Indonesia's Doctors, Midwives and Nurses

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Makalah ini adalah salah satu beberapa masukan yang dipersiapkan untuk ulasan sektor Kesehatan komprehensif yang saat ini dilakukan pemerintah Indonesia. Makalah ini berisi kompilasi, analisis dan tafsiran informasi tentang penyedia pelayanan kesehatan Indonesia ; seperti dokter, bidan dan perawat. Makalah ini menarik perhatian metode perencanaan tenaga kerja yang digunakan dan meninjaukebijakan sumber daya manusia, termasuk struktur pemerintahan dan kerangka peraturan yangterkait dengan pekerja kesehatan. Ini menyimpulkan dengan menjelaskan tantangan masa depan dan beberapa cara yang disarankan untuk mengatasi tantangan ini.

Text of Indonesia's Doctors, Midwives and Nurses

IndonesiasDoctors,MidwivesandNurses: CurrentStock,IncreasingNeeds, FutureChallengesandOptions

TheWorldBank January2009

TABLEOFCONTENTS Acknowledgments .....................................................................................................iiListofAbbreviationsandAcronyms.............................................................................................iii ListofFigures ................................................................................................................................v ListofTables..................................................................................................................................v ListofBoxes..................................................................................................................................vi ListofAppendixesandAttachments ...........................................................................................vi

EXECUTIVESUMMARY ...............................................................................................1 CHAPTERONE: INTRODUCTION............................................................................41.1 1.2 1.3 1.4 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3 4.4 5.1 5.2 5.3 6.1 6.2 6.3 6.4 6.5 Objectives....................................................................................................................... 5 ScopeandAudience....................................................................................................... 6 GovernmentStrategyforHumanResourcesforHealth(HRH) ..................................... 7 InternationalComparison .............................................................................................. 8

CHAPTERTWO:

THEPRESENT:INDONESIASHEALTHWORKFORCE ....................10

CurrentStatus/StockandDistributionofHealthWorkersinIndonesia...................... 10 PrivatePublicProviders .............................................................................................. 18 ConsequencesofUtilizationofHealthCareforHealthWorkforce ............................. 20

CHAPTERTHREE:

PRODUCTIONOFHEALTHWORKERS.......................................31

MedicalDoctorsandSpecialistsProduction............................................................... 31 MidwivesandNursesProduction ............................................................................... 33 RegulatoryFramework:Certification,LicensingandAccreditation ............................ 34

CHAPTERFOUR:

HEALTHWORKFORCEPOLICIES.................................................37

HealthWorkforceGoverningBodies ........................................................................... 37 HealthWorkforceEmployment,RecruitmentandDeploymentPolicies .................... 39 ProfessionalismandIncentives.................................................................................... 41 TheImpactofDecentralizationontheHealthWorkforce........................................... 44

CHAPTERFIVE:

INCREASINGNEEDSFORHEALTHWORKFORCE...........................47

GrowingandChangingDemand .................................................................................. 47 HealthWorkforcePlanningMethods .......................................................................... 49 EstimatingIncreasingNeeds ........................................................................................ 50

CHAPTERSIX:

CHALLENGESANDALTERNATIVEFUTURES ...................................53

ShortageandInequitableDistributionofMedicalDoctorsandMedicalSpecialists... 53 LowQualityofHealthProfessionalEducationandWeakSystemofAccreditationof SchoolsandCertificationofGraduates ....................................................................... 53 InadequateHealthWorkforcePoliciesandPlanning .................................................. 54 GrowingandChangingDemandforHealthCare......................................................... 55 NineSuggestedWaysofTakingOnTheseChallenges................................................. 55

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Acknowledgments

This review paper is an input to the ongoing broader Government of Indonesialed Comprehensive Health Sector Review which informs the GoIs next fiveyear National Development Strategic Plan. It is a review paper produced as part of the Health Workforce EconomicSectorWork(P101723)conductedbytheWorldBankinIndonesia. This paper was written by Claudia Rokx (Lead Health Specialist), Puti Marzoeki (Senior Health Specialist), Pandu Harimurti (Health Specialist) of the Jakartabased World Bank Health Team and Elan Satriawan (Assistant Professor, School of Economics) of Gadjah Mada University, Yogyakarta. It draws on consultant reports produced by Mette Davidsen (Public Health Consultant), Jups Kluyskens (Public Sector Management Consultant), Rosalia Sciortino (Public Health Consultant) Pierre Jean (Medical Education Consultant) and Nida Nasution (Health Workforce Policy consultant). We thank Samuel Lieberman (Health Economist, Consultant), Susan Stout (Health Policy Consultant), Kate Tulenko (Health Specialist) and Magnus Lindelow (Senior Health Economist) from the World Bank and Lyn Henderson (Health Advisor) and Jim Tullock(PrincipalHealthAdvisor)fromAusAIDfortheirvaluablereviewof,andcommentson, the draft paper. Special thanks are owed to Joyce Smith (Team Leader, Human Resources Development) and James Darmawan (National Longterm Expert) from GTZ for their input to earlier drafts and to John Giles (Senior Economist), George Schieber (Senior Health Policy Advisor),AjayTandon(SeniorHealthEconomist),AparnaaSomanathan(HealthEconomist),Elif Yavuz (Public Sector Management Consultant) and Eko Pambudi (Research Analyst) from the WorldBankfortheirhelpandguidanceduringthewritingofthispaper. Thepaperwasreviewed,andcommentswereprovided,byNinaSardjunani(DeputyMinisterfor HumanResourcesandReligiousAffairs,BAPPENAS)andArumAtmawikarta(DirectorforHealth and Community Nutrition, BAPPENAS) Abdurachman (Head of Center for Health Human ResourcesPlanning,DEPKES)andUntungSuseno(HeadofHealthPolicyDevelopment,DEPKES), Fasli Jalal (Director General for Higher Education, MONE) and Professor Laksono Trisnantoro (HeadofCenterforHealthServiceManagement,GadjahMadaUniversity).Theirhighlyvaluable commentswereincludedinthefinaldraftofthepaper. ThispaperwaswrittenundertheoverallguidanceofJoachimvonAmsberg(CountryDirector, Indonesia) Emmanuel Jimenez (Sector Director, EASHD) and Muhammad Pate (Acting Sector ManagerEASHD). Josh Estey was responsible for all photography used in this paper and special thanks to Alma Luciatiforfacilitatingthephotography.ThispaperwaseditedbyChrisStewart. Financingforthispaperwasprovided,inpart,bytheDutchgovernment.

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ListofAbbreviationsandAcronymsAAA ADB AFTA AIPKI ASEAN AUK BANPT BDD BKD BKN BPPSDMK CBC CCT CPDMS DAU DEPKES DGHE DIKTI DPR DSP GDS GoI GTZ HPER HRH HWF HWS IBI IDHS IDI IFLS IMR ISN Jamkesmas KDI KDP KKI LAN MCH MDG MENPAN MMR MoH AdvisoryandAnalyticalActivities AsianDevelopmentBank ASEANFreeTradeArea AsosiasiInstitusiPendidikanKedokteranIndonesia(AssociationofMedical EducationInstitutions) AssociationofSoutheastAsianNations AmalUsahaKesehatan(HealthEnterpriseCharity) BadanAkreditasiNasionalPerguruanTinggi(NationalAccreditationBoardfor HigherEducation) BidandiDesa(VillageMidwife) BadanKepegawaianDaerah(RegionalCivilServiceAgency) BadanKepegawaianNasional(NationalCivilServiceAgency) BadanPengembangandanPemberdayaanSumberDayaManusiaKesehatan (NationalInstituteofHealthHumanResourcesDevelopmentandEmpowerment) CompetencyBasedCurriculum ConditionalCashTransfers ClinicalPerformanceDevelopmentandManagementSystem DanaAlokasiUmum(GeneralAllocationGrant) DepartemenKesehatan(MinistryofHealth) DirectorGeneralofHigherEducation PendidikanTinggi(DirectorateforHigherEducation,MoNE) DewanPerwakilanRakyat(PeoplesRepresentativeCouncilIndonesian Parliament) DaftarSusunanPegawai(StaffList) GovernanceandDecentralizationSurvey GovernmentofIndonesia DeutscheGesellschaftfurTechnischeZusammenarbeit(GermanTechnical Cooperation) HealthPublicExpenditureReview HumanResourcesforHealth HealthWorkforce HealthWorkforceandServices(WorldBankfundedproject) IkatanBidanIndonesia(IndonesianMidwivesAssociation) IndonesiaDemographicandHealthSurvey IkatanDokterIndonesia(IndonesianMedicalAssociation) IndonesiaFamilyLifeSurvey InfantMortalityRate IndicatorofStaffNeed JaminanKesehatanMasyarakat(CommunityHealthInsuranceScheme) KolegiumDokterIndonesia(CollegeofIndonesianDoctors) Kecamatan(Subdistrict)DevelopmentProgram KonsilKedokteranIndonesia(IndonesianMedicalCouncil) LembagaAdministrasiNegara(NationalInstituteforPublicAdministration) MaternalandChildHealth MillenniumDevelopmentGoals KementerianNegaraPendayagunaanAparaturNegara(MinistryofState ApparatusReform) MaternalMortalityRate MinistryofHealth

iii

MoHA MoNE MRA MTKP NCD PBL PER PNPM PNS PODES PPNI PTT PUSDIKLAT PUSDIKNAKES Puskesmas PUSPRONAKES PUSRENGUN Repelita Sakernas SIB SIMPEG SIMPPSDMK

SIP SPK Susenas TBA UCT UGM UKP3KR WB WFME WISN WHO

MinistryofHomeAffairs MinistryofNationalEducation MutualRecognitionAgreement MajelisTenagaKesehatanProvinsi(ProvincialHealthWorkforceCouncil) NonCommunicableDisease ProblemBasedLearning PublicExpenditureReview ProgramNasionalPemberdayaanMasyarakat(NationalProgramforCommunity Empowerment) PegawaiNegeriSipil(PermanentCivilServant) PotensiDesa(SurveyofVillagePotential) PersatuanPerawatNasionalIndonesia(IndonesianNationalNursesAssociation) PegawaiTidakTetap(Temporary/contractedcivilservant/doctor) PusatPendidikandanLatihan(CenterforInserviceEducationandTrainingMoH) PusatPendidikanTenagaKesehatan(CenterforHealthWorkforceEducation) PusatKesehatanMasyarakat(CommunityHealthCenter) PusatPemberdayaanProfesidanTenagaKesehatanLuarNegeri(Centerfor ForeignHealthPersonnelandProfessionalEmpowerment