One of the issues in the provision of health care faced by Indonesia concerns the disparities between the number of health care workers available in urban and rural areas. For example, in 2006, there were 36.18 physicians per 100,000 residents available in urban parts of Indonesia, while there were only 5.96 in rural areas. These disparities were greatest in provinces outside Java and Bali (Rokx et al., 2010, p.43).

Since the 1970s, physicians and midwives are allowed to operate in dual practice. This means that while working in the public system, they can get additional income from working in private practices outside public working hours. It was hoped that this would improve health worker retention, particularly in rural and remote areas as well as to increase the supply for service by incentivising the provision of longer work hours. In 2007, almost 70 per cent of puskesmas physicians and approximately 90 per cent of midwives were reported to have taken up additional private practice (Rokx et al., 2010, p.42).

The dual practice policy, however, may have not been entirely successful as it has been reported that the number of new graduates seeking employment in rural and remote areas has decreased, perhaps because there are fewer opportunities for private practice. Instead, shortening the mandatory service period as part of one of the governments contracting programmes (PTT) from three years to six months increased the number of health workers willing to take up remote postings (Rokx et al., 2010, pp.17,42).

A second issue faced by the Indonesian health system concerns the high turnover rates. According to a study investigating patterns of nurse turnover rates in a private hospital in East Java, turnover rates were higher than acceptable (between 12-34%) (Dewanto & Wardhani, 2018, p.1). Factors associated with the risk of turnover include being aged up to 30 years, unmarried, and working for more than 3 years in the hospital. Personal drivers were most commonly cited as motivating the nurses’ resignation (e.g., moving locations to follow their spouses or families, getting married, having children, following a pregnancy program, and continuing their education). Other drivers to turnover are accepting job offers from other organizations and dissatisfaction with the original hospitals’ working conditions. Nurse turnover rates have consequences for patients, doctors, the other nurses, and the hospitals.

This results in a gap between the manpower available to respond to current and projected needs for different professions within public hospitals. The ‘Development Plan for Healthcare Manpower 2011-2025’ also offers estimates around the cost of human resources planning in healthcare at national level. Estimates include cost for training and education for each profession.

References:

Dewanto, A., & Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: A preliminary study at private hospitals in Indonesia. BMC Nursing, 17(Suppl 2), 1–7. https://doi.org/10.1186/s12912-018-0317-8

Kementerian Kesehatan Republik Indonesia. (2011). Rencana Pengembangan Tenaga Kesehatan Tahun 2011 – 2025. September.

Rokx, C., Giles, J., Satriawan, E., Marzoeki, P., Harimurti, P., & Yavuz, E. (2010). New Insights Into the Provision of Health Services in Indonesia: A Health Workforce Study. https://books.google.com/books?id=7l7NnxfGfycC&pgis=1