Interprovincial Coverage of Complete Basic Immunization for Infants: Challenges for Community Midwifery Care

Abstract

Background: Complete basic immunization (CBI) is a key indicator of infant health care in the community; however, coverage varies significantly across provinces and data sources. Objective: To describe variations in CBI coverage across provinces, assess the sustainability of provinces with low capacity, and compare provincial rankings based on routine data and the 2023 Indonesia Health Survey (SKI). Methods: An ecological study using open-access secondary data: 2021 routine reports on infant IDL (34 provinces), a list of provinces with IDL < 90% in 2022, monthly routine reports through September 2023, and the 2023 SKI (children aged 12–23 months). Regional differences were tested using the Mann–Whitney test, and rank agreement was assessed using Spearman’s correlation. Results: The median coverage in 2021 was 84.2% (IQR 73.6–89.9; range 42.7–100.0); only eight provinces met the 90% target. Coverage was higher in Java–Bali (90.3% vs. 81.3%; p = 0.030) and lower in the eastern region (73.0% vs. 87.3%; p = 0.015). Ten of the 11 provinces with an IDL < 90% in 2022 were among the 11 provinces with the lowest rates in 2021. The 2023 SKI recorded a national IDL of 35.8%, well below the routine rate, but provincial rankings were highly consistent (ρ = 0.95; p < 0.001; n = 8). Conclusion: Interprovincial IDL disparities are substantial and persistent; village midwives need to strengthen record-keeping, use every mother–infant contact to check immunization status, and prioritize outreach in low-capacity areas.