There were 1765 hospitals and 9.133 community health centers in Indonesia in 2010. The MOH planned to increase the number of community health centers with approximately 12.514 units by year 2019 and 14,826 units by year 2025. Furthermore, the development of hospitals is targeted to achieve the ratio of 1,5 beds per 1000 population by 2019 and 2 beds per 1000 population by year 2025.
But what is a health system without a strong workforce right? Even more important, is the number of health workers meaningful if the quality is poor? Let’s find out what the status of health workforce is in Indonesia.
We know from our previous blog that the population density throughout the country is quite divers due to geographic diversity. This also makes the provision of equitable health care services more difficult. Especially in the remote areas acces to health care services in puskemas (government-mandated community health clinics) is a big issue. The same counts for the provision of the sufficient numbers of competent health workers in those areas. Furthermore, it poses a serious challenge for achieving the goals of JKN (scroll down for the blog on JKN ; ) ) and health development.
Luckily, the ratio of health workers to the overall population increased in Indonesia, which rapidly increased the overall number of health workers. Moreover, it’s more than the minimum number recommended by the WHO, which is 2.3 doctors, nurses and midwives per 1,000 population. So where did the increase came from? Well, much of the increase came from the private sector. You know how? They invest in medical schools. About 60 per cent of the 72 medical schools in Indonesia are private!
Does this means that Indonesia is there yet? No, there is always space for improvements.
Although the number of health workers increased, the achieved numbers are still insufficient to meet population growth and therefor the growing demand for health care.
Do you know on which level the shortfall is especially?
It’s at the primary health care level (puskesmas). Also, the shortfalls of midwives and nurses in hospitals are a concern, since Indonesia needs to respond to the growing burden of Non Communicable Diseases (NCD) and injuries. And thus, the double burden of disease, such as the double burden of malnutrition! And alongside, should try to reduce maternal and infant mortality. Furthermore, there is also a shortage of other key health workers for public health and health promotion.
So what are the targets the Government wants to achieve in the future? You can find them in the tabel underneath which present the ratio per 100.000 population.
[ Source: The Indonesia Human Resources for Health Development Plan Year 2011 – 2025]
Than there is the distribution problem. Remember from our first blog within the Indonesian context section, that the country is quite different geographically, with all its Island. So imagine how you would distribute health care is such a way that it’s provided in an equal manner? Well the geographical distribution of health workers has been a longstanding challenge in Indonesia. And as of today, 30 of the 33 provinces do not have the WHO recommended standard of 1 physician per 1,000 population yet.
So what are the contributing factors of this impaired geographical distribution of health care? Well, Indonesia has a dual practice system, which means that health personnel is allowed to work in both public and private facilities. This is allowed in order to relieve budgetary pressure on government. However, it is also a contributing factor to mal-distribution of health personnel, particularly among specialist doctors.
So does the Government put effort to solve this problem?
Yes, the Government of Indonesia both central and local level implemented a range of programs and policies to improve distribution and impact of health workers, but more work is needed. Additionally, mal-distribution of health workers in underserved and remote areas is of special concern and needs more attention. However, there are no specific policies for human resources in these areas currently. And next to that, a distribution policy has not considered the need of these specific regions.
So, what about the quality of the workforce?
The competency of health workers is very important, since a lack of it will decrease people’s trust in the health care system and moreover, decrease the performance of the health system. Currently, the competency of the health workers in Indonesia is insufficient to respond to the challenges of service provision. Furthermore, because Indonesia does not have enough health workers, maximum benefit is needed from current health workers (and this will increase workload and pressure really). So what is important to improve this competence in health workers? Well, it starts with the quality of training facilities! At this moment there is much variability whiting these facilities and only half of the schools are accredited.
What are the plans to improve the HRH situation in Indonesia?
According to the HRH plan (with the vision that “all people have access to qualified health workers”), beter and sufficient amount of workforce should be achieved with the following four missions:
1. Strengthening regulation and planning for HRH development.
2. Improving the production/ HRH education.
3. Assuring the equitable distribution, well utilized and well developed of HRH.
4. Improving supervision and quality control of HRH in health services.
So time to come in action!
Written by: Jessica
Health sector review. Policy briefs 2015 – 2019. Australia Indonesia Partnership for Health Systems Strengthening (AIPHSS). Retrieved 05 December 2016. Retrieved from: http://aiphss.org/wp-content/uploads/2014/12/Kumpulan-Policy-Brief_English_Bagian-I-23Nov2014.pdf
The Indonesia Human Resources for Health Development Plan Year 2011 – 2025 , summary. The World Health Organization. Retrieved 05 December 2016. Retrieved from: http://www.who.int/workforcealliance/countries/indonesia_hrhplan_summary_en.pdf