phase focus group discussions (FGDs) where survey findings were reported and discussed. Quantitative data were analysed descriptively, and qualitative data were thematically analysed; both were synthesised at the final data analysis.
 
Results 
The survey response rate was 35% (30/85 clinics in the WhatsApp group). Compliance with the new regulation varied, with 17% of the clinics still awaiting license approval and 27% needing to obtain waste management permits. Eighteen survey participants and six key stakeholders participated in the FGDs. Five key challenges in primary clinic licensing were identified: regulation shifting, knowledge and perception, weakness in system design, time, and cost.
 
Conclusion 
The more complex licensing requirements have caused delays in license issuance for a convenience sample of primary clinics in this study. Ineffective communication and a lack of understanding between clinics, local government agencies, and external consultants have exacerbated these issues, leading to a heavy burden on clinic resources. To mitigate these challenges, policy-makers should prioritize simplifying sequential requirements, enhancing interagency coordination, and establishing clear communication channels—ensuring regulatory changes align with on-the-ground capacity and needs. By addressing these gaps, the licensing process can become more efficient and transparent, ultimately supporting clinic sustainability and healthcare access.

Keywords

References

  1. Republik Indonesia. Undang-Undang Republik Indonesia Nomor 17 Tahun 2023 Tentang Kesehatan. Republik Indonesia; 2023.
  2. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2023. Jakarta: Kementerian Kesehatan Republik Indonesia; 2024.
  3. Dinas Kesehatan Kota Surabaya. Profil Kesehatan Kota Surabaya 2023. Surabaya: Dinas Kesehatan Kota Surabaya; 2024.
  4. Dinas Kesehatan Kota Surabaya. Laporan Pembimbingan Dan Pengawasan Dinas Kesehatan Kota Surabaya Tahun 2021. Surabaya: Dinas Kesehatan Kota Surabaya; 2022.
  5. BPJS Kesehatan. Aplicares. BPJS Kesehatan; 2024. https://faskes.bpjs-kesehatan.go.id/aplicares/#/app/pnama/byname. Accessed November 29, 2024.
  6. Creswell JW. A Concise Introduction to Mixed Methods Research. 2nd ed. Thousand Oaks: SAGE Publications; 2022.
  7. Palmer M, Larkin M, de Visser R, Fadden G. Developing an interpretative phenomenological approach to focus group data. Qual Res Psychol. 2010;7(2):99-121. doi:1080/14780880802513194
  8. Abimbola S, Negin J, Jan S, Martiniuk A. Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries. Health Policy Plan. 2014;29(Suppl 2):ii29-ii39. doi:1093/heapol/czu069
  9. Naeem M, Ozuem W, Howell K, Ranfagni S. A step-by-step process of thematic analysis to develop a conceptual model in qualitative research. Int J Qual Methods. 2023;22:16094069231205789. doi:1177/16094069231205789
  10. Madon S, Krishna S. Theorizing community health governance for strengthening primary healthcare in LMICs. Health Policy Plan. 2022;37(6):706-716. doi:1093/heapol/czac002
  11. Kementerian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 71 Tahun 2013 Tentang Pelayanan Kesehatan Pada Jaminan Kesehatan Nasional. Indonesia: Kementerian Kesehatan Republik Indonesia; 2013.
  12. Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/1983/2022 Tentang Standar Akreditasi Klinik. Indonesia: Kementerian Kesehatan Republik Indonesia; 2022.
  13. Nilamsari A. Mekanisme Syarat Pengajuan untuk Masa Penerbitan Rekomendasi Izin Klinik di Dinas Kesehatan Kabupaten Tabalong. 2022.
  14. Gusman D, Borry M. Tumpah Tindih dalam Proses Perizinan Klinik Pratama di Dinas Penanaman Modal dan Pelayanan Terpadu Satu Pintu Kota Padang. Unes Law Rev. 2018;1(2):148-156.
  15. Firmansyah MM. Faktor yang Mempengaruhi Menurunnya Jumlah Klinik Medis yang Terdaftar atau Berizin di Kota Surabaya [dissertation]. Universitas Airlangga; 2009.
  16. Bohomolov D. Problems of licensing of private healthcare facilities in Ukraine. Visegrad Journal on Human Rights. 2023(5):5-11. doi:61345/1339-7915.2023.5.1
  17. Wan Abdullah NR, Kwee-Heng L. Impact of the private healthcare facilities and services Act 1998 (Act 586) & regulations 2006 on the medical practice in corporate private hospitals in Malaysia. OIDA Int J Sustain Dev. 2011;2(9):89-106.
  18. Fehrer V, Poß-Doering R, Weis A, Wensing M, Szecsenyi J, Litke N. Climate change mitigation: qualitative analysis of environmental impact-reducing strategies in German primary care. Eur J Gen Pract. 2023;29(1):2232946. doi:1080/13814788.2023.2232946
  19. Pavli A, Loblay V, Rychetnik L, Usherwood T. What can we learn from Australian general practices taking steps to be more environmentally sustainable? A qualitative study. Fam Pract. 2023;40(3):465-472. doi:1093/fampra/cmad027
  20. Cernega A, Nicolescu DN, Meleșcanu Imre M, et al. Volatility, uncertainty, complexity, and ambiguity (VUCA) in healthcare. Healthcare (Basel). 2024;12(7):773. doi:3390/healthcare12070773
  21. Rockers PC, Kruk ME, Laugesen MJ. Perceptions of the health system and public trust in government in low- and middle-income countries: evidence from the World Health Surveys. J Health Polit Policy Law. 2012;37(3):405-437. doi:1215/03616878-1573076
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 05 November 2025

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History

  • Received Date: 24 January 2025
  • Revised Date: 29 September 2025
  • Accepted Date: 21 October 2025
  • First Published Date: 05 November 2025
  • Published Date: 05 November 2025

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