Background: WHO had provided a framework on the country development of Public Health Emergency Operation Center (PHEOC). This institution was required for the country to manage its public health event, including prevention, rapid detection, and response. As a country comprises of 17000 island and extend to more than 5000 km, the central level of PHEOC was not enough. PHEOC system reform is required to accommodate Indonesia’s specific circumstances particularly in regional level. We outlined the potential of developing sub-national level PHEOC based on existing evidences. Policy Option and Recommendation: Indonesia need a fast and capable resources to be deployed during the surge capacity in Public Health Emergency situation. There are three different policy models for PHEOC at the regional level the base on the current evidence on PHEOC models in various countries. These concepts detailed different command structures for ad hoc agency models, independent agency models, and and Public Health Office (PHO)-based models. Each model has its own advantages and consequences. Conclusions: The Ministry of Health of Indonesia is proposed to adopt the third PHEOC policy model, as the line of command lies under the Province Health Office. The PHO has the ability to mobilize units and access to resources in response to a current public health emergency situation, making this model the most practicable. However, routine training and capacity-building for the local surveillance staff are required to assist PHO in its role as regional PHEOC commander.