Strategic development of integrated governance for type 2 diabetes Mellitus (T2DM) care in Indonesia: a mixed-methods...

Type 2 Diabetes Mellitus (T2DM) management requires integrated and continuous care; however, service fragmentation remains prevalent in universal health coverage (UHC) systems.

This study examines how governance arrangements influence service integration and patient-reported experiences in T2DM care in Indonesia, to develop strategic recommendations for strengthening integrated governance.

A concurrent mixed-methods design, qualitative driven, was employed. Qualitative data were collected through in-depth interviews with policymakers, insurance representatives, hospital managers, clinicians, and primary care providers Quantitative data were collected from 107 adults with T2DM using structured questionnaires assessing knowledge, medication adherence, perceived service quality, and health-related quality of life. Findings were integrated using a joint display guided by Green's PRECEDE framework; strategic positioning was assessed through a SWOT and Internal-External matrix, and a TOWS matrix was developed to formulate recommendations.

Qualitative findings identified four governance barriers: fragmented primary-referral care pathways, misaligned financing arrangements, uneven facility and workforce capacity, and weak coordination and monitoring mechanisms. Quantitative findings indicated high patient knowledge (median 86.7%) and medication adherence (76.6% highly adherent), yet generally positive service quality perceptions, though reliability showed the largest gap. Physical quality of life remained suboptimal, particularly in energy and general health. Strategic positioning placed current T2DM governance in the grow-and-build quadrant, indicating capacity for proactive reform.

The development of an integrated governance strategy emphasizing structured referral pathways, aligned financing with chronic care needs, institutionalized diabetes educator roles, and accelerated health information system interoperability - offering actionable lessons for universal health coverage systems in low-and middle-income countries.