Abstract
Universal Health Coverage (UHC) is a cornerstone global health target, reaffirmed by the World Health Organization (WHO) and United Nations' pledge to achieve it by 2030. Despite Indonesia's sustained national initiatives, structural barriers persist, including membership gaps, subnational disparities, and elevated out-of-pocket expenditures. This qualitative descriptive study investigates the SUCSES Innovation (Supporting Universal Health Coverage So Express and Sustainable)—a decentralized, village-level model designed to accelerate UHC progress. Conducted at the BPJS Kesehatan Bukittinggi Branch from January 2023 to December 2024, the research engaged purposively selected key informants: branch managers, local government officials, village leaders, and program implementers. Data collection encompassed in-depth interviews, reviews of policy/administrative documents, and membership record analyses. Thematic analysis identified governance mechanisms, implementation strategies, and outcome pathways, yielding four interconnected themes: (1) institutionalizing UHC targets via integration into village certification frameworks; (2) bolstering subnational governance and accountability; (3) enabling community micro-targeting through data-driven outreach; and (4) achieving quantifiable gains in coverage and financial performance. SUCSES implementation yielded ~135,000 new registrations, elevated coverage from 87% to 97%, generated IDR 68 billion in additional revenue, and transformed Agam Regency from zero to 50 certified UHC villages. These results position SUCSES as a scalable, context-adapted governance innovation for decentralized health systems. Recommendations urge wider institutional adoption and alignment of UHC indicators with local development plans to advance Indonesia's 2030 universal coverage ambition.
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