ANALISIS KESENJANGAN KEBIJAKAN DAN STRATEGI IMPLEMENTASI PROGRAM PENANGGULANGAN TUBERKULOSIS PADA IBU HAMIL DALAM KERANGKA RENCANA STRATEGIS NASIONAL TB 2025–2029: TINJAUAN KEBIJAKAN DAN REKOMENDASI BERBASIS MANAJEMEN STRATEGIS

Abstract

Tuberculosis (TB) in pregnant women represents a complex public health challenge in Indonesia, with an
estimated 1.09 million incident cases in 2023 and a national Case Detection Rate (CDR) of only 52%. Pregnant
women as a key population group are strategically overlooked in national TB program design, despite well
documented immunological vulnerability and poor perinatal outcomes. The National Strategic Plan for TB 2025
2029 sets ambitious 90-90-90 targets, yet implementation faces unresolved structural gaps. This article analyzes
policy gaps and implementation strategies of TB control programs for pregnant women through a strategic
management-based policy review approach. Methods employed include policy document analysis and systematic
literature synthesis using the McKinsey 7S Framework, Mazmanian & Sabatier’s (1983) Policy Implementation
Theory, and Lipsky’s (1980) Street-Level Bureaucracy Theory. Analysis identifies four main strategic gap
dimensions: (1) fragmented institutional governance between TB and MCH/ANC programs; (2) unsustainable
health financing gaps; (3) fragmented information and reporting systems; and (4) absence of systematic
community engagement in active case-finding among pregnant women. The novelty of this study lies in the
development of the Pregnant Women Policy Gap Analysis Model based on Strategic Management (AKK-IH/MS),
integrating strategic management perspectives, health policy analysis, and TB-pregnancy epidemiology into a
unified analytical framework—an original contribution not previously available in current Indonesian literature.
Evidence-based strategic management recommendations are formulated across three implementation time
horizons to support acceleration toward TB elimination 2030