The study generated several themes related to the integration of traditional medicine services into public health centers, including user preferences for using traditional medicine, success factors of integration, and challenges of improvement of the existing integration. In this study, the integration of traditional health services in public health centers was conducted through a traditional medicine polyclinic, in addition to other polyclinic services such as maternal and child health polyclinic, dental health polyclinic, and general medicine polyclinic. Traditional healthcare in Indonesia is developing rapidly, particularly after the issuance of a new omnibus health law (Law No. 17 of 2023). Previously, traditional healthcare only focused on promotive and preventive services; however, at present, this type of healthcare also covered curative services. Traditional health workers can provide services at healthcare facilities through traditional medicine polyclinics. In the absence of traditional health workers, conventional health workers who are certified in traditional health skills as stated in the Indonesian Minister of Health Regulation (Law No. 103 of 2014) concerning traditional medicine services can provide traditional medicine services in public health centers.
This study revealed that the integration of traditional medicine into public health centers has various benefits, such as the availability of alternative treatments, service innovation in public health centers, and an increase in the number of traditional medicine users. The integration of traditional medicine is a new option for users who do not like and are bored of taking chemical drugs because of the side effects and those who are seeking an alternative healthcare option that is back to nature. The use of traditional medicine as the sole treatment in Indonesia is still quite high (14). Another study in Indonesia on health-seeking behavior found that in the treatment process, most people prefer is to combine conventional medicine and traditional medicine (15).
The integration of traditional medicine has become a model of service innovation that is expected to improve the quality of health services in accordance with the preferences of Indonesians. It also enables the government to ensure the safe and standardized delivery of traditional medicine services. This is also in line with users’ preferences for utilizing traditional medicine in public health centers because of safety factors, competent service providers, adequate infrastructure, and guarantee of sterilization of equipment. Service safety is an important issue from the user’s point of view. Several studies have revealed quite worrying reported of adverse events in the use of traditional medicine. Several cases related to errors in the provision of traditional medicine have been reported. A study on adverse events in traditional medicine practices between 1999 and 2010 in Korea showed 9624 records of side effects; 522 of which were related to herbal medicine. Liver damage was the most frequently reported side effect. A total of 1389 records reported infections, pneumothorax, and burns. These side effects were associated with physical therapy (n = 285) or acupuncture/moxibustion (n = 1104) (16). Thus, to ensure patient safety, integrated traditional medicine inevitably must be implemented in public health centers.
Traditional medicine services consist of empirical, complementary, and integrated traditional medicine. An important issue in healthcare is patient safety and security. Pharmacovigilance is defined as “the science and activities concerned with the detection, assessment, understanding, and prevention of side effects or other drug-related problems.” Pharmacovigilance systems involve the systematic collection, aggregation, and analysis of suspected adverse drug reactions for signal generation (drug safety hazards), communication, and risk management. This also includes the promotion of safe and effective use of medicinal products. Pharmacovigilance aims to improve patient care and safety regarding medicine use and support public health programs by providing reliable and balanced information to assess the risk–benefit profile of medicines. Recently, its scope has expanded to include herbal medicine, traditional and complementary medicines, vaccines, and other health products. At present, pharmacovigilance includes issues beyond direct patient concerns, such as medication errors, lack of efficacy reports, and product quality assessments (17), and should be considered in the integration of traditional and conventional medicine in public health centers.
Traditional medicine is a cultural heritage in Indonesia that has been recognized as a form of local wisdom that needs to be preserved. Traditional healing systems are sociocultural phenomena. To study more deeply the customs and processing systems from the perspective of local communities, this traditional healing practice has also attracted the attention of anthropologists. This is known as ethnomedicine, which refers to traditional medical practices related to cultural interpretations of health, diseases, and how to treat and cure them (18). Local wisdom in the public in terms of treatment has various forms, such as ingredients, skills, or even thought processes. Among the Sundanese (West Java), several traditional medicines are used to cure diseases, for example, undur-undur to overcome asthma problems, cat’s whiskers for kidney problems, kabeling leaves for fever and chills, beruntus leaves for body odor, and cucumber, noni, young papaya, or mangala banana flower for hypertension (19). In Bitombang Tua Village, Bontoharu Subdistrict, Selayar Islands Regency, the people of Old Bitombang Village, Selayar Village (South Sulawesi), used 23 plant species with medicinal properties as traditional medicine. These species are divided into 18 families, and Euphorbiaceae family with three species is the most widely used. The leaves are the most widely used part of the plant (66%). In addition, local wisdom of using medicinal plants has three categories: (i) how to collect medicinal plant ingredients, (ii) how to mix medicinal plants, and (iii) when to consume medicinal plants (20). The preservation of traditional healthcare in our healthcare system is crucial, particularly in public health centers. These centers can make both individual and public health efforts by considering various factors. Despite modern advancements in medicine, the majority rely on traditional medicine. Public health centers must provide affordable and culturally suitable services. In general, people will feel comfortable if they can freely choose the treatment that suits their lifestyle (21), either traditional or conventional medicine, or choose the type of traditional medicine.
Moreover, the expected healthcare system provides satisfaction to the users. Satisfaction with services is an important indicator because user satisfaction is often linked to organizational performance. Variables that influence service satisfaction include responsiveness, empathy, guaranteed certainty, rates, service benefits, service promotion, and ease of service access (22, 23). In this study, users expressed satisfaction with service delivery, treatment outcomes, and service providers. Service providers who provide comfort to patients will improve the patient’s recovery, as the study observing the interaction of doctors and patients showed that a smile and friendliness can promote patient recovery (21). The use of traditional medicine can improve the user’s health in general. Studies have proven that patient satisfaction with the outcomes is the main variable that encourages someone to use the service or recommend it to others (24, 25).
However, this study has weaknesses because of the lack of government policy in implementing integration; financial challenges because the National Health Insurance Scheme does not cover herbal medicines, weak advocacy, and research opportunities; and the lack of training for conventional health practitioners in herbal medicine (26). The obstacles conveyed by the research participants are also nearly the same, particularly the availability of traditional health workers. In Indonesia, traditional healthcare providers are supposed to be provided by traditional health workers; however, their availability is limited. To address this issue, medical professionals are trained in traditional medicine practices such as acupressure, cupping, and herbal medicine. Ensuring continuity of care is an important aspect of the provider’s role. Patients who have received satisfactory care have praised culturally proficient nurses who are better equipped to understand and assess their cultural values (27).
This study has limitations, including the possibility of selection bias by randomly selecting interview respondents, even though data saturation was achieved. This random technique enabled us to miss respondents who had richer experience in using traditional medicine services. In addition, the concerns of patients who did not use traditional medicine services were not addressed in the study. Their statements may indicate the reasons why traditional medicine has not been an option, which needs to be considered in the development of an integration program. Future studies should aim to increase the number of participants by not using random sampling techniques to overcome this issue. In addition, further research can be conducted to explore the effectiveness of traditional medicine in treating specific diseases.