Health Workers for Health Services in Remote, Underserved, Country Borderline Areas and Small Islands
Author: Ministry of Health Republic of Indonesia
Indonesians living in remote areas and on small islands experience problems in accessing quality health services. Central government has previously provided resources to local government to build additional health facilities in remote areas. While this has brought primary health care service closer to the communities, local governments have experienced major difficulties in equipping these health facilities with qualified health workers. A survey conducted in 2006 found that a large number of health centres in these areas have no medical doctors, nurses or midwives. This is due to a general shortage of medical professionals in the country as well as reluctance on the part of existing medical professionals to take up posts in remote areas.
The Health Minister established a taskforce to investigate ways of addressing the shortage of health workers in remote areas.
The taskforce proposed two types of intervention to address shortages in both the short run and the long run:
- Short term intervention: through placement schemes for strategic health workers (doctors, midwives, nurses, sanitarians and nutritionists) in remote locations. This would be done with a specialized contract containing both financial incentives (increased pay) and non-financial incentives (the opportunity to become permanent employees as civil servants). The incentive structure was designed to improve retention of professionals in remote areas.
- Long term intervention: through the provision of financial support for those studying in medical fields with the hopes of increasing the overall supply of medical professionals over time.
The selection of locations for the short run intervention was facilitated by a survey of health facilities in Indonesia. Locations were chosen according to a set of criteria (areas with bad infrastructure, high levels of poverty, lack of social facilities etc.) and locations with limited medical professionals were prioritized. The programme was piloted in 190 remote public health centres in 38 districts. In terms of the long run intervention, the Ministry of Health provided scholarships for Medical Specialist Training, Nursing Training, and Bachelor Degree programs in Community Midwifery in collaboration with 13 medical schools, 9 health polytechnics and 2 public health schools. After being piloted for nearly a year, the project was institutionalized by the Health Minister in 2007 through a Ministerial Decree.
By August 2010, the Ministry of Health had sent 1,018 health workers into remote health centres. This included 477 medical professionals, 140 midwives and 303 community health workers sent to 257 Community Health Centers, and 98 senior residents sent to district hospitals. This has helped address the severe shortage of (and occasionally a complete lack of) health professions in 35 remote districts. Over 2000 scholarships for medical studies have been awarded since 2008, which will increase the overall supply of medical staff in remote areas in the coming years. Project implementation has at times been hampered by budget cuts at central Government level. However, the project received renewed drive and focus in 2010 when the President issued a Presidential Instruction focused on achieving the objectives of the program.
The programme addresses the current shortages of health professionals in remote areas in the short run whilst increasing the overall supply of medical professionals in the country over the longer term. The implementation experience of the programme highlights the vital importance of prioritization and financial commitment from the Ministry of Finance and Central Government in order for the objectives of the programme to be achieved.