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

Anderson, Ian ; Meliala, Andreasta ; Marzoeki, Puti ; Pambudi, Eko

World Bank Group, Washington, DC

关键词: BENEFITS;    FINANCIAL PROTECTION;    HEALTH;    HEALTHCARE DATA;    HEALTHCARE DISTRIBUTION;   

RP-ID  :  91324

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Indonesia launched the national healthinsurance program - Jaminan Kesehatan National (JKN), onJanuary 1, 2014, and aims to achieve universal healthcoverage (UHC) by 2019. Achieving UHC means not onlyincreasing the number of people covered but also expandingthe benefits package and ensuring financial protection.Although the JKN benefits package is comprehensive, a keychallenge related to the capacity to deliver the promisedservices is ensuring the availability, distribution, andquality of human resources for health (HRH). OfIndonesia's 33 provinces, 29 do not have the WHOrecommended ratio of 1 physician per 1,000 population,although Indonesia regularly produces 6,000 to 7,000 newphysicians annually. The shortage of nurses in hospitals andhealth centers (puskesmas) is noticeable despite the largenumber of graduates. The government's health workercontract policy (PTT [Pegawai Tidak Tetap]) was the mainpolicy lever to improve the distribution of physicians andmidwives; it offered a shorter contract and higher monetarybenefits for rural and remote postings. Nevertheless,evolution of the policy over more than two decades ofimplementation indicates that the outcome has not beentotally satisfactory and that distribution problems remain.Physician maldistribution has been particularly affected bythe number and concentration of hospitals in urban areas, aswell as by government's policy of allowing dualpractice. Aside from HRH production and distributionfigures, key information on the quality of Indonesianphysicians, nurses, and midwives is limited. The latest datafrom the 2007 Indonesia Family Life Survey (IFLS) vignettes,which measured diagnostic and treatment ability, showed lowaverage scores across these three integral health workercategories. Indonesia is addressing the quality issue byimproving the quality assurance system of healthprofessional education through school accreditation andgraduate certification and by strengthening healthprofessional registration and recertification systems. Withthese issues in mind, if Indonesia is to attain UHC by 2019,significant and concerted effort to improve theavailability, distribution, and quality of human resourcesfor health is required.