Balinese Traditional Medicine under the Bali Governor Regulation No. 55/2019: Policy Implementation, Utilization Gaps, and Future Integration
DOI:
https://doi.org/10.24843/JKB.2026.v16.i01.p06Keywords:
Balinese traditional medicine, traditional healer, health policy, integration, wellness tourismAbstract
This study evaluates the implementation of Bali Governor Regulation No. 55/2019 on Balinese Traditional Medicine (BTM) across traditional healers (pengusada), community health centers (Puskesmas), and hospitals. A quantitative descriptive survey was conducted in 2023 using structured online questionnaires distributed to 64 pengusada, 111 Puskesmas leaders, and 38 hospital directors. Data were analyzed using descriptive statistics. The regulation strengthened pengusada legitimacy, with 70% reporting improved recognition. While 91% of Puskesmas have integrated BTM services, hospital utilization remains low, with 70.6% reporting fewer than ten monthly visits. Key barriers include shortages of certified personnel, limited funding, weak infrastructure, and exclusion from National Health Insurance (BPJS) coverage. Nevertheless, 98.2% of facility leaders support integration with conventional healthcare and wellness tourism. Strengthening certification, financing mechanisms, and reimbursement inclusion is essential for sustainable integration within Bali’s healthcare system
References
Achan, G. K., Eni, R., Kinew, K. A., Phillips-Beck, W., Lavoie, J. G., & Katz, A. (2021). The Two Great Healing Traditions: Issues, Opportunities, and Recommendations for an Integrated First Nations Healthcare System in Canada. Health Systems and Reform, 7(1). https://doi.org/10.1080/23288604.2021.1943814
Arsana, I. N., Sudiartawan, I. P., Sudaryati, N. L. G., Wirasuta, I. M. A. G., Armita, P. M. N., Warditiani, N. K., Astuti, N. M. W., Santika, I. W. M., Wiryanatha, I. B., Cahyaningrum, P. L., & Suta, I. B. P. (2020). Pengobatan Tradisional Bali Usadha Tiwang. Jurnal Bali Membangun Bali (Vol. 1, Issue 2, pp. 111–124). Badan Riset dan Inovasi Daerah Provinsi Bali. https://doi.org/10.51172/jbmb.v1i2.113
Asa, G. A., Fauk, N. K., McLean, C., & Ward, P. R. (2024). Medical tourism among Indonesians: a scoping review. BMC Health Services Research, 24(1), 49. https://doi.org/10.1186/s12913-023-10528-1
Augsberger, A., Young, A., Toraif, N., Morris, M., & Barnett, K. G. (2023). Youth engagement to achieve health equity: Are healthcare organizations and leaders prepared?. American Journal of Community Psychology. 71(3–4), 410–422. https://doi.org/https://doi.org/10.1002/ajcp.12656
Carè, J., Steel, A., & Wardle, J. (2021). Stakeholder attitudes to the regulation of traditional and complementary medicine professions: a systematic review. Human Resources for Health, 19(1), 1–36. https://doi.org/10.1186/s12960-021-00579-y
Carrie, H., Mackey, T. K., & Laird, S. N. (2015). Integrating traditional indigenous medicine and western biomedicine into health systems: A review of Nicaraguan health policies and miskitu health services. International Journal for Equity in Health, 14(1), 1–7. https://doi.org/10.1186/s12939-015-0260-1
Chung, V. C. H., Ho, L. T. F., Leung, T. H., & Wong, C. H. L. (2021). Designing delivery models of traditional and complementary medicine services: A review of international experiences. British Medical Bulletin, 137(1), 70–81. https://doi.org/10.1093/bmb/ldaa046
Chung, V., Wong, S.Y.S., Woo, J. and Griffiths, S.M., (2021). Integrating traditional Chinese medicine services in primary healthcare in Asia: Policy lessons from Hong Kong. Health Policy, 125(2), pp.169–176.
Darmawijaya, A.A.G., Utama, I.G.B.R. and Paturusi, S.A., 2019. The typology of wellness tourism in Bali. Journal of Business on Hospitality and Tourism, 5(2), pp.307–318.
Dini, M., & Pencarelli, T. (2022). Wellness tourism and the components of its offer system: a holistic perspective. Tourism Review, 77(2), 394–412. https://doi.org/10.1108/TR-08-2020-0373
Farooq, S., Sheikh, S., Dikomitis, L., Haq, M. M. U., Khan, A. J., Sanauddin, N., Ali, M. W., Ali, J., Khan, M. F., Chaudhry, I., Husain, N., Gul, M., Irfan, M., Andrews, G., Kaistha, P., Shah, S. M. U., Azeemi, I., Hamid, S., Minhaz, A. Lewis, M. (2023). Traditional healers working with primary care and mental health for early intervention in psychosis in young persons: protocol for the feasibility cluster randomised controlled trial. BMJ Open, 13(7), 1–13. https://doi.org/10.1136/bmjopen-2023-072471
Global Wellness Institute. (2023). Global Wellness Economy Monitor 2023. In Global Wellness Economy Monitor. https://globalwellnessinstitute.org/wp-content/uploads/2023/11/GWI-WE-Monitor-2023_FINAL.pdf
Global Wellness Institute. (2024). Global Wellness Economy Monitor 2024.
Goniewicz, K., Carlström, E., Hertelendy, A. J., Burkle, F. M., Goniewicz, M., Lasota, D., Richmond, J. G., & Khorram-Manesh, A. (2021). Integrated healthcare and the dilemma of public health emergencies. Sustainability (Switzerland), 13(8), 1–13. https://doi.org/10.3390/su13084517
Hisyam, M. A., Damyati, A. R., Khambali Hambali, K. B. M., & Toksöz, H. (2024). Tri Hita Karana and Islamic Ethics: Bridging Universal Values for Social Harmony and Environmental Sustainability. Teosofi: Jurnal Tasawuf Dan Pemikiran Islam, 14(2), 167–194. https://doi.org/10.15642/teosofi.2024.14.2.167-194
Hoenders, R., Ghelman, R., Portella, C., Simmons, S., Locke, A., Cramer, H., Gallego-Perez, D., & Jong, M. (2024). A review of the WHO strategy on traditional, complementary, and integrative medicine from the perspective of academic consortia for integrative medicine and health. Frontiers in Medicine, 11(June), 1–15. https://doi.org/10.3389/fmed.2024.1395698
Kessler, C. S., Perera, P. K., Puthiyedath, R., & Dhruva, A. (2024). Editorial: The increasing relevance of traditional medicine systems for the primary health care sector and general practice: global research perspectives. Frontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1533361
Kim, H., Kang, H.C. and Kim, J., 2020. Trends in the utilization of Kampo medicine in Japan: Analysis of health insurance claims data. Traditional Medicine Research, 5(3), pp.111–121.
Kim, J. K., Kim, K. H., Shin, Y. C., Jang, B. H., & Ko, S. G. (2020). Utilization of traditional medicine in primary health care in low-and middle-income countries: A systematic review. Health Policy and Planning, 35(8), 1070–1083. https://doi.org/10.1093/heapol/czaa022
Kleinman, A. (1980). Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry (1st ed., Vol. 5). University of California Press. https://doi.org/10.2307/jj.2711689
Kompas.com (2020). Penjelasan Ahli soal Terapi Uap Arak Bali Mempercepat Kesembuhan OTG Corona. Tersedia di: https://regional.kompas.com/read/2020/07/24/11571121/penjelasan-ahli-soal-terapi-uap-arak-bali-mempercepat-kesembuhan-otg-corona?page=all (Diakses: 20 Agustus 2025).
Krah, E., de Kruijf, J., & Ragno, L. (2018). Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in Rural Northern Ghana. Journal of Community Health, 43(1), 157–163. https://doi.org/10.1007/s10900-017-0398-4
Madan S, Sembhi J, Khurana N, Makkar K, Byati P. Yoga for Preventive Health: A Holistic Approach. Am J Lifestyle Med. (2022) Jan 4;17(3):418-423. doi: 10.1177/15598276211059758. PMID: 37304753; PMCID: PMC10248378.
Meikassandra, L., Astawa, I.B.M. and Sudana, I.M., (2020). Wellness tourism in Ubud: A qualitative approach to study the aspects of wellness tourism development. Journal of Tourism and Hospitality Management, 8(2), pp.57–66.
Mendive, F., Giovannetti, C., & García Arce, S. (2023). Ancient medicine for a modern disease: traditional Amazonian medicine to treat substance use disorders. The American Journal of Drug and Alcohol Abuse, 49(6), 691–704. https://doi.org/10.1080/00952990.2023.2264466
Mildawani, I., Asmiwyati, I., Apriyanti, R., & … (2024). The Application of Tri Hita Karana Principles in Landscape Architecture and Urban Planning: A Case Study of Kedonganan Traditional Village, Bali. EVOLUTIONARY …. http://esiculture.com/index.php/esiculture/article/view/741
Mirta, I., Suryana, I. N. M., & Candranegara, I. M. W. (2023). Implementation of The Sad Kertih Concept in The Development of A Spiritual Tourism Area Based on Green Tourism in Nusa Penida District, Klungkung Regency. EAI: Innovating Research https://doi.org/10.4108/eai.28-10-2022.2328244
Nooteboom, L., De Beer, C., Heek, E., & Vermeiren, R. (2023). Engaging youth in research, education, and practice: a workshop on various forms of youth participation. International Journal of Integrated Care, 23(S1), 165. https://doi.org/10.5334/ijic.icic23657
Octaviani, N., Meliana, M., & Yudhistira, P. G. A. (2024). Encouraging Pro-Environmental Behavior Through Environmental Communication Based on Tri Hita Karana. Journal of Tourism Sustainability, 4(2), 73–82. https://doi.org/10.35313/jtospolban.v4i2.122
Park, Y. L., & Canaway, R. (2019). Integrating Traditional and Complementary Medicine with National Healthcare Systems for Universal Health Coverage in Asia and the Western Pacific. Health Systems and Reform, 5(1), 24–31. https://doi.org/10.1080/23288604.2018.1539058
Patwardhan, B., Chorghade, M., Vaidya, A.D.B. and Chopra, A., (2023). Ayurveda and integrative medicine: Evolving global health paradigms. Journal of Ayurveda and Integrative Medicine, 14(1), p.100638.
Pedersen, D., Engel, S., & Sheridan, L. (2024). The Impact of Neoliberalism on Crisis Management in Bali’s Tourism Sector. Tourism Planning & Development, 21(6), 862–880. https://doi.org/10.1080/21568316.2024.2366408
Pemerintah Provinsi Bali. (2020). Peraturan Daerah Provinsi Bali Nomor 6 Tahun 2020 Tentang Penyelenggaraan Kesehatan, Provinsi Bali
Pengpid, S., & Peltzer, K. (2019). Use of traditional medicines and traditional practitioners by children in Indonesia: Findings from a national population survey in 2014-2015. Journal of Multidisciplinary Healthcare, 12, 291–298. https://doi.org/10.2147/JMDH.S203343
Presiden RI. (2023). Undang-Undang Republik Indonesia Nomor 17 Tahun 2023 Tentang Kesehatan.
Presiden RI. (2024). Peraturan Pemerintah (PP) Nomor 28 Tahun 2024 tentang Peraturan Pelaksanaan Undang-Undang Nomor 17 Tahun 2023 tentang Kesehatan.
Purnamawati, I. G. A., Jie, F., & Hatane, S. E. (2022). Cultural Change Shapes the Sustainable Development of Religious Ecotourism Villages in Bali, Indonesia. Sustainability (Switzerland), 14(12), 1–15. https://doi.org/10.3390/su14127368
Putri, N. M. L. K. (2022). Pengobatan tradisional di RS Bali Mandara obati sakit non medis. detikBali. Diakses dari Detik.com. 24 Mei 2022
Rinto, R., Iswari, R. S., Mindyarto, B. N., & Saptono, S. (2023). Bridging the generational gap: Exploring youth understanding on ethnobotanical knowledge and its integration in higher education curricula. Ethnobotany Research and Applications, 26. https://doi.org/10.32859/era.26.48.1-16
Rumah Sakit Umum Daerah Bali Mandara. (2025, March 7). Efforts to develop traditional health services at RSUD Bali Mandara. RSUD Bali Mandara. Retrieved from https://rsbm.baliprov.go.id/upaya-pengembangan-pelayanan-kesehatan-tradisional-di-rsud-bali-mandara/
Shim, J. and Lee, H., 2017. Acupuncture and moxibustion in South Korea: Integrative medicine perspectives. Integrative Medicine Research, 6(4), pp.341–349.
Shim, J. M., & Lee, Y. S. (2017). The association between the use of biomedical services and the holistic use of traditional East Asian medicine: A national survey of outpatients in South Korea. BMJ Open, 7(12), 1–6. https://doi.org/10.1136/bmjopen-2017-018414
SINDOnews.com (2020). Ini Penjelasan Tim Peneliti soal Arak Bali untuk Terapi COVID-19. Tersedia di: https://daerah.sindonews.com/read/111406/174/ini-penjelasan-tim-peneliti-soal-arak-bali-untuk-terapi-covid-19-1595516837 (Diakses: 20 Agustus 2025).
Situmorang Y.. (2018). Pelayanan Kesehatan Tradisional Integrasi Di Indonesia: Tantangan Dan Kemajuan Terkini. Kementerian Kesehatan RI.
Steel, A., Foley, H., Bugarcic, A., Adams, J., Leach, M., & Wardle, J. (2024). Designing the Contemporary Implementation of Traditional knowledge and Evidence (CITE) framework to guide the application of traditional knowledge in contemporary health contexts: a Delphi study. Evidence & Policy, 1–23. https://doi.org/10.1332/17442648Y2024D000000037
Suatama, I. B. (2019). Multikulturalisme Usada Bali. In Widya Kesehatan. core.ac.uk. https://core.ac.uk/download/pdf/229113646.pdf
Suatama, I. B. (2021). Usada Bali Modern. In Angewandte Chemie International Edition, 6(11), 951–952.
Subawa, N.S., Budiartha, I.K., Dewi, I.G.A.A.O. and Nurkholis, 2023. Exploring the hidden potential of Bali’s domestic wellness tourism: An empirical analysis. International Journal of Tourism Research, 25(4), pp.567–579.
Subramaniam, T., Vashu, D., & Khan, R. U. (2025). Capturing the healing journey of medical and spiritual tourism: a systematic literature review. Journal of Spirituality in Mental Health, 27(4), 515–533. https://doi.org/10.1080/19349637.2024.2438085
Sugata, I. M., Ayu Kartika, I. G. A., Puspita Apsari , D., & Windra Wartana Putra, I. G. N. A. (2025). The Cultural, Pharmacological, and Spiritual Significance of Tri Ketuka in Balinese Healing and Yoga. Jurnal Kajian Bali (Journal of Bali Studies), 15(2), 770–796. https://doi.org/10.24843/JKB.2025.v15.i02.p13
Suharmiati, S., Laksono, A. D., Nantabah, Z. K., & Kristiana, L. (2023). Traditional health services utilization in rural Indonesia: does socioeconomic status matter?. Rural And Remote Health, 23(3), 7701. https://doi.org/10.22605/RRH7701
Surpi, N. K., Sudiana, I. G. N., Arta Widana , I. K., & I Ketut Sudharma Putra. (2025). Revitalizing Ancient Balinese Yoga: A Strategic Framework for Sustainable Spiritual Tourism Development Anchored in Divine Transcendence. Jurnal Kajian Bali (Journal of Bali Studies), 15(3), 1190–1221. https://doi.org/10.24843/JKB.2025.v15.i03.p11
Udiana, G. K., & Bagiastra, I. N. (2024). Pengobatan Tradisional Bali Empiris Dalam Peraturan Gubernur Bali Nomor 55 Tahun 2019 Tentang Kesehatan Tradisional Bali. Jurnal Kertha Semaya, 12(2), 1–14. https://doi.org/10.24843/KS.2024.v12.i02.p01
Utama, I.G.B.R. and Nyandra, M., 2021. Bali wellness tourism and spa industry development: Opportunities and challenges. Journal of Tourism Economics and Policy, 3(1), pp.45–60.
von Schoen-Angerer, T., Manchanda, R. K., Lloyd, I., Wardle, J., Szöke, J., Benevides, I., Martinez, N. S. A., Tolo, F., Nicolai, T., Skaling-Klopstock, C., Parker, T., Suswardany, D. L., van Haselen, R., & Liu, J. (2023). Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO’s current and future strategy. BMJ Global Health, 8(12), 1–7. https://doi.org/10.1136/bmjgh-2023-013150
World Health Organization (WHO). (2013). WHO traditional medicine strategy: 2014–2023. Geneva: WHO.
World Health Organization (WHO). (2019). Global report on traditional and complementary medicine 2019. Geneva: WHO.
Zhang, Y., Tian, X., Chen, Z., Hu, Z., Li, H., Zong, X., Li, A., Zhang, F., Chen, Y., Zhang, H., Yan, L., Liang, N., Shi, N., & Wang, Y. (2025). Policy research on the role of traditional medicine in emergency health system construction based on the PMC index model: evidence from China. BMC Complementary Medicine and Therapies, 25(1). https://doi.org/10.1186/s12906-024-04743-4













