Data-driven investment policy strategy for industry resilience in Indonesia: a case of stroke burden

Indonesia faces intertwined public health and economic security challenges driven by the rapid rise of non-communicable diseases (NCDs) and persistent dependence on global supply chains for essential health commodities (Castillo-Carandang et al., 2020). Within this context, stroke has emerged as the leading cause of death and disability in Indonesia, accounting for 18.03 percent of total fatalities (IHME, 2025). Stroke also provides a strategic case for examining weaknesses in health industry resilience because its management requires a broad range of products, including antihypertensive medicines, CT scanners, digital tensimeters, and rehabilitation technologies. At the same time, more than 90 percent of active pharmaceutical ingredients (APIs) are imported, exposing the health system to major global supply-chain vulnerabilities (Adak, 2024). Consequently, stroke offers an important lens through which to assess the alignment between investment incentives, industrial capacity, and public value outcomes.

These vulnerabilities became highly visible during the COVID-19 pandemic, when global supply disruptions caused shortages of essential medicines and price increases of up to 30 percent in Indonesia (Tjandrawinata and Heliany, 2024). In response, health system resilience became a core component of Indonesia’s Health Transformation Agenda (Gamalliel and Fuady, 2024). The government introduced policies to strengthen domestic industry, including the National Health Insurance (JKN) scheme and investment incentives for pioneer industries. However, these policies remain broad and insufficiently targeted to stimulate upstream pharmaceutical and medical device production, which continues to lag behind national needs (Tjandrawinata and Heliany, 2024).

This paper argues that addressing these challenges requires a broader public management perspective beyond conventional health economics or industrial policy. The analysis, therefore, adopts Moore’s Public Value framework, which evaluates policy effectiveness not only through economic outcomes but also through broader societal goals such as health security, equity, and public trust (Jones, 2022; Moore, 1997). Moore’s strategic triangle, comprising Public Value, Authorizing Environment, and Operational Capacity, provides a framework for understanding how policy design and institutional capacity interact to shape outcomes.

Public value has increasingly been used to explain how governments create outcomes valued by society, particularly during periods of crisis and uncertainty. Papi et al. (2018) emphasize that public value requires both conceptual clarity and practical tools for implementation, while Ritonga (2024) demonstrates how external governance conditions shape investment outcomes in Indonesia. These perspectives support the argument that investment policy should be linked more directly to disease-burden priorities and health system resilience objectives.

Recent studies further highlight the importance of coordination and co-creation in public management. Strokosch and Roy (2025) argue that sustainable value creation in health systems depends on collaboration across institutional ecosystems, while Eriksen et al. (2025) stress the importance of adaptive approaches in complex service innovation. Similarly, Virtanen and Jalonen (2024) emphasize that public value is created through interactions among institutions, policy instruments, and societal needs rather than through linear policy implementation alone.

Taken together, these challenges raise an important policy question: how can investment policy in the health sector be strategically designed, based on disease-burden evidence, to strengthen domestic production capacity and create sustainable public value in Indonesia? The paper proposes a shift from broad, sector-neutral incentives to a more targeted, data-driven strategy linked to high-burden diseases such as stroke. It introduces the concept of strategic production as a supply-side complement to strategic purchasing, where investment policy functions not only as an economic tool but also as a market-shaping mechanism for strengthening health system resilience (Skålén and Trischler, 2024; Virtanen and Jalonen, 2024).

This study employs a qualitative, single-case study design. This approach is recognized as particularly suitable for public policy analysis as it allows for an in-depth, holistic investigation of a complex, contemporary phenomenon within its real-world context. The case study method is ideal for answering the ‘how’ and ‘why’ questions central to this study, namely, how and why current investment policies are failing to build health system resilience and how they can be redesigned for greater effectiveness (Revillard, 2021). This design facilitates a detailed exploration of policy processes, outcomes, and the complex relationship between economic, social, and health factors.

The focus of analysis is the Indonesian public management approach to building health system resilience through industrial policy. The specific case selected for in-depth analysis is the policy ecosystem surrounding stroke care. This case was selected for several strategic reasons, making it a critical case and providing valuable insights (Revillard, 2021). First, stroke represents the single largest contributor to Indonesia’s disease burden, making it a national health priority and an illustration of the economic costs of NCDs (Allen and Bayraktutan, 2008; IHME, 2025). Second, the comprehensive management of stroke, from prevention and diagnosis to treatment and rehabilitation, requires a wide range of health products, including high-volume generic medicines (antihypertensives), advanced diagnostic equipment (CT scanners), consumer medical devices (digital tensimeters), and emerging rehabilitation technologies (robotics). This diversity demonstrates Indonesia’s import dependency and the corresponding opportunities for domestic production (MOH, 2025).

To ensure the reliability and validity of the findings, this study draws on multiple sources of evidence to enable data triangulation (Revillard, 2021). Evidence was collected and synthesized from three main categories.

First, policy and regulatory documents were systematically reviewed to capture the policy environment shaping Indonesia’s pharmaceutical and medical device sectors. These included the Ministry of Health (MOH)’s strategic plans and regulations (MOH, 2023), Presidential Instructions on the prioritization of locally produced goods (Republic of Indonesia, 2022), Ministry of Finance (MOF) Regulations (PMK) outlining investment incentives for pioneer industries, such as PMK No. 130/2020 (MOF, 2020), and investment guidelines issued by the Investment Coordinating Board/BKPM (BKPM, 2021). Together, these documents have provided the institutional and regulatory framework relevant to investment strategies for strengthening industry resilience.

Second, the study incorporated secondary quantitative data to establish a solid empirical foundation. Epidemiological data on the burden of disease and forward projections were obtained from the Institute for Health Metrics and Evaluation’s (IHME) Global Burden of Disease (GBD) study (IHME, 2025). Complementing this, economic data, including market prices and public procurement costs for essential pharmaceuticals and medical devices, were sourced from peer-reviewed studies analyzing Indonesia’s e-catalog system and retail markets (Pisani et al., 2023). These data points enabled a rigorous assessment of both health needs and financial considerations.

Third, the analysis was informed by an extensive review of peer-reviewed literature and international reports. Publications from academic sources and organizations such as the World Bank and the World Health Organization provided critical context on Indonesia’s health system, the structure and challenges of its pharmaceutical industry, and the implications of decentralized governance. This body of evidence also offered comparative insights on broader trends in NCDs management across Southeast Asia (Castillo-Carandang et al., 2020).

Document selection was guided by relevance to three analytical dimensions: health system resilience, investment and industrial policy, and stroke-related healthcare needs. Priority was given to national-level policy documents, peer-reviewed studies, government regulations, and institutional reports published between 2019 and 2025 to capture post-pandemic policy developments and recent shifts in Indonesia’s health transformation agenda. Sources that did not directly relate to pharmaceutical production, medical technology, investment policy, or disease-burden analysis were excluded from the core analytical review.

The analysis of the collected data was systematically guided by Moore’s Public Value framework (Jones, 2022; Moore, 1997). This framework’s strategic triangle provides a structured approach to evaluating the effectiveness of a public policy or management strategy (Figure 1).

Data from the sources described above were coded and mapped onto the three core components of the policy triangle framework. The first component, the authorizing environment, examines the sources of legitimacy and support for the policy. Data on laws, regulations, investment policies, and political mandates, such as the Health Transformation Agenda, were reviewed alongside the expectations of key stakeholders, including government agencies, industry actors, and the public. This analysis helped to illuminate the formal and informal contexts that either enable or constrain policy action.

The second component, operational capacity, focuses on the ability of public agencies and their partners to implement policy effectively and deliver intended outcomes. To assess this dimension, the study analyzed data on the condition of the domestic pharmaceutical and medical device industry, health system infrastructure, human resources, and procurement systems. Together, these factors provided insights into existing capabilities as well as key constraints.

The third component, the public value outcomes dimension, highlights the tangible and intangible benefits generated for society. In this context, the analysis moved beyond simple measures of cost savings to include broader considerations such as enhanced health security, improved equity in access to care, and strengthened national resilience. These outcomes illustrate how policy action can create public value.

This theory-driven analytical approach ensures a rigorous evaluation that moves beyond a simple descriptive account of policies to a deeper diagnosis of their strategic alignment and effectiveness in creating public value (Revillard, 2021).

The process of linking evidence to Moore’s Strategic Triangle was conducted through thematic coding and policy mapping. All policy documents, secondary datasets, and literature sources were reviewed and coded according to categories corresponding to the three dimensions of the framework: authorizing environment, operational capacity, and public value outcomes. For example, regulations concerning investment incentives, procurement policy, and industrial mandates were categorized under the authorizing environment, while evidence relating to pharmaceutical production capacity, supply-chain dependency, infrastructure readiness, and procurement bottlenecks was coded under operational capacity. Themes associated with health security, equity in access, affordability, and institutional trust were categorized as public value outcomes. The coding process enabled systematic comparison across heterogeneous sources and strengthened analytical consistency by ensuring that interpretations were grounded in predefined conceptual categories rather than ad hoc interpretations. This approach also supported triangulation between epidemiological, policy, and economic evidence relevant to Indonesia’s stroke-care ecosystem.

In this study, stroke is treated not merely as a clinical condition, but as a strategic policy case through which broader vulnerabilities in Indonesia’s health industry ecosystem can be examined. The findings are presented in four parts. The first subsection establishes the challenge by detailing the burden of stroke and the corresponding supply chain vulnerabilities. The subsequent two subsections analyze Indonesia’s policy landscape and industrial capacity through the lens of the public value framework’s authorizing environment and operational capacity. The final subsection presents a quantitative analysis projecting the demand for key stroke-related medical supplies and the potential value of stimulating local production.

The motivation for a strategic shift in public management originates from the severe and worsening epidemiological reality. Projections indicate that the burden of stroke, measured in Disability-Adjusted Life Years (DALYs), will continue to rise, from 12.67 percent of the total national burden in 2025 to 12.93 percent by 2030 (IHME, 2025). This trend is consistent with the broader NCDs crisis across the ASEAN region, where NCDs now account for 62 percent of all deaths, many of them premature (Castillo-Carandang et al., 2020). Critically, the burden of stroke in Indonesia begins to increase sharply in the 40-44 age group, impacting individuals in their most productive years and imposing a decades-long period of disability and substantial economic cost on families and the state (IHME, 2025).

This health challenge is managed by a system with critical weaknesses due to the deep dependence on imported health products. This vulnerability is evident across the continuum of stroke care. Over 90 percent of the APIs for essential medicines are imported, including antihypertensives like amlodipine (Tjandrawinata and Heliany, 2024). Similarly, advanced diagnostic equipment, such as Computed Tomography (CT) scanners, and modern rehabilitation technology, like therapeutic robotics, are sourced from abroad, often at a high cost that limits their accessibility. This lack of domestic production capacity for essential health technologies is a common challenge in developing countries, creating significant barriers to affordable and equitable access to care (El Hajj et al., 2023).

The Indonesian government has constructed a broad policy framework that, in principle, authorizes and supports the development of a resilient domestic health industry. At the highest level, the government’s Health Transformation Agenda, particularly the pillar of Health Resilience System Transformation as one of its six foundational pillars, provides a clear political mandate for action (Gamalliel and Fuady, 2024). This is complemented by long-standing industrial policies, such as the Domestic Component Level (TKDN) requirement, which mandates a minimum percentage of local content in government procurement, and the ‘Proudly Made in Indonesia’ movement, which encourages prioritization of local products (Republic of Indonesia, 2022). Furthermore, the implementation of the JKN system since 2014 has fundamentally reshaped the pharmaceutical market by massively expanding access to care and creating a great, stable demand for generic medicines.

Within this context, the MOF has established a specific investment incentive regime designed to attract investment. Under regulations such as PMK-130/2020, the government offers a suite of powerful incentives, including tax holidays and tax allowances, for investors in 18 designated pioneer industry sectors (MOF, 2020). Crucially, the primary pharmaceutical raw material industry is included on this list. New investments in this sector with a value of at least IDR 100 billion are eligible for a corporate income tax reduction of 50 percent to 100 percent for a period of 5 to 20 years, depending on the investment amount (MUC Consulting, 2025). Additionally, a super tax deduction of up to 300 percent of costs is available for qualifying research and development (R&D) activities conducted within Indonesia (BKPM, 2021).

However, the existence of these powerful tools on paper belies their limited effectiveness in practice. A central finding of this analysis is the paradox of available but ineffective incentives. Despite the formal designation of API manufacturing as a pioneer industry eligible for generous tax holidays, the country remains overwhelmingly dependent on imports, and investment in the sector lags behind regional peers (Tjandrawinata and Heliany, 2024). The root of this failure lies not in the absence of policy but in its design. By grouping pharmaceutical raw materials with 17 other disparate sectors, from base metals to digital economy activities, the policy is too broad and untargeted (MUC Consulting, 2025). It fails to recognize the unique strategic importance and distinct economic drivers of the health sector, treating API production as just another industrial activity rather than a national health security concern. This lack of strategic prioritization weakens the effectiveness of the incentive regime and signals limited policy commitment toward health-sector industrial resilience. From the perspective of Moore’s Strategic Triangle, this reflects a misalignment between the authorizing environment and the operational capacity required to achieve sustainable public value outcomes.

This study found that there is a divided industrial landscape in Indonesia’s operational capacity. The country possesses a large and mature downstream pharmaceutical industry, comprising approximately 220 companies focused on the formulation and manufacturing of finished drug products. This sector has demonstrated its ability to meet the vast demand generated by the JKN program. However, the upstream capacity for producing APIs and key components for medical devices is exceptionally weak. Local production of raw materials meets only about 10 percent of the national demand, creating a critical bottleneck and a point of extreme vulnerability in the value chain (Tjandrawinata and Heliany, 2024).

This industrial limitation is compounded by constraints within the healthcare delivery system. Despite the progress made under the JKN, significant disparities in access to care persist. Essential medicines, diagnostic tools like CT scans, and modern rehabilitation services remain scarce and unaffordable, particularly in rural and remote regions outside of major urban centers (Frija et al., 2021). Indonesia’s decentralized governance structure further complicates the operational landscape. The decentralization of health responsibilities to district-level governments has created frequent discrepancies between national policies and local implementation practices. Studies have documented challenges in medicine procurement, quantification, and distribution at the local level, often leading to stockouts of essential medicines even when they are available nationally (Fanda et al., 2025). This fragmented operational environment poses a significant challenge to implementing a coherent, nationwide strategy for health system resilience. These operational constraints demonstrate that policy authorization alone is insufficient unless supported by institutional coordination and implementation capacity capable of translating national priorities into equitable service delivery outcomes.

The preceding findings demonstrate that Indonesia’s stroke-care ecosystem faces interconnected vulnerabilities across pharmaceutical supply chains, medical technology dependency, and uneven healthcare access. While these challenges are often discussed qualitatively in policy debates, translating them into investment priorities requires a more concrete illustration of their potential economic implications. For this reason, the following analysis provides indicative demand and cost projections for selected stroke-related products to demonstrate how disease-burden evidence can inform targeted industrial and investment strategies.

To operationalize the concept of strategic production, this study synthesized multiple secondary data sources to estimate indicative demand for selected stroke-related health products and to illustrate the potential economic implications of expanding domestic production capacity. Table 1 presents a cost-benefit analysis for four representative products across the stroke care continuum. This table is an analytical tool designed to make the public value proposition tangible for policymakers. It demonstrates the multi-faceted nature of the supply chain challenge, spanning high-volume pharmaceuticals, high-cost capital equipment, consumer devices, and frontier technology, and links specific vulnerabilities to tailored investment policy interventions. Given the absence of comprehensive national manufacturing datasets for several emerging medical technologies, the projections presented below are intended as policy-oriented modelling estimates based on triangulated secondary data sources.

The estimates presented in Table 1 are illustrative modelling projections intended to demonstrate the potential scale of public value creation from targeted local production strategies, rather than precise economic forecasts. Estimated annual demand figures were synthesized from multiple sources, including IHME burden-of-disease projections, national utilization trends, public procurement patterns, and published market studies related to stroke care in Indonesia. For pharmaceuticals such as amlodipine, estimated import and local production prices were derived from comparisons between branded generic market prices and Indonesia’s national e-catalog procurement prices (Maria et al., 2025; Rahmawati et al., 2025). Estimates for CT scanners and rehabilitation robotics were informed by MOH procurement documents, international market references, and published literature on medical technology costs (Kaplan and Laing, 2005; Lo et al., 2019; MOH, 2024). Digital tensimeter prices were approximated using median retail prices across major Indonesian e-commerce platforms. Estimated local production costs for non-pharmaceutical products represent projected benchmark targets under assumptions of partial domestic manufacturing, technology transfer, economies of scale, and government-supported investment incentives. Actual production costs may vary depending on exchange rates, production capacity, infrastructure readiness, import dependence of intermediate components, and future market conditions. Accordingly, the projections should be interpreted as indicative policy scenarios designed to support strategic discussion regarding industrial resilience and public value creation, rather than as definitive financial forecasts.

The analysis reveals a substantial economic case for a targeted industrial strategy. For amlodipine alone, shifting from reliance on imported APIs (reflected in higher branded generic prices) to fully localized generic production (benchmarked against public e-catalog prices) could generate annual savings of approximately IDR 264 billion. The potential savings from localizing the production of higher-value items like CT scanners and rehabilitation robotics are even more significant, collectively amounting to hundreds of billions of Rupiah annually. These figures represent a tangible metric of public value that could be unlocked, resources that could be reinvested into the health system to expand access, improve quality, or fund preventive health programs. From a public value perspective, these projections illustrate how investment policy can extend beyond fiscal incentives to become a strategic instrument for improving health security, affordability, and long-term system resilience.

The findings reveal a fundamental misalignment in Indonesia’s approach to health system resilience. Based on Moore’s Strategic Triangle, this section interprets how weaknesses in policy design, operational capacity, and institutional coordination constrain the creation of sustainable public value in the health sector. Taken together, the findings suggest that Indonesia’s current investment framework remains only partially aligned with the institutional and industrial capacities needed to address high-burden diseases effectively.

The findings clearly demonstrate a strategic misalignment among the three core components of Moore’s framework (Moore, 1997). Indonesia has an authorizing environment that is supportive in principle, with high-level political mandates for health resilience and a range of available investment tools (Gamalliel and Fuady, 2024). However, as previously argued, the design of these policy instruments is flawed, too broad, and untargeted to be effective. This authorizing environment fails to build the necessary operational capacity in the most critical areas: the upstream pharmaceutical and medical device sectors (Tjandrawinata and Heliany, 2024). The consequence of this misalignment is a systemic failure to maximize public value. This failure manifests not only in economic terms but also in core societal values: continued supply chain vulnerability undermines national security, limited access to affordable diagnostics and treatments compromises health equity, and the inefficient use of public funds undermines public trust (Jin et al., 2024). The current approach implicitly prioritizes the goals of a general industrial policy over the specific and urgent public value of health security.

The findings also connect to the wider applied public management literature. Previous studies emphasized that managerial practices significantly influence service quality, especially in healthcare provision (Angelis et al., 2021). This supports that, beyond investment incentives, operational improvements at the level of hospitals and local service providers are important to building resilience in stroke care. At the same time, research on Indonesia’s New Public Management (NPM) reforms shows that policy design often produces unintended consequences when institutional and cultural capacities are overlooked (Harun et al., 2019). This echoes our finding of a misalignment between Indonesia’s authorizing environment and operational capacity, which constrains the creation of sustainable public value. Thus, this study’s contribution lies in reframing investment incentives as tools for strategic production.

A key conceptual contribution of this study lies in the introduction of “strategic production” as a complement to the well-established notion of strategic purchasing in health management. Strategic purchasing has been widely discussed as a demand-side mechanism for improving efficiency and equity in health financing (WHO, 2025). The supply-side dimension has received far less attention in public management literature. By reframing investment policy as a tool for shaping markets and cultivating domestic capacity in response to disease-burden priorities, this paper expands Moore’s (1997) public value framework into a new domain. Strategic production thus provides public managers with a novel lens to address polycrisis conditions, where reliance on global markets undermines both resilience and equity. In this way, the study contributes not only applied insights for Indonesia but also a broader conceptual advancement relevant to public administration debates on how governments actively create markets in pursuit of public value.

Indonesia’s challenge is not only how to purchase healthcare more strategically, but also how to ensure sufficient domestic production capacity for essential medicines and health technologies. Existing discussions on strategic purchasing primarily focus on the demand side of health financing, while the supply-side dimension remains underdeveloped. This study, therefore, proposes “strategic production” as a complementary concept, where investment policy is used to shape markets and strengthen domestic industrial capacity based on disease-burden priorities. From a public value perspective, investment incentives should not function merely as broad economic tools, but as targeted instruments to reduce supply-chain vulnerability, improve equitable access, and strengthen national resilience. By aligning investment incentives with high-burden diseases such as stroke, governments can move from reactive dependence on global markets toward a more proactive and resilient model of health industry development.

Achieving this strategic alignment between health needs and industrial policy cannot be the view of a single ministry. The complexity of the task, linking epidemiological data to investment regulations and investment promotion, demands a robust network governance approach (WHO, 2024). Effective implementation requires seamless and institutionalized coordination among key actors: the MOH, which holds the disease burden data and defines the country’s health priorities; the MOF, which designs and legislates the investment instruments; the BKPM, which promotes and facilitates investment; and the private sector, which provides the capital and technical expertise.

Public-Private Partnerships (PPPs) are a crucial mechanism for operationalizing this network governance model, particularly for capital-intensive projects such as the construction of new API manufacturing facilities or high-tech rehabilitation centers (Hendraputra, 2026). The existing partnership between the International Finance Corporation (IFC) and Indonesia’s MOH to support private sector projects in the pharmaceutical and medical technology sectors demonstrates this collaborative approach and provides a foundation upon which to build (IFC, 2023). Formalizing these cross-sectoral linkages is essential to ensure that policy is coherent, implementation is coordinated, and the ultimate goal of creating public value is shared across the network.

The importance of network governance is reinforced by international examples that demonstrate how multi-stakeholder coordination between governments, industry, and research institutions can promote resilience and innovation in the health sector. South Korea’s experience demonstrates how targeted public investment, regulatory support, coordinated R&D, and public-private partnerships can strengthen domestic vaccine and biomanufacturing capacity while reducing import dependency during crises (Choi and Lee, 2022). Similarly, Singapore’s experience shows how planned cluster development, through infrastructure investment, investment incentives, and state-supported ecosystem development, has attracted multinational companies and sparked local medical technology and biopharma capabilities (Chan, 2020). These international cases show that network governance requires the alignment of investment incentives with regulatory support, physical infrastructure, and coordinated institutional mandates; for Indonesia’s stroke agenda, integrating strategic production into such a network governance model means that investment tools are designed in collaboration with the MOH, MOF, investment agencies, research institutions, and industry to ensure legitimacy, operational capacity, and sustainability.

This paper advances both conceptual and applied dimensions of public management scholarship. On the conceptual side, it introduces strategic production as a novel complement to strategic purchasing or demand-oriented policy tools, highlighting how public managers can proactively shape supply capacities in response to disease burdens, rather than merely responding to demand. At the same time, this is not a purely theoretical exercise. Through its empirical analysis of Indonesia’s stroke care system, the paper demonstrates how linking investment policy, industrial capacity, and health outcomes can produce actionable policy strategies. By blending theory and praxis, the study speaks to scholars interested in public administration, network governance, and industrial policy, as well as to practitioners seeking resilient health systems in polycrisis settings.

Stroke in Indonesia is both a pressing public health crisis and a strategic opportunity to re-engineer the country’s approach to industry resilience fundamentally. The heavy reliance on imported medicines and medical devices is an unsustainable vulnerability that burdens the country’s budget and restricts citizens’ access to timely and affordable care. This paper has examined this challenge through a public policy lens, answering the research question of how investment policy can be strategically redesigned to build domestic capacity and create public value.

The findings suggest that Indonesia’s current investment framework remains insufficiently aligned with the country’s evolving disease burden and health industry needs. Broad and sector-neutral incentives have not adequately strengthened domestic production capacity for essential medicines and medical technologies, particularly in high-burden areas such as stroke care. In this context, disease-burden evidence can serve not only as a health planning tool but also as a strategic basis for industrial prioritization and investment targeting. By linking investment incentives with public value objectives, strategic production offers a more targeted approach to strengthening supply-chain resilience, improving equitable access to healthcare technologies, and reducing dependence on volatile global markets. Rather than functioning solely as economic instruments, investment policies can operate as market-shaping tools that support long-term health system resilience and national health security.

Theoretically, this study demonstrates the utility of Moore’s Public Value framework as a diagnostic tool for complex socio-economic challenges (Moore, 1997). It reveals how a misalignment between a policy’s authorizing environment and the operational capacity of its delivery system can fundamentally undermine the creation of public value, even when political will and financial resources are available. By introducing the concept of strategic production, this paper also contributes to the discussion on health system management, proposing a more holistic approach that integrates supply-side industrial strategies with demand-side purchasing reforms.

From a policy perspective, the findings suggest that Indonesia should adopt more targeted and coordinated investment strategies linked to high-burden diseases. Potential approaches include enhanced incentives for domestic production of essential health products, dedicated innovation funding for smaller health technology actors, stronger inter-ministerial coordination between health and investment institutions, and expanded public-private partnerships for critical healthcare infrastructure and manufacturing capacity. Such measures could help align industrial policy with long-term health system priorities and strengthen national health security.

These recommendations also align with recent studies that governments need investment instruments that safeguard liquidity and solvency to avoid the failure of strategic financial plans (Bergmann, 2024). Similarly, the use of disease-burden data to prioritize incentives parallels calls for more context-sensitive investment planning in developing countries, where environmental and institutional constraints strongly influence policy outcomes (Ritonga, 2024). By situating the policy recommendations within these applied insights, the study demonstrates both academic and practical relevance for decision-makers.

This study has several limitations. The analysis relies primarily on secondary data sources and does not incorporate direct stakeholder interviews with policymakers, industry actors, or local governments. As a result, the findings should be interpreted as a theory-informed policy analysis rather than a comprehensive account of implementation dynamics. Future research could strengthen this work through field-based studies, stakeholder interviews, and comparative analysis across other high-burden disease sectors in developing countries.