Health Management Challenges in Tuberculosis Control in Archipelagic and Culturally Complex Settings: Evidence from Baumata Timur Village, Eastern Indonesia

Abstrak

Tuberculosis (TB) remains a persistent public health challenge in Indonesia, particularly in archipelagic and remote regions where geographic fragmentation, limited access to health services, and strong socio-cultural practices intersect. This article aims to analyze TB control through a health management perspective by integrating cultural determinants, access barriers, and service delivery systems in Baumata Timur Village, East Nusa Tenggara Province. Using a qualitative secondary analysis of a master’s thesis complemented by national and international literature, this study applies health management frameworks, including Planning–Organizing–Actuating–Controlling (POAC) and access to care models. The findings reveal that TB transmission risks are amplified by communal cultural practices, while health service management remains largely biomedical, centralized, and administratively driven. Weak contextual planning, limited community integration, rigid service delivery, and performance monitoring focused on numerical indicators undermine treatment adherence and equity. The study concludes that TB elimination in archipelagic settings requires adaptive, decentralized, and culturally responsive health management models that prioritize community engagement and continuity of care.