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Design and Governance of a National Preventive Digital Health System: An Interpretive Case Study from Indonesia
ABSTRACT
Background:
Digital health transformation efforts have largely focused on curative care, administrative systems, and disease-specific surveillance platforms, while national preventive digital health systems remain comparatively underexamined. Preventive systems pose distinct governance and operational challenges because they must support population-scale engagement, distributed service delivery, and longitudinal coordination across heterogeneous implementation settings.
Objective:
This study aimed to examine the design and governance of a national preventive digital health system implemented through Indonesia’s Cek Kesehatan Gratis (CKG) programme within the SATUSEHAT ecosystem.
Methods:
This study employed a theory-informed interpretive case study design using the CKG programme as an instrumental case. Data sources included system architecture documents, governance and policy materials, metadata specifications, operational workflows, and aggregated implementation indicators from the initial national implementation phase in 2025. The analysis combined architectural abstraction, governance mapping, and iterative design pattern synthesis informed by socio-technical systems theory and digital health governance scholarship.
Results:
The CKG system functioned as an integrated preventive digital health ecosystem combining multi-channel population registration, registry-based identity governance, standardised life-course preventive workflows, territorially coordinated outreach mechanisms, and governance-by-design arrangements embedded within a unified national infrastructure. Four recurring architectural and governance patterns were identified: inclusive multi-channel participation pathways, authoritative registry integration, centrally governed metadata with distributed implementation, and embedded proportional oversight through role-based governance structures. During the initial implementation phase, the system recorded more than 70 million preventive health screenings across 10,225 primary healthcare facilities in all 38 provinces of Indonesia.
Conclusions:
The findings suggest that population-scale preventive digital health systems may require governance and architectural arrangements extending beyond conventional facility-centred digitalisation models. Preventive digital health systems may function as broader socio-technical coordination infrastructures integrating interoperable registries, longitudinal preventive workflows, distributed implementation mechanisms, and embedded governance arrangements within unified national ecosystems. These insights may inform the development of preventive digital health systems in other low- and middle-income country settings.
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Copyright
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