Effectiveness and Implementation of PROLANIS for Hypertension in Indonesia: A Systematic Review with RE-AIM Synthesis

Abstract

Hypertension remains a major disease burden in Indonesia; the national chronic disease management program (PROLANIS) in primary care is positioned as a key strategy. Heterogeneous field performance highlights the need for a systematic review of clinical effectiveness and implementation quality. This study aims to synthesize evidence on PROLANIS effects on blood pressure control and to map implementation factors moderating results in first-level health facilities. Systematic literature review following PRISMA 2020. Data sources were Scopus and PubMed (2014–2025). Records identified: 770; after de-duplication/retraction removal, 711 remained for screening; 85 passed title screening; 11 full-text articles were included. Dual-reviewer extraction; appraisal with JBI/CASP/MMAT; effectiveness synthesized with SWiM; implementation factors mapped using RE-AIM. Results. Evidence suggested a favorable direction of effect on blood pressure control and adherence, especially when structured pharmacist counseling, regular monitoring, and physical activity were implemented consistently. Cohort/quasi-experimental studies supported reductions in SBP/DBP and improved adherence; HRQoL tended to improve but was not always statistically significant. RE-AIM mapping indicated that reach/retention, inter-professional adoption, medicine/equipment availability, and documentation fidelity influenced between-facility variation. In conclusion, PROLANIS can improve hypertension outcomes when core components are well executed and documented. Policies linking minimum process indicators (counseling, monitoring, retention) to performance-based incentives may enhance implementation consistency and sustainability.