In a critical step toward improving infectious disease control, researchers from Universitas Padjadjaran (Unpad) have uncovered key factors that prevent private doctors in Indonesia from following national guidelines in treating tuberculosis (TB)—a disease that still claims over a million lives globally each year.

The study was led by Dr. Bony Wiem Lestari from the Department of Public Health, Faculty of Medicine, and Unpad’s Research Center for Care and Control of Infectious Disease. Their findings were recently published in the internationally recognized BMJ Global Health Journal.

Addressing a Silent Crisis in TB Management

Indonesia is one of the world’s highest TB burden countries, and over 60% of patients first seek care from private doctors. But when those practitioners lack diagnostic tools, training, or clear coordination with public health services, it can lead to delayed diagnosis, mistreatment, and continued transmission of TB—including its drug-resistant strains.

To explore this challenge, the Unpad team conducted in-depth interviews and focus groups with 24 private practitioners and 6 key stakeholders in Bandung, West Java. They found that unclear guidelines, complex referral systems, lack of diagnostic access, and limited incentives all contribute to poor adherence to standard TB protocols.

“We Can’t Fix What We Don’t Understand”

“This study gives voice to the challenges that many private doctors face on the ground,” said Dr. Lestari. “By listening to them, we can start designing practical reforms—like clearer policies, better training, and stronger public-private partnerships—that improve care for everyone.”

The researchers emphasized that collaboration—not blame—is key to improving TB outcomes. Strengthening links between private providers and the national TB program could ensure patients are diagnosed faster, treated correctly, and monitored effectively, all while improving trust in the system.

From Evidence to Impact

The findings of this study have important implications not only for Indonesia, but also for other countries with mixed public-private health systems. Solutions like harmonizing TB guidelines, improving referral infrastructure, and empowering private doctors through supportive policies can directly lead to better patient outcomes.

By promoting transparency, integration, and local ownership of health policy, the research also supports broader goals such as antimicrobial resistance prevention, data accuracy, and sustainable healthcare financing.

Strengthening Global Goals from West Java

This work contributes to Sustainable Development Goal (SDG) 3: Good Health and Well-being, by supporting stronger TB control strategies. It also aligns with SDG 17: Partnerships for the Goals, through its emphasis on multi-sectoral collaboration.

By addressing real-world systemic barriers and offering evidence-based solutions, Universitas Padjadjaran once again reinforces its role as a regional leader in public health research—and strengthens its impact contribution to the Times Higher Education (THE) Impact Rankings.

The full article is available in BMJ Global Health: https://gh.bmj.com/content/9/12/e015261