Tjokroprawiro, Brahmana Askandar and Sulistya, Hanif Ardiansyah and Rahma, Annisa Aghnia and Novitasari, Khoirunnisa and Ulhaq, Renata Alya and Yuliati, Indra and Utami, Tofan Widya and Anggraeni, Tricia Dewi (2026) Geographic barriers to gynaecological cancer care in Indonesia: a geospatial and infrastructure analysis. BMJ Open, 16 (3).

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Abstract

Objective: This study aimed to identify underserved regions and evaluate the population coverage based on travel time and distance to hospitals with gynaecologic oncologists in Indonesia.MethodsThe travel time and distance to hospitals with gynaecologic oncologists were evaluated using the Quantum Geographic Information System. Data from 139 gynaecologic oncologists and their affiliated hospitals were obtained from the Indonesian Society of Gynecologic Oncologists (November 2024) and cross-referenced with the Ministry of Health records. The female population density data were sourced from Facebook�s high-resolution settlement layer. Isochrones were generated to estimate travel times and distances using zonal statistics, which facilitated the calculation of population coverage.ResultsA total of 139 gynaecologic oncologists were identified nationwide, practising in 243 hospitals (7.6 of the 3202 hospitals in Indonesia), with a concentration in Java (60.4). 11 of the 38 provinces lack sub-specialists. Population coverage varies sharply: the travel time to a hospital with gynaecologic oncologists is �2�hours for 79.1 of women in Java, compared with 4.9 in Papua; overall, 34.4 reside more than 100�km away from hospitals with gynaecologic oncologists. Hospitals with gynaecologic oncologists are predominantly urban class B general hospitals, and 83.1 participate in the National Health Insurance Schemes. Exploratory district-level correlations showed positive associations between the number of such hospitals and total female population (r=0.44, p<0.001), female life expectancy (r=0.29, p<0.001), per-capita expenditure (r=0.54, p<0.001), female population density (r=0.68, p<0.001), female Human Development Index (r=0.4, p<0.001) and a negative association with land area size (r=�0.15, p<0.001).ConclusionsGynaecological oncology services in Indonesia remain heavily concentrated in Java, leaving nearly one-fifth of women residing more than 100�km away. The travel time is greater than 2�hours for many. Targeted expansion of the gynaecologic oncologists workforce, diagnostic and treatment infrastructure, and sustainable financing mechanisms are required to close these gaps. © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.

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