Communication Dynamics Between the Bali Provincial Health Office and Local Government in the Implementation of the Primary Care Integration Program

Abstract

This study analyzes the communication dynamics between the Bali Provincial Health Office and local governments regarding the implementation of the Primary Care Integration (Integrasi Layanan Primer / ILP) program. While launched nationally in August 2023, the implementation in Bali faced a seven-month delay, emphasizing the urgent need for effective cross-sectoral coordination. Drawing upon Goldhaber’s organizational communication theory, this research evaluates four primary aspects: information clarity, communication flow, communication frequency, and message alignment. Methods: A qualitative approach with a case study design was employed. Data were comprehensively collected through in-depth interviews with 11 key informants across the provincial office and various regencies/cities in Bali, alongside field observations and policy document analysis. Results: The findings indicate that inter-institutional communication is functionally active but remains suboptimal at the operational level. Information is conceptually clear but technically ambiguous due to incomplete regulations and unintegrated digital reporting systems (e.g., ASDK). The communication flow is heavily dominated by a top-down approach, while bottom-up mechanisms remain informal and face bureaucratic hurdles. Furthermore, the frequency of coordination is inconsistent across regencies, ranging from low to medium intensity. Consequently, a policy-practice gap exists where macro-level messages align with national goals, but micro-level execution is hampered by inadequate infrastructure, changing report formats, and low participation from health cadres. Conclusion: Effective organizational communication is a crucial determinant in public health policy execution. To ensure the sustainability of the ILP program in Bali, it is imperative to strengthen communication Standard Operating Procedures (SOPs), establish formal bottom-up feedback dashboards, and increase the frequency of tiered, cross-sectoral coordination.