Multi-stakeholder perspectives on cervical cancer screening implementation in Indonesia: A qualitative study of cervical screening barriers in Banda Aceh.

Indonesia is committed to the WHO's cervical cancer elimination strategy through the National Action Plan for Cervical Cancer Elimination 2023-2030, aiming to achieve 75% screening coverage by 2030. However, current rates remain critically low at 7.02%. This study aimed to explore the multi-stakeholder perspectives to identify implementation barriers and facilitators for policy enhancement. A qualitative descriptive case study was conducted in Banda Aceh (July-August 2025) involving 25 stakeholders: the City Health Office head, 11 Puskesmas heads, 11 coordinators of visual inspection with acetic acid (VIA) test, and 2 community organization representatives. Thematic analysis was conducted using NVivo v.16 to identify key implementation factors. Five major themes emerged: (1) knowledge gaps-screening perceived necessary only when symptomatic despite available information; (2) access paradox-excellent geographic access and flexibility undermined by limited examination rooms, insufficient midwives, and psychosocial barriers (shame, fear, lack of spousal support); (3) financial sustainability- free services threatened by complex National Health Insurance claims and low reimbursement affecting logistics; (4) service quality variation-dependent on cross- sector collaboration and staff competency, with uneven training and limited cryotherapy; and (5) communication challenges-inconsistent digital media use necessitates face-to- face counseling and cadres, though reach remains limited. Implementation faces psychological barriers, capacity limitations, and uneven digital adoption despite strong infrastructure. Priority policy recommendations include: (1) human papillomavirus (HPV) DNA self-sampling to overcome privacy barriers; (2) simplified National Health Insurance claims with adequate reimbursement; (3) systematic competency-building and cryotherapy expansion; and (4) culturally-adapted education integrating local language and religious leaders. In conclusion, strengthening health-system capacity and culturally responsive service delivery is essential to close the gap between national policy commitments and community-level screening uptake, thereby accelerating progress toward Indonesia's cervical cancer elimination targets.