Dana Bantuan Operasional Kesehatan (BOK) merupakan instrumen fiskal utama pemerintah untuk mendukung layanan kesehatan primer, termasuk intervensi spesifik percepatan penurunan stunting. Namun, evaluasi Dana BOK masih lebih sering berfokus pada penyerapan anggaran atau dampak jangka panjang, sementara penilaian terhadap kesesuaian desain alokasi dengan capaian output layanan kesehatan masih terbatas. Penelitian ini bertujuan menilai ketepatan desain alokasi Dana BOK stunting tahun 2024 terhadap capaian output layanan intervensi spesifik penurunan stunting yang diukur melalui Indeks Komposit Output BOK (ICO-BOK), serta menganalisis peran faktor kontekstual daerah dalam hubungan tersebut. Penelitian ini menggunakan desain potong lintang dengan unit analisis 484 kabupaten/kota di Indonesia. Variabel dependen utama adalah skor ICO-BOK (0–100) yang disusun dari indikator capaian intervensi spesifik bidang kesehatan. Variabel independen utama adalah alokasi Dana BOK stunting per balita. Analisis dilakukan menggunakan regresi linier robust, dilengkapi analisis heterogenitas berdasarkan beban stunting awal, status daerah tertinggal (3T), dan kapasitas fiskal daerah, serta uji sensitivitas melalui pendekatan PCA dan transformasi logaritma alokasi anggaran. Hasil analisis menunjukkan hubungan negatif yang signifikan antara alokasi Dana BOK stunting per balita dan skor ICO-BOK pada tingkat nasional. Pola serupa juga ditemukan pada sebagian besar subkelompok wilayah. Hasil uji sensitivitas menunjukkan bahwa arah dan signifikansi hubungan tetap konsisten pada berbagai spesifikasi model. Hubungan negatif yang ditemukan tidak menunjukkan ketidakefektifan Dana BOK, melainkan mencerminkan karakteristik desain alokasi yang bersifat afirmatif dan berbasis kebutuhan. Evaluasi Dana BOK perlu menekankan ketepatan desain alokasi dengan mempertimbangkan kondisi awal dan kapasitas daerah, serta menggunakan indikator output layanan sebagai ukuran kinerja yang proporsional.

The Health Operational Assistance Fund (BOK) is a key fiscal instrument supporting primary health care services in Indonesia, including health-sector specific interventions for stunting reduction. However, evaluations of BOK funding have largely focused on budget absorption or long-term outcomes, while limited attention has been given to assessing whether allocation design aligns with service delivery outputs. This study aimed to assess the alignment of the 2024 BOK stunting allocation design with service delivery outputs, measured using the Composite Output Index of BOK (ICO-BOK), and to examine the role of regional contextual factors in this relationship. A cross-sectional study was conducted using district-level data from 484 districts/cities in Indonesia. The primary dependent variable was the ICO-BOK score (0–100), constructed from indicators of health-sector specific intervention coverage. The main independent variable was BOK stunting allocation per child under five. Robust linear regression was applied, complemented by heterogeneity analyses based on baseline stunting burden, disadvantaged area status (3T), and fiscal capacity, as well as sensitivity analyses using PCA-based indices and logarithmic transformation of allocations. The analysis demonstrated a significant negative association between BOK stunting allocation per child and ICO-BOK scores at the national level. Similar patterns were observed across most regional subgroups. Sensitivity analyses confirmed that the direction and significance of the association remained consistent across alternative model specifications. The negative association observed should not be interpreted as evidence of BOK ineffectiveness. Instead, it reflects the affirmative and needs-based nature of BOK allocation, whereby areas with greater challenges receive higher funding. Evaluation of BOK funding should therefore emphasize allocation design appropriateness within regional contexts and prioritize service delivery outputs as proportional performance measures in cross-sectional analyses.