NEAR-ZERO SECONDARY PLASTIC AND DIGITAL-FIRST OPERASIONS IN A PRIMARY CARE FACILITY: A DESCRIPTIVE CASE STUDY WITH COUNTERFACTUAL ANALYSIS AT KLINIK & APOTEK SION, BATAM, INDONESIA

Abstract

Background: Primary healthcare may generate substantial secondary plastic waste through routine medicine repackaging practices. Systematic documentation of plastic reduction efforts in Indonesian primary care facilities remains absent. Objective: To quantify the environmental and economic impact of a near-zero secondary plastic policy combined with digital-first operational practice at Klinik & Apotek SION, Batam. Methods: A descriptive quantitative case study design was employed using 12 months (May 2025 - April 2026) of operational transaction data. A counterfactual scenario was constructed assuming one conventional HDPE plastic bag (±5 grams) per transaction, reflecting standard pharmacy dispensing practice in Indonesia. Actual plastic expenditure data were used to calculate plastic volume avoided and cost avoidance. Sensitivity analysis was performed at 3g and 8g per-bag assumptions to test robustness of the counterfactual estimate. A conflict of interest is disclosed, as the corresponding author serves as the facility owner. Results: A total of 22,086 transactions were recorded. The counterfactual scenario estimated that conventional practice would have generated ±110.4 kg of secondary plastic waste annually at a cost of IDR 4,417,200. Actual HDPE bag expenditure was IDR 11,000, representing ±55 bags used — a secondary plastic reduction exceeding 99.7%. Notably, 71.1% of all transactions required no outer packaging. Paper bags were used in 28.9% of transactions, offered selectively following patient education. All clinical workflows were fully digitalized. Conclusion: A near-zero secondary plastic operational model is demonstrably feasible in Indonesian primary care settings. This facility provides real-world evidence that digital-first operations, combined with patient-centered packaging protocols, can eliminate more than 99.7% of secondary plastic waste while generating measurable cost avoidance. National-scale projections suggest that adoption by 10,000 comparable primary care facilities could prevent over 1,100 tonnes of plastic waste annually. These findings offer actionable evidence for policymakers seeking to embed environmental sustainability standards within Indonesia's ongoing digital health transformation agenda.