Health Workforce Planning in Indonesia

This study aims to develop a health workforce plan for Indonesia, focusing on an environmental scan, data profiles, critical issues, and implementation strategies.

Running head: HEALTH WORKFORCE PLANNING 1
Health Workforce Planning in Indonesia
(Author’s name)
(Institutional Affiliation)

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Table of Contents
Introduction......................................................................................................................................3
Environmental Scan.........................................................................................................................4
Geography and demography........................................................................................................4
Economic and Political Contest...................................................................................................5
Health Status................................................................................................................................6
Health Workforce Data Profile........................................................................................................7
Stakeholders.................................................................................................................................7
Health Care Workers Profiles and Statistics................................................................................7
Critical Issues...................................................................................................................................9
Strategies Needed to Implement the Workforce Plan....................................................................10
Conclusion.....................................................................................................................................12

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Introduction
The ability of a given state of a country to meet its healthcare objectives primarily
depends on motivation, skills, knowledge, and deployment of individuals required for making
health decisions, plans and delivering health services(Douglas, 2012). The population health
outcomes largely rely on the number of health workers available and the quality of care
delivered(Kurniati, Rosskam, Afzal, Suryowinoto, & Mukti, 2015). However, many nations
especially those who are have been categorized by World Health Statistics Report 2015 as low or
lower middle-income lack enough human resources needed for delivery of essential health
intervention. This may due to various reasons such as migration of health care workers to other
countries, limited population, demographic imbalances, inequality and poor distribution of
human resources, and a poor mix of skills. In order to combat these challenges, such countries
need to formulate strategies and policies that address human resources for convenient health
development objectives that have evidence and sound information(Kurniati et al., 2015).
Therefore, nations should work on health workforce quality development using national
databases and information to produce and distribute enough human resources for health across its
geographical area.
This study intends to develop a health workforce plan for Indonesia. Being one of the
Southeast Asian countries, Indonesia is among the one of the lower middle-income countries as
by WHO Statistic Report in 2015 that has among the largest population in the region and with
vast of burdens of both communicable and non-communicable diseases (WHO, 2015). Due to
that reason, studying the health workforce in this region can provide the basic information for the
development of strategies and recommendations that can be used in making plans and policies
regarding human resources for health in the region and other similar nations. Therefore, this

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study will give an environmental scan for Indonesia, data profiles for the health workforce,
critical issues and challenges arising, and give strategies relevant for the implementation of the
health workforce plan.
Environmental Scan
Geography and demography
Indonesia currently ranks as the fourth nation with the largest population in the world
after the United States, India, and China with a population of 269, 137, 233 people. The country
is located in Southeast Asia with more than 17, 000 islands and it covers about 1.9 million square
miles of land (World Population Review, 2019). More than half of the people in the nation live
in Java Island and its population density is at 140 persons per square kilometer. The population
grows at an annual rate of 1.18%. The country has 33 decentralized regions with 497 districts
and more than 700 languages are spoken (World Population Review, 2019). About 43% of the
population is aged between 25 to 54 years and the mean age of the whole population in the
country is 30years (World Population Review, 2019). The number of youths is expected to go
high in the years to come increasing the nation workforce due to the fact that there is about 25%
of the mean age between 0-14 years (World Population Review, 2019). Below is a map of
Indonesia.
Figure 1 Map of Indonesia

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(World Population Review, 2019)
Economic and Political Contest
The country experienced several economic drawbacks in the late 1990s but since the year
2004, there has been rapid economic growth (WHO, 2011). Although there are about 3% of
Chinese, in Indonesia, they control most of the nation’s wealth and commerce (World Population
Review, 2019). By the year 2009, the Gross Domestic Product was accounted for about 60% of
domestic consumption followed by 31% by investments and 9% from government consumption
(WHO, 2011). The proportion of people living below the poverty line by 2010 was at 31% with
an unemployment rate of 7.4% and an average health budget per individual of 2.5%(WHO,
2011). However, currently, Indonesia is one of the major determinants of the economy in the
Association of South East Asia Nations.
Politically, Indonesia is headed by the President and Vice President directly put to the
office through public elections using a popular vote method (WHO/Indonesia, 2019). The
country is ruled through democracy and it has been undergoing decentralization since the year
1999 where most of the public money has been directed to provincial and district governments.
All governors and district level representatives are also elected by popular vote. Villages

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represent the smallest political units at which the voice of the citizens and prioritization of
community problems are identified (WHO/Indonesia, 2019).
Health Status
This country is on the right track to meet the Millennium Development Goals. Indonesia
values the health of its citizens at which most of the health services are delivered at local levels.
The laws of Indonesia provide that the delivery of clean water, health care, and sanitation should
be the responsibility of the local governments (WHO, 2011). Most of the national health
mortalities are due to cardiovascular diseases representing about 30% of all deaths although
diarrhea leads with 21% of all national health morbidity. Therefore the country has both non-
communicable and communicable disease health burdens (WHO, 2011). To combat these, the
country is developing a disease control program adapting both global and regional strategies.
Below is a table showing the health indicators in the nation.
Table 1 Health Indicators by 2010
Indicators Both Sex by 2010
Life Expectancy 70.2
Crude mortality rate 6.26
Under 5 Mortality rate 41
Maternal mortality rate 228
HIV/AIDS prevalence rate 8.66
% with access to sanitation 80%
% with access to water 52%

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Health Workforce Data Profile
Stakeholders
The health workforce in Indonesia consists of various stakeholders which include the
Ministry of Health, provincial and local governments, the private sectors, national and global
health alliances, and the health care workers (WHO/Indonesia, 2019). The Ministry of Health
provides guidance, policies, and supervisions regarding healthcare delivery, resources utilization,
employment and distribution of health workforce (WHO/Indonesia, 2019). The provisional and
district governments deploy health care workers, distribute and manage all health care resources
at local levels. The healthcare workers directly manage and deliver healthcare workers to the
citizens. Among the healthcare workers in the country include majorly the following thirteen
categories; General practitioners, medical specialists, midwife, nurses, dentist, pharmacists,
dental nurses, pharmaceutical assistants, sanitarians, public health officers, nutritionists, medical
technicians, and physiotherapists(Douglas, 2012). Other than those, the health workforce in
Indonesia includes other hospital staffs and assistants like health records keepers, administrative
officers, cleaners, and other supportive staffs.
Health Care Workers Profiles and Statistics
According to the WHO statistics by 2018, major data that are recorded in Indonesia
regarding health care workforce in Indonesia include medical doctors, nursing and midwifery
personnel, dentistry personnel ,pharmaceutical workers, environment and occupational health
and hygiene personnel, medical and pathology laboratory personnel, physiotherapy personnel,
traditional and complementary medicine workers and community health workers
(WHO/Indonesia, 2019). Below is a table that represents the data profiles for the above workers
between the years 2010, 2012, 2013, 2015 and 2017.

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Table 2 Population of health care workers in Indonesia for the years 2010, 2012, 2013, 2015
and 2017 as indicated by WHO Global Health Observatory Data Repository
yearsMedical
doctors
Nurses
and
midwives
DentistryPharmaceutical
workers
Environmental,
occupation and
hygiene
workers
Medical
and
pathology
laboratory
personnel
physiotherapistsTraditional and
complementary
medicine
Community health
workers
2010 1.391 10.581 0.36 N/A 21336 N/A N/A N/A N/A
2012 3.075 13.601 0.425 N/A 44206 N/A N/A N/A N/A
2013 3.118 11.443 N/A N/A 43293 N/A N/A N/A N/A
2015 2.740 13.001 0.425 1.175 N/A N/A 4866 66 N/A
2017 3.777 20.583 0.548 1.736 N/A N/A N/A N/A N/A
The first four categories which include nurses and midwives, medical doctors, dentists,
and pharmaceuticals are presented as per 10,000 people (WHO, 2019). All the rest are a direct
count of the total number of each category in the whole country. Regarding the population, the
country has very low numbers of health workers meaning health care delivery is at stake
(WHO,2018). Other than that, the country lack community health workers thus community
priority in making health care decisions is not considered. Generally, the country needs to take
immediate actions regarding their healthcare workforce (WHO, 2018). However, the nation
seems to be recruiting a new workforce each and every year meaning there are already some of
the working strategies that need to be enforced or implemented.

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Critical Issues
Following the beginning of decentralization of health care in Indonesia in 2001, the local
districts governments were given the mandate to make health decisions and priorities in their
regions(Kurniati et al., 2015). Due to this reason, Human Resources for Health have been largely
at hands of these local governments which have led to various challenges such as defenses in
findings, attention to healthcare workers and differences in employment rates and work
allowances. This can be well be demonstrated by looking at how workers are inequitably
distributed. For instance, in 2008, North Sulawesi Province had 53.89 medical doctors per
100,000 people as compared to Lampung province which had only 10.36 doctors within the same
population. Other than the inequitable distribution of health workforce, there are other challenges
that affect human resources for health in Indonesia. This includes issues related to recruitment,
planning, and retention of healthcare workers as compared to other neighboring countries. This
has made most of the healthcare workers to migrate to other nations in for look for work leaving
the country in serious workforce problems(Kurniati et al., 2015). In addition to that, Indonesia
lack quality of care related to oversight and effective licensing majorly in private sectors. Due to
poor pay by the district governments, most of the public health workers usually have a second
job in private sectors and thus they are not able to be as effective as required during delivery of
care(Campbell et al., 2013).
Regarding the current population in the country which is around 267million people, the
citizen’s health status has not been met as needed. For instance according to WHO in 2016,
below was the statistics regarding certain data that require health workforce.
Table 3 Factors that may need the country to have more health workforce
Life expectancy for both females and males 71 years and 67 years respectively

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probability of dying in under five years was
25 per 1000 live births
205
Total expenditure on health as % of GDP 2.9
Despite the above data, there are only around nine community health centers and 1765
hospitals in the nation. In order to access quality health services only around 60% of Indonesia
has health insurance(World Health Organization, 2011). Other than that, the available healthcare
workers are not able to meet the required needs in the health facilities. This demonstrates how
serious the conditions are in Indonesia and yet the health workforce is not regarded as a major
priority in healthcare delivery (WHO, 2016). However, the country of Indonesia in their Human
Resources for Health Development Plan year2011-2025 has outlined various strategies they will
use to combat health workforce issues(World Health Organization, 2011). This includes
strengthening planning and regulations related health workers, improving HRH education and
production, ensuring health care workers are equally distributed, and improving supervision and
quality control.
Strategies Needed to Implement the Workforce Plan
In order for Indonesia to cab challenges related to health workforce in the country,
various strategies need to be put into place by both local and national governments (WHO, 2016)
. First both the government needs to provide strategies that can increase healthcare facilities
through funding and thus creating more jobs for absorption and retention of workers(Kurniati et
al., 2015). Promoting both public and private investments can lead to deployment of health care
workers in healthcare majorly in youths and women with medical knowledge and
skills(Heywood, Harahap, & Aryani, 2011). This can be done through the development and

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implementation of health policies by the government that promotes a sustainable health
workforce.
Another strategy that can be used to improve health workforce in Indonesia includes
education and training quality healthcare knowledge and skills throughout the nation(WHO,
2016) . Educating health workers especially to all matters related to the population health
problems can be cheap and promote the increase of work to full potentials(Pozo-Martin et al.,
2017). All unnecessary barriers for absorption and retention should be eliminated and thus
workers are supposed to be trained and equipped with an education that can be utilized for longer
durations(Al-Sawai & Al-Shishtawy, 2015). For instance, Indonesia lacks crucial health care
workers in its health workforce such as community health workers. Community health workers
form a vital branch that links hospital with patients at need in the local communities thus
promoting working efficiency(Schiffbauer, O'Brien, Timmons, & Kiarie, 2008).
Other than that, Indonesia can make sure they finance health care and local governments
with adequate funds for health care services (WHO, 2016). This includes requesting support
from donors and other developed nations, domestic funding into private and public hospitals
where is appropriate, investment of the needed skills, provincial of decent working conditions
and employment of the adequate health workers(Addicott et al., 2015). Indonesia needs to
consider health as a priority issue and thus recognising the need for appropriate health
workforce(WHO, 2010). Health financing policies require both society and political leaders to
come together in order to bring a positive change. In addition to finance, an Indonesia needs to
promote intersectoral collaboration across the nation between both national, regional and district
governments and health sectors in order to archive a good union of workers that allows proper

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health delivery. This, in turn, will lead to an increase in employment of workers and reduce
inequality in the distribution of health resources.
Conclusion
The adequate health workforce is required for a nation to be able to deliver enough health
care. Indonesia has one of the largest population with various burdens of diseases, few hospitals,
and very few health workers. There are various reasons that have led to the existence of poor
health workforce in the country. This includes unequal distribution of workers, failure of
absorption of workers and retention in the healthcare systems, poor coordination, and supervision
of workers and decentralization which led to the negligence of human resource for health by the
local government. However, with proper job creation, education and government support the
health care workforce in the country can be improved.

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