Policy Analysis of Integrated Antenatal Care in Indonesia: An Application of the Policy Triangle Framework
Keywords:
Policy Analysis, Triangle Framework, Maternal Health, Integrated Antenatal Care, Primary Health CareAbstract
Background: Integrated Antenatal Care (ANC) is an important public health intervention to reduce maternal and infant mortality rate. In Indonesia, integrated ANC implementation requires a comprehensive policy analysis to identify gaps between policy design and the implementation. Method: This study uses a descriptive analytical narrative review approach using the Policy Triangle Framework. The analysis was conducted on integrated ANC policies using secondary data obtained from national regulations, technical guidelines, monitoring and evaluation reports, and relevant scientific evidence published since 2020. Policy documents and supporting literature were analysed thematically across four domains: actors, content, context, and processes. Results: The findings show that, in terms of policy content, integrated ANC in Indonesia has developed comprehensively, characterized by an increase in the minimum number of visits from four to six (K6) and the integration of 10T service standards. However, significant challenges still remain in the realm of actors, especially the uneven distribution of health workers, workload and the shortage of general practitioners trained in obstetric ultrasound, especially in Papua. From a contextual perspective, geographical barriers and sociocultural factors remain the main determinants of the sharp differences between provinces in K6 coverage, ranging from 4.77% to 95%. Conclusion: Integrated ANC policies have strong content but are hampered by uneven distribution of actors and geographic access. Policy innovations are needed in the form of task shifting, strengthening telemedicine, equitable distribution of doctors and midwives and strengthening family support systems to overcome sociocultural barriers in remote areas and a more comprehensive antenatal class.
References
[1] BPS RI, “Jumlah Tenaga Kesehatan Menurut Provinsi, 2023 ,” Jakarta, 2023. Accessed: Jan. 03, 2026. [Online]. Available from: https://www.bps.go.id/id/statistics-table/3/YVdwSFJHRjRVVkJqWlRWRU9EQkhNVFY0UjB4VVVUMDkjMw==/jumlah-tenaga-kesehatan-menurut-provinsi--2023.html?year=2023
[2] Kemenkes RI, “Peraturan Menteri Kesehatan Nomor 21 Tahun 2021,” 2021.
[3] G. L. O’Brien, S. J. Sinnott, V. Walshe, M. Mulcahy, and S. Byrne, “Health policy triangle framework: Narrative review of the recent literature,” Dec. 01, 2020, Elsevier B.V. DOI: https://doi.org/10.1016/j.hpopen.2020.100016
[4] Kemenkes RI, Pedoman Pelayanan Antenatal Terpadu Edisi Ketiga. Jakarta: Kementerian Kesehatan Republik Indonesia, 2020.
[5] WHO, WHO recommendations Intrapartum care for a positive childbirth. World Health Organization, 2018.
[6] F. M. Mutia, Masnawati, A. R. Nasution, R. Siregar, A. H. S. Lubis, and N. A. Nasution, “Pengaruh Keterampilan Komunikasi Interpersonal Bidan Terhadap Kepatuhan Ibu Hamil Melakukan Pemeriksaan Antenatal Care (ANC) di Wilayah Kerja Puskesmas Batangtoru Tahun 2025,” Vol. 10 No.2 Desember 2025JurnalKesehatanIlmiahIndonesia(IndonesianHealthScientificJournal), vol. 10, no. 2, 2025, Accessed: Jan. 03, 2026. [Online]. Available from: https://jurnal.unar.ac.id/index.php/health/article/view/2325/1341
[7] K. Khairani and F. Pramita Gurning, “Analisis Implementasi Kebijakan Program Pelayanan Antenatal Care (Anc) Dalam Upaya Menurunkan Angka Kematian Ibu Di Puskesmas X Kota Medan,” 2025. DOI: https://doi.org/10.61902/motorik.v20i2.1869
[8] A. M. Azan, Hardisman, and R. SEmitarty, “Evaluasi Kinerja Bidan Dalam Pelayanan Antenatal Care (ANC) Terpadu Di Kabupaten Bungo Tahun 2025,” JUKEJ: Jurnal Kesehatan Jompa, vol. 4, no. 2, pp. 586–593, 2025, Accessed: Jan. 03, 2026. [Online]. Available from: https://jurnal.jomparnd.com/index.php/jkj/article/view/1760/1335
[9] I. Yuliani, “Analisis Faktor-Faktor Yang Memengaruhi Implementasi Antenatal Terpadu oleh Praktik Mandiri Bidan di Kabupaten Sleman,” Jurnal Ilmiah Bidan, vol. III, no. 2, p. 45, 2018. Available from: https://ibi.or.id/journal/index.php/jib/article/view/64/57
[10] WHO, WHO recommendations on maternal health guidelines approved by the WHO Guidelines Review Committee second edition. World Health Organization;, 2025.
[11] N. Elga Haryono, V. Wiyana, M. Agustina Meha, and Kurniawati, “Coverage and Determinants of the Success of Antenatal Care (ANC) in First Trimester Pregnant Women at Lubuk Pakam Public Health Center,” Jurnal Kebidanan Kestra (JKK), vol. 8, no. 1, pp. 121–131, 2025, Accessed: Jan. 03, 2026. [Online]. Available from: https://ejournal.medistra.ac.id/index.php/JKK/article/view/3218/1636
[12] UNFPA, UNICEF, Bappenas, and Canada, “Program UNICEF dan UNFPA untuk menangani kesehatan dan hak seksual dan reproduksi | UNICEF Indonesia.” Accessed: Jan. 03, 2026. [Online]. Available from: https://www.unicef.org/indonesia/id/perlindungan-anak/publikasi/program-unicef-unfpa-berani?utm_source
[13] Kemenkes RI, Pedoman Pelayanan Antenatal Terpadu. Jakarta: Kementerian Kesehatan RI, 2010.
[14] Kemenkes RI, Pedoman Pelayanan Antenatal Terpadu Edisi Kedua. Jakarta, 2015.
[15] Kemenkes RI, Pedoman Pelaksanaan Kelas Ibu Hamil. Jakarta: Kementerian Kesehatan Republik Indonesia, 2014.
[16] R. Nurfitria Andini and D. Sartika, “The Influence of Family Support on Compliance with Antenatal Care (ANC) Visits Among Pregnant Women,” The Health Journal of a Brilliant Researcher, vol. 2, no. 2, 2023, [Online]. Available from: https://creativecommons.org/licenses/by-sa/4.0/
[17] N. Alfiah Nuraini, I. Sari Afrida, and S. Maryam, “Pengaruh Dukungan Suami dan Keluarga terhadap Kepatuhan Ibu Hamil dalam Melakukan Kunjungan Antenatal untuk Deteksi Dini Komplikasi,” DELIMA : Jurnal Kajian Kebidanan, vol. 3, no. 2, pp. 69–75, 2025, [Online]. Available from: https://ejournal.stikesbbmajene.ac.id/index.php/delima
[18] N. K. Aryastami and R. Mubasyiroh, “Traditional practices influencing the use of maternal health care services in Indonesia,” PLoS One, vol. 16, no. 9, Sep. 2021. DOI: https://doi.org/10.1371/JOURNAL.PONE.0257032
[19] F. Khoerunnisa, “Hubungan Paritas, Pengetahuan, Dan Jarak Ke Fasilitas Kesehatan Terhadap Rendahnya Kunjungan Pemeriksaan Kehamilan (ANC) K4 Di PMB Siti Mulyanti Tahun 2022,” Dohara Publisher Open Access Journal, vol. 02, no. 04, pp. 614–623, 2022. DOI: https://doi.org/10.54402/isjnms.v2i04.278
[20] A. S. Lestari, R. A. Syakurah, H. Idris, P. S2, I. Kesehatan, and K. Masyarakat, “Analisis Implementasi Pelayanan Antenatal Care di Puskesmas: Literatur Review,” SEHATRAKYAT (Jurnal Kesehatan Masyarakat), vol. 4, no. 3, pp. 570–582, 2025. DOI: https://doi.org/10.54259/sehatrakyat.v4i3.4858
[21] N. Pradita Syafitri, P. Astuti Wiratmo, W. Setyaningsih, P. Studi Keperawatan, and U. Binawan, “Hubungan Status Sosial Ekonomi Ibu Hamil Terhadap Kunjungan Antenatal Care,” Binawan Student Journal (BSJ), vol. 2, no. 1, pp. 237–241, 2020. DOI: https://doi.org/10.54771/bsj.v2i2.164
[22] R. D. Wulandari, A. D. Laksono, and N. Rohmah, “Urban-rural disparities of antenatal care in South East Asia: a case study in the Philippines and Indonesia,” BMC Public Health, vol. 21, no. 1, pp. 1–9, Dec. 2021. DOI: https://doi.org/10.1186/S12889-021-11318-2/TABLES/2
[23] H. Shi et al., “Reduced-visit antenatal care model combined with telemedicine for low-risk pregnant women: protocol for a randomised controlled trial,” BMJ Open, vol. 13, no. 7, p. e067110, Jul. 2023. DOI: https://doi.org/10.1136/BMJOPEN-2022-067110
[24] Direktorat Bina Gizi, Panduan Sistem Informasi Gizi (SIGIZI) Aplikasi Capaian Indikator Kegiatan Pembinaan Gizi Kementerian Kesehatan RI DIITJEN BIna Gizi dan KIA Direktorat Bina Gozi 2013. Kementerian Kesehatan RI, 2013.
[25] A. J. Dawson, J. Buchan, C. Duffield, C. S. E. Homer, and K. Wijewardena, “Task shifting and sharing in maternal and reproductive health in low-income countries: A narrative synthesis of current evidence,” Health Policy Plan, vol. 29, no. 3, pp. 396–408, 2014. DOI: https://doi.org/10.1093/heapol/czt026
[26] K. K. Than et al., “The potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar: a mixed-method study”. DOI: https://doi.org/10.1186/s12889-017-5020-2
[27] B. D. Fulton, R. M. Scheffler, S. P. Sparkes, E. Y. Auh, M. Vujicic, and A. Soucat, “Health workforce skill mix and task shifting in low income countries: a review of recent evidence,” 2011. DOI: https://doi.org/10.1186/1478-4491-9-1
[28] S. Lukhele et al., “The training of midwives to perform obstetric ultrasound scan in Africa for task shifting and extension of scope of practice: a scoping review,” BMC Med Educ, vol. 23, no. 1, Dec. 2023. DOI: https://doi.org/10.1186/s12909-023-04647-w
[29] Kemenkes RI, “Profil Kesehatan Indonesia 2024,” Jakarta, 2025. Accessed: Jan. 03, 2026. [Online]. Available from: https://drive.google.com/file/d/1-lNRA3k9o9jM5vGacbnKY4OZorUQ-_Sc/view
[30] H. Idris, R. N. Karimah, A. Yulianti, R. Nurul, K. Phd, and N. Jember, “Malaysian Family Physician Official Journal of the Academy of Family Physicians of Malaysia and Family Medicine Specialist Association of Malaysia Urban-rural differences in the incompleteness of antenatal care coverage in Indonesia: A cross-sectional study,” Malays Fam Physician, vol. 20, p. 18, 2025. DOI: https://doi.org/10.51866/oa.616
[31] R. Amalia, F. Zuriyatun, and D. R. Yuliani, “Kelas Edukasi Antenatal Persiapan Persalinan Berbasis Ketrampilan Meningkatkan Efikasi Diri Ibu Menghadapi Persalinan,” Jurnal Sains Kebidanan, vol. 5, no. 2, pp. 60–67, 2023. DOI: https://doi.org/10.31983/jsk.v5i2.10699
[32] N. Lolowang, M. Enggune, G. A. Merentek, and E. Lalawi, “Dukungan Suami Dalam Antenatal Care,” Jurnal Keperawatan Profesional (KEPO), vol. 5, no. 2, pp. 185–192, Nov. 2024. DOI: https://doi.org/10.36590/kepo.v5i2.979
[33] N. Rahardjo Putri, R. Amalia, and I. Indri Kusmawati, “Kelas Ibu Hamil Terhadap Kesehatan Psikologis Ibu Hamil dan Persiapan Persalinan: Systematic Review,” Indonesian Journal of Midwifery (IJM), vol. 5, no. 1, 2022, [Online]. Available from: http://jurnal.unw.ac.id/index.php/ijmAvailableat:http://jurnal.unw.ac.id:1254/index.php/ijm/issue/view/125
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ni Made Diaris
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All articles in Primary Care Science and Practice (PCSP) are published as open access under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license. This license permits non-commercial use, distribution, and reproduction in any medium freely, provided the original work is properly cited. Authors do not require additional permission from PCSP to reuse tables or figures from their own articles published in this journal for scientific or educational purposes.
