Recent changes in human resources for health and health facilities at the district level in Indonesia: evidence from
Peter Heywood1, Nida P Harahap, Siska Aryani
1Menzies Centre for Health Policy, University of Sydney, NSW, Australia. pfheywood@gmail.com.
Background:
There is continuing discussion in Indonesia about the need for improved information on human resources for health at the district level where programs are actually delivered. This is particularly the case after a central government decision to offer doctors, nurses and midwives on contract the chance to convert to permanent civil service status. Our objective here is to report changes between 2006 and 2008 in numbers and employment status of health staff in three districts following the central government decision.
Methods:
Information was derived from records at the district health office and, where necessary for clarification, discussions with district officials.
Results:
Across the three districts and all public sector provider categories there was an increase of almost 680 providers between 2006 and 2008 - more than 300 nurses, more than 300 midwives and 25 doctors. The increases for permanent public servants were proportionately much greater (43%) than the total (16%). The increase in those who are permanent civil servants was greatest for nurses (51%) and midwives (35%) with corresponding decreases in the proportion of staff on contract. There was considerable variation between the three districts.
Conclusions:
There has been a significant increase in the number of healthcare providers in the 3 districts surveyed and the proportion now permanent public servants has increased even more than the increase in total numbers. The changes have the effect of increasing the proportion of total public expenditure allocated to salaries and reducing the flexibility of the districts in managing their own budgets. Because public servants are allowed private practice outside office hours there has also been an increase in the number of private practice facilities offering health care. These changes illustrate the need for a much improved human resources information system and a coherent policy to guide actions on human resources for health at the national, provincial and district levels.
Related Concept Videos
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:28International Nursing Organizations II
The WHO provides expert team support, including funding, vaccines, testing, and treatment tools at the country level to fight...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:11Secondary Healthcare System
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...