Strategic Investment Pathways for Healthcare Micro-Enterprises: A SWOT Analysis of Independent Midwifery Practices in Malang, Indonesia

  • Chavid Moyo Jaladri Universitas Islam Negeri Sayyid Ali Rahmatullah Tulungagung, Indonesia
  • Agung Winarno Universitas Negeri Malang, Indonesia
  • Puji Handayati Universitas Negeri Malang, Indonesia
  • Subagyo Universitas Negeri Malang, Indonesia
DOI: https://doi.org/10.54783/ijsoc.v8i4.1705
Keywords: Investment Strategy, Independent Midwifery Practice, SWOT Analysis, Healthcare Micro-enterprise, Qualitative Case Study, Malang.

Abstract

The sustainability and growth of independent midwifery practices (Praktik Bidan Mandiri, PBM) are critical for enhancing maternal and child healthcare access in Indonesia, particularly in urban and rural settings. However, these small-scale healthcare enterprises face significant challenges in securing investment for development. This study aims to formulate strategic investment recommendations for PBMs in Malang City and Malang Regency by identifying their internal and external strategic factors. A qualitative case study approach was employed, utilizing in-depth interviews and focus group discussions with 15 midwives and 5 healthcare stakeholders. Data were analyzed using thematic analysis and structured into a SWOT (Strengths, Weaknesses, Opportunities, Threats) matrix. The results delineate key strengths (e.g., trusted community relationships, personalized care) and weaknesses (e.g., limited capital, informal management). Major opportunities include government insurance schemes (JKN) and digital health trends, while threats encompass regulatory uncertainty and competition. The cross-analysis generates four strategic investment quadrants: aggressive (S-O), diversification (S-T), turnaround (W-O), and defensive (W-T). The discussion emphasizes that investment strategies must be context-specific, aligning with the distinct operational environments of urban versus rural practices. This study contributes to the literature on healthcare micro-enterprise financing by providing a grounded, context-sensitive SWOT framework to guide investors, policymakers, and midwives in making informed, sustainable investment decisions for practice growth.

References

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., & Khusun, H. (2019). Universal health coverage in Indonesia: Concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

Al-Dmour, R. H., Al-Qassab, M. A., & Amin, A. (2020). The impact of social media marketing on patient trust and loyalty in private healthcare clinics. International Journal of Healthcare Management, 14(4), 1121–1131. https://doi.org/10.1080/20479700.2020.1755811

Antlöv, H., Wetterberg, A., & Dharmawan, L. (2016). Village governance, community life, and the 2014 Village Law in Indonesia. Bulletin of Indonesian Economic Studies, 52(2), 161–183.

Anwar, S., & Nurwati, N. (2021). The role of village fund (Dana Desa) allocation in accelerating rural health and sanitation outcomes in Indonesia. Journal of Asian Finance, Economics and Business, 8(3), 1159–1168. https://doi.org/10.13106/jafeb.2021.vol8.no3.1159

Bates, D. W., & Bitton, A. (2020). The future of digital health and telehealth in primary care. The Lancet Digital Health, 2(7), e341–e343.

Bhandari, N., & Smith, J. (2020). Task-sharing and collaborative primary healthcare networks: Strengthening referral efficiency between rural mid-level providers and secondary hospitals. Social Science & Medicine, 258, 113098 .https://doi.org/10.1016/j.socscimed.2020.113098

Bonifasius, B., Kayika, I. P. G., Abdul madjid, O., Seno Adjie, J. M., & Marceliano Rumopa, H. I. (2024). Effectiveness of the Telemedicine Approach on Maternal Health Practices among Pregnant Women in Rural Areas. Indonesian Journal of Obstetrics and Gynecology, 179–185. https://doi.org/10.32771/inajog.v12i3.2100 Cited by: 7

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

Brennan, M. L., & Browne, J. (2021). Sustaining continuity of care: The impact of relational trust and family-centered midwifery care in rural and underserved communities. Midwifery, 99, 103009. https://doi.org/10.1016/j.midw.2021.103009

Chang, H. H., & Huang, W. C. (2006). Application of a quantification SWOT analytical method. Mathematical and Computer Modelling, 43(11-12), 1279–1290.

D'Ambruoso, L., Martha, E., & Norheim, O. F. (2010). Miscarriage, abortion or stillbirth? Maternal health in rural Indonesia. Qualitative Health Research, 20(8), 1088–1100.

Darmawan, A., Pratiwi, I. N., & Sari, K. (2021). Sustainability challenges of independent midwifery practices in rural Indonesia: A qualitative study. BMC Health Services Research, 21(1), 345. https://doi.org/10.1186/s12913-021-06348-w

Dartanto, T., Rezki, J. F., Pramono, W., Bintara, H., Siregar, C. H., Moertiono, R. B., & Usman. (2020). Participation of informal sector workers in Indonesia's national health insurance system. Development Studies Research, 7(1), 32–42.

Dharmayanti, I., Tjandrarini, D. H., & Ipa, M. (2022). Disparities in access to maternal healthcare facilities across urban and rural settings in Indonesia: A spatial equity analysis. BMC Health Services Research, 22, 1421.https://doi.org/10.1186/s12913-022-08821-2

Dorsey, E. R., & Topol, E. J. (2020). Telemedicine 2020 and the future of connected health in rural and isolated settings. The Lancet, 395(10227), 859. https://doi.org/10.1016/S0140-6736(20)30424-4

Ensor, T., Quayyum, Z., Nadjib, M., & Sucahya, P. (2009). Public funding for community-based skilled birth attendants: The case of the midwife in the village in Indonesia. Health Policy and Planning, 24(1), 32–40.

Fattah, M. A., & Hastuti, R. (2022). Competition and collaboration in urban primary healthcare: A case of midwife clinics in Indonesia. Journal of Health Management, 24(1), 156–170. https://doi.org/10.1177/09720634221077945

Frankenberg, E., Suriastini, W., & Thomas, D. (2005). Can expanding access to basic healthcare services improve children's health status? Lessons from the Indonesian 'bidan di desa' program. Food and Nutrition Bulletin, 26(2_suppl2), S211–S229.

Fuady, A., Anindhita, M., Haniifah, M., Ahsan, A., Sugiharto, A., Haya, M. A. N., Pakasi, T., Kusuma, D., Solikha, D. A., Ali, P. B., & Widyahening, I. S. (2024). Bridging the gap: financing health promotion and disease prevention in Indonesia. Health Research Policy and Systems, 22. https://doi.org/10.1186/s12961-024-01206-7

Ghaffari, M., & Rakhshanderou, S. (2021). Enhancing maternal and child health literacy through digital mobile platforms: A systematic review of community interventions. Journal of Medical Internet Research, 23(7), e26532. https://doi.org/10.2196/26532

Halcomb, E., & Ashley, C. (2020). Australian primary health care nurses and midwives during COVID-19: A qualitative study of business continuity and operational vulnerability. Collegian, 27(6), 661–666. https://doi.org/10.1016/j.colegn.2020.08.007

Helms, M. M., & Nixon, J. (2010). Exploring SWOT analysis – where are we now? A review of academic research from the last decade. Journal of Strategy and Management, 3(3), 215–251. https://doi.org/10.1108/17554251011064837

Hensher, M., & McGrail, M. (2020). Small-scale primary care sustainability: Overcoming low volume and geographic vulnerability in rural clinical micro-enterprises. Human Resources for Health, 18(1), 58.https://doi.org/10.1186/s12960-020-00501-5

Hull, T. C., & Riono, P. (2014). Women’s reproductive healthcare in Indonesia: Challenges and opportunities for private midwives. Asia-Pacific Journal of Public Health, 26(4), 341–352.

Karfin, K., Hasrun, A., Rokhimah, R., Masseni, M., & Kahinah, D. I. (2024). Assistance with Empirical Assessment of Increasing Community Welfare Through Village Fund Management. Teumulong: Journal of Community Service, 2. https://doi.org/10.62568/jocs.v2i4.148

Koblinsky, M., Moyer, C. A., Calvert, C., Campbell, J., Campbell, O. M. R., Feigl, A. B., Graham, W. J., Liang, J., Marks, Z., Matthews, Z., Montagu, D., Penn-Kekana, L., Powell-Jackson, T., Neves, M., van den Broek, N., & Lawn, J. E. (2016). Quality maternity care for every woman, everywhere: A call to action. The Lancet, 388(10057), 2307–2320.https://doi.org/10.1016/S0140-6736(16)31333-2

Kurniasari, N. D., & Setyonaluri, D. (2020). Financial barriers to quality improvement in private midwifery practices in Indonesia. The International Journal of Health Planning and Management, 35(1), e1–e11. https://doi.org/10.1002/hpm.2836

Kutzin, J., Sparkes, S. P., & Soucat, A. (2021). Financing health systems for universal health coverage: A decade of analysis and reform. Health Systems & Reform, 7(1), e2003696. https://doi.org/10.1080/23288604.2021.2003696

Lewis, B. D. (2017). Local government spending and service delivery in Indonesia: The impact of fiscal decentralization on maternal health. The Journal of Development Studies, 53(9), 1438–1453.

Mahendradhata, Y., Trismantoro, L., Listyadewi, S., Soewondo, P., Marthias, T., Harimurti, P., & Prawira, J. (2017). The Republic of Indonesia health system review. World Health Organization. https://apps.who.int/iris/handle/10665/254716

Marmot, M., & Allen, J. J. (2014). Social determinants of health equity: The role of primary health care and community networks. Health Promotion International, 29(suppl_1), i146–i154. https://doi.org/10.1093/heapro/dau032

Mars, M., & Scott, R. E. (2017). Telemedicine in rural and remote settings: Overcoming geographical barriers in primary care. Journal of Medical Internet Research, 19(4), e120.

Meliala, A., Hort, K., & Trisnantoro, L. (2013). Addressing the unequal geographic distribution of specialist doctors in Indonesia: The role of the private sector and incentives. Human Resources for Health, 11(1), 30.

Merali, H. S., Lipsitz, S., Hevelone, N., Gawande, A. A., & Lashoher, A. (2020). Audit-and-feedback and peer-mentoring strategies to support rural health workers facing limited continuous professional development. Bulletin of the World Health Organization, 98(6), 401–412.https://doi.org/10.2471/BLT.19.245803

Novignon, J., Nonvignon, J., & Arthur, E. (2018). Purchasing arrangements and financial sustainability of healthcare providers under national health insurance schemes in developing economies. BMC Health Services Research, 18, 554.https://doi.org/10.1186/s12913-018-3375-7

Pisani, E., Kok, M. O., & Nugroho, K. (2017). Indonesia’s road to universal health coverage: A political journey. Health Policy and Planning, 32(2), 267–276.

Porter, M. E., & Lee, T. H. (2013). The strategy that will fix healthcare: Value-based healthcare delivery. Harvard Business Review, 91(10), 50–70.

Pratomo, H., Laksono, A. D., & Wulandari, R. D. (2021). Challenges of the national health insurance (JKN) implementation for primary care providers in Indonesia: A systematic review. Journal of Public Health Research, 10(3), jphr.2021.2237. https://doi.org/10.4081/jphr.2021.2237

Putri, L. P., & Trisnantoro, L. (2021). The commercialization of primary healthcare: The rise of chain clinics and its competitive pressures on independent family practices in developing urban centers. Health Policy and Planning, 36(8), 1269–1279. https://doi.org/10.1093/heapol/czab064

Radnor, Z. J., & Osborne, S. P. (2013). Lean: A failed theory for public services or a missed opportunity? Developing operational efficiency in healthcare ecosystems. Public Management Review, 15(2), 265–287. https://doi.org/10.1080/14719037.2012.748820

Renfrew, M. J., McFadden, A., Bastos, M. H., Campbell, J., Channon, A. A., Cheung, N. F., Silva, D. R. A. D., Downe, S., Kennedy, H. P., Malata, A., McCormick, F., Wick, L., & Declercq, E. (2014). Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129–1145. https://doi.org/10.1016/S0140-6736(14)60789-3

Ronsmans, C., Scott, S., Qomariyah, S. N., Achadi, E., Braunholtz, D., Marshall, T., Pambudi, E., Witten, K. H., & Graham, W. J. (2009). Professional assistance during birth and maternal mortality in two Indonesian districts. Bulletin of the World Health Organization, 87(6), 416–423.

Sethi, B. A., Sethi, A., Ali, S., & Aamir, H. S. (2020). Impact of digital health applications and social platforms on managing reputation and community medical practice during health disruptions. Pakistan Journal of Medical Sciences, 36(COVID19-S4), S77–S82. https://doi.org/10.12669/pjms.36.COVID19-S4.2760

Setyonaluri, D., & Aninditya, F. (2021). Rural-urban disparities in maternal healthcare utilization in Eastern Indonesia. BMC Health Services Research, 21(1), 845.

Short, S. D., & McDonald, J. (2021). Professional survival strategies for primary care clinicians: Coalition building, resource pooling, and collective bargaining against corporate medical groups. Social Science & Medicine, 270, 113645. https://doi.org/10.1016/j.socscimed.2020.113645

Smith, J., & Siriwardhana, C. (2020). Financial sustainability of small-scale private healthcare providers in low-resource settings: A scoping review. Globalization and Health, 16(1), 86. https://doi.org/10.1186/s12992-020-00613-z

Sulistyawati, S. (2019). The pivotal role of community midwives in achieving maternal health targets in Indonesia. Journal of Pregnancy and Child Health, 6(2), 392. https://doi.org/10.35248/2376-127X.19.6.392

Susanto, B. T., & Kurniawan, R. (2022). Barriers and facilitators to telemedicine adoption in primary healthcare settings in developing countries. International Journal of Medical Informatics, 161, 104721.

Ten Hoope-Bender, P., Nove, A., Sochas, L., Matthews, Z., Homer, C. S. E., & Pozo-Martin, F. (2019). The ‘Dream Team’ for sexual, reproductive, maternal, newborn and adolescent health: An adjusted service target model to estimate the ideal mix of health professionals to cover population need. Human Resources for Health, 17(1), 90. https://doi.org/10.1186/s12960-019-0430-0

Thabrany, H. (2019). Jaminan Kesehatan Nasional: The Indonesian road to universal health coverage. PT RajaGrafindo Persada.

Trisnantoro, L., Hendrartini, S., Susilowati, T., & Hafidz, F. (2014). The role of private providers in the era of National Health Insurance in Indonesia. Journal of Health Policy and Management, 2(1), 15–28.

Weihrich, H. (1982). The TOWS matrix—A tool for situational analysis. Long Range Planning, 15(2), 54–66. https://doi.org/10.1016/0024-6301(82)90120-0

Widiyanti, N. P., Widarini, N. P., & Suarjana, I. K. (2024). The Factors Influencing Normal Childbirth Among Midwives Providing National Health Insurance Services in Tabanan Regency. Jurnal Ilmiah Kebidanan (The Journal of Midwifery), 12, 174–184. https://doi.org/10.33992/jik.v12i2.3629

World Bank. (2020). The Village Fund Program: Supporting infrastructure and primary healthcare in rural Indonesia. World Bank Policy Research Report.

World Health Organization. (2018). Delivering quality health services: A global imperative for universal health coverage. World Health Organization, World Bank Group, and OECD. https://doi.org/10.1787/9789264300309-en

Wulandari, L. P. L., & Kurniawati, W. (2018). Business management challenges for midwife entrepreneurs in Bali, Indonesia. International Journal of Healthcare Management, 11(4), 311–317. https://doi.org/10.1080/20479700.2017.1390180

Yin, R. K. (2018). Case study research and applications: Design and methods. Sage Publications.

Published
2026-10-21
How to Cite
Jaladri, C. M., Winarno, A., Handayati, P., & Subagyo. (2026). Strategic Investment Pathways for Healthcare Micro-Enterprises: A SWOT Analysis of Independent Midwifery Practices in Malang, Indonesia. International Journal of Science and Society, 8(4), 404-420. https://doi.org/10.54783/ijsoc.v8i4.1705
Issue
Vol 8 No 4 (2026): International Journal of Science and Society (IJSOC)
Section
Articles

Copyright (c) 2026 International Journal of Science and Society

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Ownership of copyright
The copyright in this website and the material on this website (including without limitation the text, computer code, artwork, photographs, images, music, audio material, video material and audio-visual material on this website) is owned by IJSOC and its licensors.
 
Copyright license
IJSOC grants to you a worldwide non-exclusive royalty-free revocable license to:
   - view this website and the material on this website on a computer or mobile device via a web browser;
   - copy and store this website and the material on this website in your web browser cache memory; and
   - print pages from this website for your  use.
   - All articles published by Academic Journals are licensed under the Creative Commons Attribution 4.0 International License. This permits anyone to copy, redistribute, remix, transmit and adapt the work provided the original work and source is appropriately cited.
IJSOC does not grant you any other rights in relation to this website or the material on this website.   In other words, all other rights are reserved.
For the avoidance of doubt, you must not adapt, edit, change, transform, publish, republish, distribute, redistribute, broadcast, rebroadcast or show or play in public this website or the material on this website (in any form or media) without  appropriately and conspicuously citing the original work and source or ACADEMIC JOURNALS prior written permission.  
 
Permissions
You may request permission to use the copyright materials on this website by writing to compliance@ijsoc.goacademica.com.
 
Enforcement of copyright
IJSOC takes the protection of its copyright very seriously.
 
If IJSOC discovers that you have used its copyright materials in contravention of the license above, IJSOC may bring legal proceedings against you seeking monetary damages and an injunction to stop you using those materials.  You could also be ordered to pay legal costs.
 
If you become aware of any use of IJSOC' copyright materials that contravenes or may contravene the license above, please report this by email to Compliance@ijsoc.goacademica.com.
 
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to Compliance@ijsoc.goacademica.com.