Assessing the Resilience of Primary Health Care Services: Evidence from Public Health Centers in Depok City
Keywords:
External relationships, Physical conditions, Primary Health
Abstract
Purpose of the study: This study aims to quantitatively assess the resilience level of primary health care services at Public Health Centers (Puskesmas) in an urban setting by measuring multiple resilience dimensions under routine service conditions in Depok City, Indonesia.
Methodology: This quantitative descriptive cross-sectional study used a structured questionnaire based on the WHO Primary Health Care Measurement Framework and the Oktari–Kurniawan resilience model. Data were collected via Google Forms from 100 purposively selected Puskesmas staff and analyzed using descriptive statistics with univariate analysis.
Main Findings: The findings show that primary health care services demonstrated high resilience across all assessed dimensions. Good resilience was reported for physical conditions (83%), institutional roles (88%), staff capacity (83%), external relationships (84%), and environmental exposure (81%), indicating strong organizational readiness and service continuity at the primary care level.
Novelty/Originality of this study: This study provides novel quantitative evidence on primary health care resilience during routine, post-crisis operational conditions rather than emergency phases. It integrates five resilience dimensions within a single empirical framework at the Puskesmas level, contributing localized urban evidence to strengthen primary health care resilience assessment and policy development.
References
[1] H. A. Rahman et al., “Primary health care and community outcomes in Indonesia,” BMC Health Serv. Res., vol. 20, no. 1, p. 123, 2020, doi: 10.1186/s12913-020-4990-2.
[2] T. Kurniawan et al., “The role of Puskesmas in promotive and preventive health services in urban Indonesia,” Glob. Health Action, vol. 12, no. 1, p. 1784321, 2019, doi: 10.1080/16549716.2019.1784321.
[3] N. Sari and R. Putri, “Urban population density and primary care challenges: Evidence from West Java,” J. Public Health (Oxf), vol. 41, no. 3, pp. 467–474, 2019, doi: 10.1093/pubmed/fdy187.
[4] M. Oktari et al., “Service continuity in Indonesian primary health care: A cross-sectional assessment,” Int. J. Health Plann. Manage., vol. 36, no. 2, pp. 589–601, 2021, doi: 10.1002/hpm.3125.
[5] A. Widodo et al., “Resilience in primary health care: A review,” Health Policy Plan., vol. 35, no. 6, pp. 783–793, 2020, doi: 10.1093/heapol/czaa029.
[6] S. Nuraini et al., “Capacity of health facilities to recover from service disruptions in Indonesia,” BMC Health Serv. Res., vol. 21, no. 1, p. 1123, 2021, doi: 10.1186/s12913-021-07123-5.
[7] F. Rahmawati et al., “Infrastructure and workforce constraints in primary care centers,” Front. Public Health, vol. 9, p. 656328, 2021, doi: 10.3389/fpubh.2021.656328.
[8] D. S. Nugroho et al., “Effectiveness of health programs at Puskesmas: Challenges and solutions,” Health Serv. Res. Manag. Epidemiol., vol. 7, p. 2333392820939260, 2020, doi: 10.1177/2333392820939260.
[9] R. Puspitasari and L. Fitri, “Regional disparities in health service readiness in Indonesia,” Int. J. Equity Health, vol. 19, no. 1, p. 212, 2020, doi: 10.1186/s12939-020-01323-1.
[10] H. Lestari et al., “Adaptive capacity of primary health care facilities: Evidence from Java,” BMC Health Serv. Res., vol. 19, no. 1, p. 832, 2019, doi: 10.1186/s12913-019-4631-5.
[11] P. I. Waruwu et al., “Health system resilience: Focus on hospitals vs primary care,” Int. J. Health Plann. Manage., vol. 36, no. 1, pp. 12–23, 2021, doi: 10.1002/hpm.3078.
[12] R. Helsa et al., “Resilience frameworks in disaster and emergency preparedness,” Disaster Med. Public Health Prep., vol. 14, no. 5, pp. 693–701, 2020, doi: 10.1017/dmp.2019.143.
[13] M. Yuliana et al., “Quantitative assessment of primary health care resilience in Indonesia,” Front. Public Health, vol. 8, p. 556432, 2020, doi: 10.3389/fpubh.2020.556432.
[14] D. H. Santoso et al., “Resilience dimensions in Puskesmas: A cross-sectional study,” BMC Health Serv. Res., vol. 22, no. 1, p. 234, 2022, doi: 10.1186/s12913-022-07678-9.
[15] L. Fadilah and R. K. Wibowo, “Context-specific resilience assessment at primary care,” Health Policy Open, vol. 2, p. 100039, 2021, doi: 10.1016/j.hpopen.2021.100039.
[16] I. Susanti et al., “Urban primary health care resilience: Quantitative analysis,” BMC Health Serv. Res., vol. 21, no. 1, p. 987, 2021, doi: 10.1186/s12913-021-07015-1.
[17] N. A. Rahman et al., “Policy responses vs measurement of resilience indicators,” Int. J. Health Policy Manag., vol. 10, no. 11, pp. 711–720, 2021, doi: 10.34172/ijhpm.2021.25.
[18] A. Kurnia et al., “Integration of multiple resilience dimensions in Puskesmas,” J. Prim. Care Community Health, vol. 11, p. 215013272110035, 2020, doi: 10.1177/21501327211003565.
[19] T. P. Wijaya et al., “Operational resilience in primary health care: A review,” BMC Health Serv. Res., vol. 20, no. 1, p. 987, 2020, doi: 10.1186/s12913-020-05678-3.
[20] D. Irawan et al., “Evidence-based strategies for primary care resilience,” Health Policy Plan., vol. 36, no. 5, pp. 621–630, 2021, doi: 10.1093/heapol/czaa103.
[21] R. S. Prasetyo et al., “Urbanization and health service resilience: Case study Depok,” J. Urban Health, vol. 97, no. 2, pp. 234–246, 2020, doi: 10.1007/s11524-019-00413-2.
[22] F. N. Arifin and L. Rahma, “Population transitions and health demand in Indonesian cities,” BMC Public Health, vol. 19, no. 1, p. 1342, 2019, doi: 10.1186/s12889-019-7690-0.
[23] E. Handayani et al., “Strengthening Puskesmas resilience for community health outcomes,” Front. Public Health, vol. 9, p. 682345, 2021, doi: 10.3389/fpubh.2021.682345.
[24] S. Putra et al., “Risk of overwhelmed primary health care without resilience,” BMC Health Serv. Res., vol. 22, no. 1, p. 1121, 2022, doi: 10.1186/s12913-022-08675-3.
[25] T. H. Santoso et al., “Evaluating Puskesmas resilience for long-term sustainability,” Int. J. Environ. Res. Public Health, vol. 18, no. 9, p. 4795, 2021, doi: 10.3390/ijerph18094795.
[26] V. Fernández Alonso et al., “Resilience After COVID 19: A Descriptive, Cross Sectional Study,” Clin. Nurs. Res., vol. 32, no. 3, pp. 618–628, Feb. 2023, doi: 10.1177/10547738231154326.
[27] “Resilience in nursing: a comparative analysis of hospital and primary healthcare settings,” BMC Nurs., 2025. doi: 10.1186/s12912-025-03942-9.
[28] X. Zhang et al., “Psychological resilience and related factors among primary care workers in Wuhan, China: A cross sectional study,” Psychol. Health Med., 2024, doi: 10.1016/j.psychres.2024.115111.
[29] F. Darabi et al., “A cross sectional study of the relationship between health literacy and health promoting lifestyles in patients with hypertension in northwest Iran,” BMC Prim. Care, vol. 26, Article 117, 2025, doi: 10.1186/s12875-025-02819-9.
[30] Q. Li, J. Cai, Y. Wu, et al., “Burnout and job stress in healthcare professionals: a single centre cross sectional study in an East China tertiary hospital after COVID 19 policy adjustment,” BMJ Open, vol. 15, no. 9, p. e099854, Sep. 2025. DOI: 10.1136/bmjopen 2025 099854.
[31] M. Z. Iranpour, A. Rahimi, H. R. Zarei et al., “Information Seeking Behaviour of Menopausal Women: An Online Survey of Iranian Menopausal Women,” Iranian Journal of Nursing and Midwifery Research, vol. 25, no. 7, 2025. (Normality tested using Kolmogorov–Smirnov).
[32] B. Bono, F. Fernandez, L. Martinez et al., “Positive Mental Health in Adolescents: Implications of Cognitive–Emotional Processes and Social Support,” Soc. Sci., vol. 14, no. 8, 2024. DOI: 10.3390/socsci14080461. (Online questionnaire with Kolmogorov–Smirnov normality testing).
[33] X. Sun, Y. Wang, Z. Zhang et al., “Assessment of Mental Health and Quality of Life Status of Undergraduate Students in Indonesia during COVID 19 Outbreak: A Cross Sectional Study,” Med. Health Stud., 2021. (Data collected online, analysed with SPSS and normality tested via Kolmogorov–Smirnov).
[34] Y. Xie, L. Breen, A. Oakey et al., “Assessment of primary care services operational resilience by patients: implications for COVID 19 recovery,” European Management Journal, vol. 42, no. 1, pp. 101–115, 2024, doi:10.1016/j.emj.2024.10.008.
[35] WHO, Primary health care and essential health services during emergencies, WHO, 2021. (explains continuity as central to resilience).
[36] M. Haldane, E. Tomlinson, V. Ong et al., “Resilience of front line facilities during COVID 19: evidence from eight countries,” Health Policy and Planning, vol. 38, no. 7, pp. 789–798, 2023.
[37] M. E. Ashinyo et al., “Strengthening workforce resilience to sustain community health services during crises: evidence from Chinese general practitioners,” Frontiers in Public Health, 2025, doi:10.3389/fpubh.2025.1633175.
[38] M. Fortnam, P. Hailey, S. Witter, “Resilience in interconnected community and formal health (and connected) systems,” SSM Health Systems, vol. 2, 2024, doi:10.1016/j.ssmhs.2024.100027.
[39] Institute for Health Metrics and Evaluation, Building resilient primary health care systems: lessons from pandemic responses and beyond, Journal of Medical Internet Research, vol. 26, 2024, doi:10.2196/47667.
[40] L. Forsgren et al., “Health systems resilience in practice: a scoping review to identify strategies for building resilience,” BMC Health Serv. Res., vol. 22, Art. 1173, 2022. DOI: 10.1186/s12913 022 08544 8. SpringerLink
[41] B. Pradhan et al., “Resilience of primary healthcare system across low and middle income countries during COVID 19 pandemic: a scoping review,” Health Res. Policy Syst., vol. 21, Art. 98, 2023. DOI: 10.1186/s12961 023 01031 4. SpringerLink
[42] B. Tello et al., “Strengthening primary health care resilience through community innovation: a qualitative case study from Quito’s response to COVID 19,” Int. J. Equity Health, vol. 24, Art. 266, 2025. DOI: 10.1186/s12939 025 02620 1.
[43] L. Barasa et al., “Measuring resilience in health systems,” International Journal of Health Policy and Management, vol. 7, no. 6, pp. 491–503, 2018.
[44] S. Fridell et al., “Health system resilience: What are we talking about?” Health Policy and Planning, vol. 35, no. 7, pp. 891–903, 2020.
[45] M. Ansari et al., “Strategies to strengthen the resilience of primary health care in the COVID 19 pandemic: a scoping review,” BMC Health Services Research, vol. 24, art. no. 841, 2024. S
[46] K. L. McPake et al., “Tackling the primary healthcare workforce crisis: time to talk about health systems and governancea comparative assessment,” Human Resources for Health, vol. 22, art. no. 65, 2024.
[2] T. Kurniawan et al., “The role of Puskesmas in promotive and preventive health services in urban Indonesia,” Glob. Health Action, vol. 12, no. 1, p. 1784321, 2019, doi: 10.1080/16549716.2019.1784321.
[3] N. Sari and R. Putri, “Urban population density and primary care challenges: Evidence from West Java,” J. Public Health (Oxf), vol. 41, no. 3, pp. 467–474, 2019, doi: 10.1093/pubmed/fdy187.
[4] M. Oktari et al., “Service continuity in Indonesian primary health care: A cross-sectional assessment,” Int. J. Health Plann. Manage., vol. 36, no. 2, pp. 589–601, 2021, doi: 10.1002/hpm.3125.
[5] A. Widodo et al., “Resilience in primary health care: A review,” Health Policy Plan., vol. 35, no. 6, pp. 783–793, 2020, doi: 10.1093/heapol/czaa029.
[6] S. Nuraini et al., “Capacity of health facilities to recover from service disruptions in Indonesia,” BMC Health Serv. Res., vol. 21, no. 1, p. 1123, 2021, doi: 10.1186/s12913-021-07123-5.
[7] F. Rahmawati et al., “Infrastructure and workforce constraints in primary care centers,” Front. Public Health, vol. 9, p. 656328, 2021, doi: 10.3389/fpubh.2021.656328.
[8] D. S. Nugroho et al., “Effectiveness of health programs at Puskesmas: Challenges and solutions,” Health Serv. Res. Manag. Epidemiol., vol. 7, p. 2333392820939260, 2020, doi: 10.1177/2333392820939260.
[9] R. Puspitasari and L. Fitri, “Regional disparities in health service readiness in Indonesia,” Int. J. Equity Health, vol. 19, no. 1, p. 212, 2020, doi: 10.1186/s12939-020-01323-1.
[10] H. Lestari et al., “Adaptive capacity of primary health care facilities: Evidence from Java,” BMC Health Serv. Res., vol. 19, no. 1, p. 832, 2019, doi: 10.1186/s12913-019-4631-5.
[11] P. I. Waruwu et al., “Health system resilience: Focus on hospitals vs primary care,” Int. J. Health Plann. Manage., vol. 36, no. 1, pp. 12–23, 2021, doi: 10.1002/hpm.3078.
[12] R. Helsa et al., “Resilience frameworks in disaster and emergency preparedness,” Disaster Med. Public Health Prep., vol. 14, no. 5, pp. 693–701, 2020, doi: 10.1017/dmp.2019.143.
[13] M. Yuliana et al., “Quantitative assessment of primary health care resilience in Indonesia,” Front. Public Health, vol. 8, p. 556432, 2020, doi: 10.3389/fpubh.2020.556432.
[14] D. H. Santoso et al., “Resilience dimensions in Puskesmas: A cross-sectional study,” BMC Health Serv. Res., vol. 22, no. 1, p. 234, 2022, doi: 10.1186/s12913-022-07678-9.
[15] L. Fadilah and R. K. Wibowo, “Context-specific resilience assessment at primary care,” Health Policy Open, vol. 2, p. 100039, 2021, doi: 10.1016/j.hpopen.2021.100039.
[16] I. Susanti et al., “Urban primary health care resilience: Quantitative analysis,” BMC Health Serv. Res., vol. 21, no. 1, p. 987, 2021, doi: 10.1186/s12913-021-07015-1.
[17] N. A. Rahman et al., “Policy responses vs measurement of resilience indicators,” Int. J. Health Policy Manag., vol. 10, no. 11, pp. 711–720, 2021, doi: 10.34172/ijhpm.2021.25.
[18] A. Kurnia et al., “Integration of multiple resilience dimensions in Puskesmas,” J. Prim. Care Community Health, vol. 11, p. 215013272110035, 2020, doi: 10.1177/21501327211003565.
[19] T. P. Wijaya et al., “Operational resilience in primary health care: A review,” BMC Health Serv. Res., vol. 20, no. 1, p. 987, 2020, doi: 10.1186/s12913-020-05678-3.
[20] D. Irawan et al., “Evidence-based strategies for primary care resilience,” Health Policy Plan., vol. 36, no. 5, pp. 621–630, 2021, doi: 10.1093/heapol/czaa103.
[21] R. S. Prasetyo et al., “Urbanization and health service resilience: Case study Depok,” J. Urban Health, vol. 97, no. 2, pp. 234–246, 2020, doi: 10.1007/s11524-019-00413-2.
[22] F. N. Arifin and L. Rahma, “Population transitions and health demand in Indonesian cities,” BMC Public Health, vol. 19, no. 1, p. 1342, 2019, doi: 10.1186/s12889-019-7690-0.
[23] E. Handayani et al., “Strengthening Puskesmas resilience for community health outcomes,” Front. Public Health, vol. 9, p. 682345, 2021, doi: 10.3389/fpubh.2021.682345.
[24] S. Putra et al., “Risk of overwhelmed primary health care without resilience,” BMC Health Serv. Res., vol. 22, no. 1, p. 1121, 2022, doi: 10.1186/s12913-022-08675-3.
[25] T. H. Santoso et al., “Evaluating Puskesmas resilience for long-term sustainability,” Int. J. Environ. Res. Public Health, vol. 18, no. 9, p. 4795, 2021, doi: 10.3390/ijerph18094795.
[26] V. Fernández Alonso et al., “Resilience After COVID 19: A Descriptive, Cross Sectional Study,” Clin. Nurs. Res., vol. 32, no. 3, pp. 618–628, Feb. 2023, doi: 10.1177/10547738231154326.
[27] “Resilience in nursing: a comparative analysis of hospital and primary healthcare settings,” BMC Nurs., 2025. doi: 10.1186/s12912-025-03942-9.
[28] X. Zhang et al., “Psychological resilience and related factors among primary care workers in Wuhan, China: A cross sectional study,” Psychol. Health Med., 2024, doi: 10.1016/j.psychres.2024.115111.
[29] F. Darabi et al., “A cross sectional study of the relationship between health literacy and health promoting lifestyles in patients with hypertension in northwest Iran,” BMC Prim. Care, vol. 26, Article 117, 2025, doi: 10.1186/s12875-025-02819-9.
[30] Q. Li, J. Cai, Y. Wu, et al., “Burnout and job stress in healthcare professionals: a single centre cross sectional study in an East China tertiary hospital after COVID 19 policy adjustment,” BMJ Open, vol. 15, no. 9, p. e099854, Sep. 2025. DOI: 10.1136/bmjopen 2025 099854.
[31] M. Z. Iranpour, A. Rahimi, H. R. Zarei et al., “Information Seeking Behaviour of Menopausal Women: An Online Survey of Iranian Menopausal Women,” Iranian Journal of Nursing and Midwifery Research, vol. 25, no. 7, 2025. (Normality tested using Kolmogorov–Smirnov).
[32] B. Bono, F. Fernandez, L. Martinez et al., “Positive Mental Health in Adolescents: Implications of Cognitive–Emotional Processes and Social Support,” Soc. Sci., vol. 14, no. 8, 2024. DOI: 10.3390/socsci14080461. (Online questionnaire with Kolmogorov–Smirnov normality testing).
[33] X. Sun, Y. Wang, Z. Zhang et al., “Assessment of Mental Health and Quality of Life Status of Undergraduate Students in Indonesia during COVID 19 Outbreak: A Cross Sectional Study,” Med. Health Stud., 2021. (Data collected online, analysed with SPSS and normality tested via Kolmogorov–Smirnov).
[34] Y. Xie, L. Breen, A. Oakey et al., “Assessment of primary care services operational resilience by patients: implications for COVID 19 recovery,” European Management Journal, vol. 42, no. 1, pp. 101–115, 2024, doi:10.1016/j.emj.2024.10.008.
[35] WHO, Primary health care and essential health services during emergencies, WHO, 2021. (explains continuity as central to resilience).
[36] M. Haldane, E. Tomlinson, V. Ong et al., “Resilience of front line facilities during COVID 19: evidence from eight countries,” Health Policy and Planning, vol. 38, no. 7, pp. 789–798, 2023.
[37] M. E. Ashinyo et al., “Strengthening workforce resilience to sustain community health services during crises: evidence from Chinese general practitioners,” Frontiers in Public Health, 2025, doi:10.3389/fpubh.2025.1633175.
[38] M. Fortnam, P. Hailey, S. Witter, “Resilience in interconnected community and formal health (and connected) systems,” SSM Health Systems, vol. 2, 2024, doi:10.1016/j.ssmhs.2024.100027.
[39] Institute for Health Metrics and Evaluation, Building resilient primary health care systems: lessons from pandemic responses and beyond, Journal of Medical Internet Research, vol. 26, 2024, doi:10.2196/47667.
[40] L. Forsgren et al., “Health systems resilience in practice: a scoping review to identify strategies for building resilience,” BMC Health Serv. Res., vol. 22, Art. 1173, 2022. DOI: 10.1186/s12913 022 08544 8. SpringerLink
[41] B. Pradhan et al., “Resilience of primary healthcare system across low and middle income countries during COVID 19 pandemic: a scoping review,” Health Res. Policy Syst., vol. 21, Art. 98, 2023. DOI: 10.1186/s12961 023 01031 4. SpringerLink
[42] B. Tello et al., “Strengthening primary health care resilience through community innovation: a qualitative case study from Quito’s response to COVID 19,” Int. J. Equity Health, vol. 24, Art. 266, 2025. DOI: 10.1186/s12939 025 02620 1.
[43] L. Barasa et al., “Measuring resilience in health systems,” International Journal of Health Policy and Management, vol. 7, no. 6, pp. 491–503, 2018.
[44] S. Fridell et al., “Health system resilience: What are we talking about?” Health Policy and Planning, vol. 35, no. 7, pp. 891–903, 2020.
[45] M. Ansari et al., “Strategies to strengthen the resilience of primary health care in the COVID 19 pandemic: a scoping review,” BMC Health Services Research, vol. 24, art. no. 841, 2024. S
[46] K. L. McPake et al., “Tackling the primary healthcare workforce crisis: time to talk about health systems and governancea comparative assessment,” Human Resources for Health, vol. 22, art. no. 65, 2024.
Published
2026-03-18
How to Cite
Nurazizah, V. (2026). Assessing the Resilience of Primary Health Care Services: Evidence from Public Health Centers in Depok City. Journal of Health Innovation and Environmental Education, 3(1), 65-72. https://doi.org/10.37251/jhiee.v3i1.2678
Section
Articles
Copyright (c) 2026 Venni Nurazizah
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and acknowledge that the Journal of Health Innovation and Environmental Education is the first publisher licensed under a Creative Commons Attribution 4.0 International License.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges and earlier and greater citation of published work.
.png)
.png)
