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Table 2 Actor, process, context and content of the rural area definitions

From: A critical review of definitions of rural areas in Indonesia and implications for health workforce policy and research

  MoH definition Presidential definition CBS definition
Actors (who established the definition) Established by the MoH Established by the president, with more detailed technical guidelines issued by the MoVDT Established by the CBS
Process (when the definition was established) One of the MoH responses to the Indonesian Government’s National Long-Term Development Plan 2005–2025, to accelerate the growth of less developed and more remote Indonesian areas. Regulations for remote health facilities have been established or revised three times, in 2007, 2013 and 2015 In conjunction with the National Long-Term Development Plan 2005–2025 to accelerate the growth of less developed and more remote Indonesian areas. The definition was updated in 2010, 2015 and 2020 The latest urban/rural classification was released in 2010, as the update from previous versions (1971, 1981 and 1990), using the 10-yearly population census data
Context and content (purpose of the definition and use in the health service policy) The definition was aimed to improve healthcare access and quality in remote and very remote areas, strengthen community empowerment and provide legal certainty for healthcare workers
Guide for deploying health workers under the rural financial programme (i.e. Nusantara Sehat, voluntary contractual posting or PTT Daerah)
A higher capitation rate is allocated for remote health facilities, of which at least 50% must be given for health personnel incentives. Remote health facilities receive a capitation payment rate at least twice as much as their non-remote counterparts (i.e. non-remote facilities with one full-time doctor will receive IDR 4500, while remote facilities with one full-time doctor will receive IDR 10,000). Remote facilities can also receive a capitation fund for 1000 members even if the actual number of members is lower
The definition aimed to accelerate the reduction of the gap between regions to achieve more equitable development and supply the basic needs, facilities and infrastructure in the less developed areas
Doctors working in less developed districts are prioritized for scholarships and recommendation letters from the local government for specialist education
Health facilities, both primary healthcare centres and hospitals, are prioritized for special funding for building healthcare infrastructure. The quality of health facilities is important to recruit and retain health workers in rural and remote areas
The classification was aimed to promote uniformity in the use of concepts, definitions and criteria for urban and rural areas in Indonesia
The MoH classifies government-owned primary healthcare facilities (Puskesmas) as urban or rural based on a modified CBS classification. However, neither the original nor modified CBS classification has been used in health-funding policy; there is no substantial difference between urban and rural Puskesmas regarding the scope of services and capitation rate received
  1. MoH Ministry of Health, MoVDT Ministry of Villages, Development of Disadvantaged Regions, and Transmigration, CBS Central Bureau of Statistics