Regulatory Input Readiness of the PESIAR Program for Accelerating Universal Health Coverage in Indonesia: A Descriptive Qualitative Study

Aims: Universal Health Coverage (UHC) in Indonesia remains constrained by uneven local-level implementation. The PESIAR program (Petakan, Sisir, Advokasi, Registrasi) was introduced to accelerate enrolment, yet its implementation depends on stakeholders' readiness and available inputs. Therefore, this study explored the readiness of the regulatory input of the PESIAR program toward UHC achievement in Indonesia.Methods: A descriptive qualitative study was conducted in West Sumatra, Indonesia, between January and March 2026. Semi-structured, in-depth interviews were carried out with 13 purposively selected participants across four organizational levels: one Branch Head, four Heads of the Membership Division, four Membership Staff, and four PESIAR Agents. Data were analyzed using thematic analysis, and trustworthiness was enhanced using Lincoln and Guba’s criteria.Results: Findings revealed three themes: (1) policy support, (2) regulatory framework adequacy, and (3) local government commitment. National policies were perceived as providing clear strategic direction and legitimacy for PESIAR implementation. However, successful implementation largely depended on local government and sub-district authorities' engagement and commitment. Although formal regulatory instruments, including memoranda of understanding (MoUs), cooperation agreements, and UHC work plans, provided a sufficient legal and administrative foundation, they were inconsistently translated into clear, standardized operational guidance.Conclusion: Regulatory inputs for the PESIAR program are established but remain unevenly operationalized at the local level. Bridging this policy-to-practice gap through standardized operational guidance, stronger accountability mechanisms, and committed local leadership is essential for advancing UHC in Indonesia.