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The Production, Distribution, and Performance of Physicians, Nurses, and Midwives in Indonesia: An Update

Author

Listed:
  • Ian Anderson
  • Andreasta Meliala
  • Puti Marzoeki
  • Edo Pambudi

Abstract

Indonesia launched the national health insurance program - Jaminan Kesehatan National (JKN), on January 1, 2014, and aims to achieve universal health coverage (UHC) by 2019. Achieving UHC means not only increasing the number of people covered but also expanding the benefits package and ensuring financial protection. Although the JKN benefits package is comprehensive, a key challenge related to the capacity to deliver the promised services is ensuring the availability, distribution, and quality of human resources for health (HRH). Of Indonesia?s 33 provinces, 29 do not have the WHO recommended ratio of 1 physician per 1,000 population, although Indonesia regularly produces 6,000 to 7,000 new physicians annually. The shortage of nurses in hospitals and health centers (puskesmas) is noticeable despite the large number of graduates. The government?s health worker contract policy (PTT [Pegawai Tidak Tetap]) was the main policy lever to improve the distribution of physicians and midwives; it offered a shorter contract and higher monetary benefits for rural and remote postings. Nevertheless, evolution of the policy over more than two decades of implementation indicates that the outcome has not been totally satisfactory and that distribution problems remain. Physician maldistribution has been particularly affected by the number and concentration of hospitals in urban areas, as well as by government?s policy of allowing dual practice. Aside from HRH production and distribution figures, key information on the quality of Indonesian physicians, nurses, and midwives is limited. The latest data from the 2007 Indonesia Family Life Survey (IFLS) vignettes, which measured diagnostic and treatment ability, showed low average scores across these three integral health worker categories. Indonesia is addressing the quality issue by improving the quality assurance system of health professional education through school accreditation and graduate certification and by strengthening health professional registration and recertification systems. With these issues in mind, if Indonesia is to attain UHC by 2019, significant and concerted effort to improve the availability, distribution, and quality of human resources for health is required.

Suggested Citation

  • Ian Anderson & Andreasta Meliala & Puti Marzoeki & Edo Pambudi, 2014. "The Production, Distribution, and Performance of Physicians, Nurses, and Midwives in Indonesia: An Update," Health, Nutrition and Population (HNP) Discussion Paper Series 91324, The World Bank.
    • Handle: RePEc:wbk:hnpdps:91324
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    References listed on IDEAS

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    2. Finnegan, Amy, 2020. "Effects of a sister's death in childbirth on reproductive behaviors: Difference-in-difference analyses using sisterhood mortality data from Indonesia," Social Science & Medicine, Elsevier, vol. 250(C).

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    Keywords

    access to health care; access to health services; allocative efficiency; anesthesia; antenatal care; back pain; basic health services; birth complications; budgetary ... See More + esources; burden of disease; Center for Health; certification; child mortality; cities; citizens; cleanliness; clinics; communicable diseases; Community Health; contract arrangements; cost-effectiveness; deaths; debt; Decision making; delivery of health services; demand for health; demographic transition; dentistry; developing countries; diabetes; disability; disasters; doctors; economic growth; employment; employment opportunities; epidemiological transition; epidemiology; essential care; essential drugs; expenditures; families; financial incentive; financial incentives; financial protection; freedom of choice; gender equity; general practitioners; glucose; government policies; gross national income; growth in population; health budgets; health care demand; health care financing; health care professionals; health centers; health costs; Health Coverage; Health data; health expenditure; health expenditure Per capita; health facilities; health financing; health information; health information systems; health insurance coverage; health insurance program; Health Organization; health outcomes; health professionals; health promotion; health providers; health resources; health risks; health sector; health sector workers; Health Service; health service delivery; Health Service Management; health service providers; health services; Health Specialist; health spending; health system; HEALTH WORKERS; health workforce; Home Affairs; hospital; hospital beds; hospital sector; hospitals; household level; human resources; ill health; illness; immunization; impact evaluations; implications for health; income; income countries; inequities; Infant; Infant mortality; Infant mortality rate; injuries; insurance coverage; International Community; international comparisons; iron; labor market; labor markets; large population; leading causes; leading causes of death; life expectancy; Life expectancy at birth; live births; Local governments; low income; maternal death; maternal deaths; maternal health; maternal health outcomes; maternal mortality; maternal mortality ratio; maternal nutrition; medical care; medical doctors; Medical Education; medical fees; medical school; medical specialists; medical staff; medical support; midwife; midwifery; MIDWIVES; Millennium Development Goals; Ministry of Education; Ministry of Health; mortality; mother; national health; national health insurance; national level; Natural disasters; nature of health; needs assessment; Neonatal Mortality; newborn; newborns; number of people; nurse; NURSES; Nursing; Nutrition; obstetric services; patient; patients; pediatrics; Pharmacists; PHO; physician; PHYSICIANS; pocket payments; policy decisions; policy development; POLICY IMPLICATIONS; policy lever; policy makers; population growth; population structure; Pregnant women; premature death; prenatal care; primary care; primary health care; private hospitals; private sector; private sectors; private services; progress; Public expenditure; public health; public health care; Public health expenditure; public health providers; public hospitals; public sector; public services; pull factor; Purchasing Power; Purchasing Power Parity; quality assurance; quality of care; quality of services; reducing maternal mortality; referral system; respect; richer countries; rural areas; sanitation; scarce resources; service provision; skill level; social insurance; social insurance system; socialization; surgery; Sustainable Development; traditional healers; training opportunities; tuberculosis; Under-five mortality; urban areas; urban bias; WORKERS; World Health Organization;
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