BACKGROUND: Indonesia faces significant challenges in adopting and implementing tobacco control policies at the subnational level, despite high tobacco consumption rates and associated health risks. One notable policy initiative is the introduction of a specific budget nomenclature for tobacco control, aimed at ensuring dedicated funding for smoke-free area (KTR) programs. However, the uptake of this policy has been limited across districts and cities. This study investigates the barriers to adoption and provides insights into improving policy implementation at the local government level.
METHODS: The research employs a qualitative methodology, analyzing policy documents, budget data, and reports from local governments, alongside interviews with key stakeholders, including officials from district health offices, representatives from the Ministry of Home Affairs (MoHA), and public health advocates. Data collection focuses on identifying systemic, administrative, and socio-political obstacles that hinder policy adoption.
RESULTS: Results reveal several barriers, including weak policy dissemination and enforcement, insufficient awareness among local government officials, and pre-existing budget commitments that limit flexibility for new initiatives. Additionally, the lack of technical capacity and understanding of the policy's long-term benefits among local stakeholders further constrains adoption. Socio-political factors, such as resistance from interest groups and competing priorities in resource allocation, exacerbate the issue. Despite these challenges, the study identifies promising practices in districts that successfully adopted the nomenclature, highlighting the role of advocacy and multi-stakeholder collaboration.
CONCLUSIONS: The findings underscore the need for stronger enforcement mechanisms, capacity-building programs for local officials, and broader dissemination of tobacco control policies. Integrating these measures with digital tools, such as the Governance Information System (SIPD), can enhance transparency and accountability. This study provides actionable recommendations for policymakers and advocates to address barriers, ensuring more effective implementation of tobacco control policies at the subnational level and contributing to improved public health outcomes in Indonesia.