Regional Government Preparedness in Response to the COVID-19 Pandemic in Indonesia

Background: The high number of COVID-19 cases in Indonesia, with 6,811,201 people affected and 161,844 deaths up to June 2023, was influenced by regional governments' varying approaches to disease control. This study aimed to analyze regional government preparedness in response to the COVID-19 pandemic and the factors that influenced their preparedness. Methods: We conducted a qualitative research study using purposive sampling. We collected data from September 2023 to April 2024 via semi-structured interviews with staff at health and disaster agencies in Bali and West Java. The interview guide was developed using the Six Building Blocks of World Health Organization (WHO)'s Health Systems Framework and Practical Actions in Cities to Strengthen Preparedness. We validated and analyzed data using content analysis. Results: When assessing regional government preparedness, we identified the following themes: leadership and policy; cross-sector collaboration; communication and coordination; human resources; supplies; information management; budget adequacy; funds availability; facilities and infrastructure availability. Almost all informants said that cross-sector collaboration and coordination between regional and central government influenced pandemic preparedness. Conclusion: Initial challenges in the handling of the pandemic health crises included supply shortages and limited resources. However, with central support, regional governments prioritized cross-sector collaboration and secured budgets to manage effectively. The COVID-19 pandemic enhanced Indonesia's health governance, shifting from reactive to proactive planning and strengthening national-regional cooperation. This experience bolstered the resilience and readiness of Indonesia's health system for future challenges.