Village co-op clinics? Indonesia's doctors say fix the empty health posts first

Indonesia's plan to turn its village cooperatives into health clinics is running into a wall of doctors. The Indonesian Medical Association (IDI) says the idea of upgrading Koperasi Desa Merah Putih (KDMP) outlets into klinik pratama — front-line primary care facilities — is 'too forced' given the money and manpower it would swallow. IDI chairman Slamet Budiarto told BBC News Indonesia the government should fix its existing health centres first.

The numbers he cites are grim. More than 400 puskesmas, Indonesia's kecamatan-level public health centres, still have no doctor at all. Health Ministry figures from May 2025 put 424 of 10,212 puskesmas without a doctor, 2,743 without a dentist, 1,217 without environmental sanitation staff and 814 without a medical laboratory technologist. Hundreds more are short on nutritionists, pharmacists and health promotion officers.

Health Minister Budi Gunadi Sadikin isn't backing off. He said his ministry has already set up pilot projects to test the business model, describing the clinic as just one arm of the cooperative alongside logistics, trade and pharmacies. The model would run like a private clinic — patients pay, unlike at free puskesmas — but would still accept BPJS Kesehatan participants, he said in Jakarta on Friday. The legal hook is already there: Ministry of Cooperatives Regulation No. 2 of 2025 lists village clinics, pharmacies, warehousing, logistics and savings-and-loans among permitted KDMP businesses. As of mid-October, at least 10,070 KDMPs had started operating across the country at once, selling staples and helping distribute social aid.

Staffing rules make the ambition steeper. Under Health Ministry Regulation No. 17 of 2024, an outpatient primary clinic needs at least two doctors, a nurse or dental therapist, and support staff; an inpatient one adds a pharmacist, pharmacy technician, nutritionist and lab technologist. Slamet ran the math out loud: a single doctor costs at least Rp30 million a month, or Rp15 million each if there are two. If 30,000 cooperatives ran clinics, he said, that's 60,000 doctors plus roughly 60,000 nurses — about 120,000 health workers, while villages of 1,000 people barely justify one doctor under IDI's ratio of 1:3,000 to 5,000 residents.

The money question looms too. Slamet noted the government already spends around Rp47 trillion a year subsidising BPJS Kesehatan members on the PBI scheme, with another Rp20 trillion needed to shore up the insurer's finances. IDI says it isn't rejecting the clinic idea outright — it just wants puskesmas stocked with doctors, pharmacists and nurses first. 'Better that Kopdes is used for selling,' he said, questioning whether the government can really meet the licensing demands.

Dede Nasrullah, a health expert at Universitas Muhammadiyah Surabaya, landed on the same phrase: too forced. With a puskesmas in every kecamatan, he warned the cooperatives' clinics would overlap with services that already exist — and some KDMP sites sit close together, which he called a potential waste of budget unless the location is remote with no health service nearby. He also flagged the pharmacy plan, saying cooperatives can't simply sell medicine without qualified pharmacists on hand.