Publication: Indonesia's Doctors, Midwives and Nurses : Current Stock, Increasing Needs, Future Challenges and Options
Loading...
Published
2009
ISSN
Date
2012-03-19
Author(s)
Editor(s)
Abstract
This paper is one of several inputs prepared for a comprehensive Health Sector Review that the Government of Indonesia is currently conducting. It compiles, analyzes and interprets available information on Indonesia's health service providers; doctors, midwives and nurses. Within the limitations imposed by questions about the accuracy and timeliness of current workforce data, the paper describes the stock and distribution of health workers. The paper draws attention to weaknesses in the workforce planning methods in use, and then reviews the human resource policies, including governance structures and the regulatory framework, that affect health workers. It concludes by describing future challenges and some suggested ways of addressing these challenges. In brief, this paper identifies a number of main challenges in the health workforce in Indonesia. These are: (i) there is a shortage and inequitable distribution of medical doctors and specialists; (ii) the education of health professionals is of poor quality and the accreditation and certification system is weak; (iii) health workforce policy development and planning are not based on evidence or demand, but rather on standard norms that do not reflect real need or take into account the contribution of the private health sector; nor have they adapted to a decentralized paradigm, and finally; (iv) the growing and changing demand for health care due to demographic and epidemiological changes will increase the burden on the already ineffective health system. The final section of this paper makes nine suggestions designed to address these main challenges.
Link to Data Set
Citation
“World Bank. 2009. Indonesia's Doctors, Midwives and Nurses : Current Stock, Increasing Needs, Future Challenges and Options. © World Bank. http://hdl.handle.net/10986/3053 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Community Midwifery Education Program in Afghanistan(World Bank, Washington, DC, 2013-08-01)In the immediate post conflict period, Afghanistan's health services were in a deplorable and chaotic state. Access and utilization of reproductive health services and skilled care during pregnancy, childbirth, and the first month after delivery are key to saving those women at risk of dying due to pregnancy and childbirth complications. In a society where women seek care only from female providers, one barrier to expansion of services was the lack of qualified female health workers who could be deployed to remote health facilities. Very few midwives who had trained in Kabul or other big cities were willing to work in rural areas, and there were no education facilities and too few female school graduates who could be trained in the provinces. As maternal health was one of the top priorities of the health sector, the shortage of midwives to provide reproductive health services had to be tackled urgently. Hence the Community Midwifery Education (CME) Program was created. The program aimed not only to train more midwives, but also to ensure both their initial deployment in remote health facilities as well as good retention rates. These aims were realized through the creation of a new health cadre known as "community midwives," along with new competency-based curricula; establishment of CME schools in each province; relaxation of the admission criteria for students; and establishment of a strong accreditation board to ensure qualified midwives were trained by the program. The program's success is attributed to stakeholder strong engagement, equity, and strengthened human resource for health. The program should be expanded to address the continuing shortage of midwives. The Mnistry of Public Health considers the program a successful intervention and believes that there is great potential to replicate this model to train other health professionals and tackle the shortage of other human resources for health.Publication Toward Synergy and Collaboration to Expand the Supply of and Strengthen Primary Health Care in Nigeria’s Federal Context, with Special Reference to Ondo State(World Bank, Washington DC, 2013-01)This study examines an innovative example of the expansion of supply and the strengthening of primary health care to improve key health-related Millennium Development Goal, or MDG indicators through synergy and collaboration between the federal Government of Nigeria (FGN) and state governments in an extreme federal context, and with particular reference to Ondo State. That is, the Nigerian Federal Constitution grants the federal government only very limited and indirect influence or control over the fiscal and financial affairs of state and local governments, such that 'plans, budgets, accounts and procurements are not subject to federal control and scrutiny'. Nor must the lower tiers account to the federal level for how funds transferred to them from the central level are used. The rest of case study is organized as follows. Section two describes the design of the HCP, including its interaction with the rest of the health system; section three discusses the targeting, identification, and enrolment system; section four examines the management of public funds within the HCP; section five analyses the management of the benefits package; section six reviews the information environment and monitoring systems of the HCP; section seven summarizes and analyses the evidence on the key theme of the study, which is the extent to which the HCP is expanding access to, and strengthening, primary health care within the federal system; and section eight looks at the pending agenda for action, drawing on the lessons learned and challenges for the HCP's future. The annexes present the country and health system context; a general overview of health system financing and delivery; a brief description of primary care and key supply-side efforts; and key data on Ondo State, including a description of the state's health system.Publication Private Health Sector Assessment in Mali : The Post-Bamako Initiative Reality(World Bank, 2011)This country assessment of the private health sector in Mali is part of a series of studies designed to deepen understanding of ways to enhance the health policy framework, business environment, and investment climate in which the private health sector operates in African countries. The Malian health system has evolved dramatically since the middle of the 1980s. A large part of the analysis in this report relies on the reprocessing and the mining of existing databases, the financial and macroeconomic models based on those data, and elements reconstructed through triangulation. Those calculations proved indispensable for assessing the main demographic trends in the private sector, for estimating the growth of community centers (CSCOMs) and private mutual insurance, and identifying how to reinforce them. The growth of the private sector is further held back by insufficient educational preparation for practice in the private sector and in rural areas. For-profit and not-for-profit health care providers, pharmacies, and schools should be given beefier access to funding during start-up. Other financial engineering strategies (participation, etc.) could also be devised. The government of Mali has an opportunity to take advantage the large and dynamic private health sector in contributing to its national health care objectives and outcomes. The study describes the various instruments of stewardship towards the private sector that could be used such as information, regulations, financing and direct provision of public services in areas of significant market failure.Publication The Human Resources for Health Crisis in Zambia : An Outcome of Health Worker Entry, Exit, and Performance within the National Health Labor Market(World Bank, 2011-04-26)This report compiles recent evidence on the Zambian health labor market and provides some baseline information on human resources for health (HRH) to help the government address its HRH challenges. Rather than focusing on making policy recommendations, the report is designed to be a source book to benefit and fuel discussions related to HRH in Zambia. Most of the data presented in the report covers the period 2005-08. The report analyzes the national health labor market to better understand the available evidence related to the stock, distribution, and performance of HRH in Zambia (that is, the HRH outcomes). It aims to explain those HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics, that is, the flow of health workers into, within, and out of the health labor market, as well as the core factors influencing these dynamics. Finally, this report examines the issue of access and equity of HRH. It finds that even if health workers are available, in either urban or rural areas, and performing adequately, the wealthy in Zambia have better access to services than the poor. This situation is found in most if not all other countries. The report finds that as far as access to health workers is concerned, the poor generally loose out. It also reveals that even if health workers are available, wealthier segments of the population often continue to have better access to health workers than poorer segments. Wealthier women have the highest probability of receiving any antenatal care. There is an even steeper pro-rich gradient in delivery attendance in Zambia. In contrast to antenatal care, there is little variation across socioeconomic quintiles among those seeking medical treatment for children with diarrhea or cough and fever. The poor are slightly more likely to be visited by a health worker and receive certain services during visits. The factors linked to these variations in use of services remain to be examined (they could be linked to expense, fear of receiving care from an individual belonging to a higher social stratum, or different gender, and so forth). Either way, they should be taken into consideration when planning to improve access for the poor to health care services and providers.Publication The Contribution of Traditional Herbal Medicine Practitioners to Kenyan Health Care Delivery : Results from Community Health-seeking Behavior Vignettes and a Traditional Herbal Medicine Practitioner Survey(World Bank, Washington, DC, 2011-09)This study examines the role that Traditional Herbal Medicine Practitioners (THMPs) play in Kenya in the context of its human resources for health crisis. Two surveys were carried out to obtain evidence. The first documented the choices and perceptions of households in 36 communities on seeking medical assistance for eight common illnesses. The second survey asked 258 THMPs in five provinces to identify their knowledge sources, training, common illnesses treated, forms of payment, challenges, and concerns. Community-derived data show that households make reasonable decisions when faced with difficult circumstances: they prefer hospitals when these are affordable and seek care at clinics and health centers when hospitals are too far away. There is significant self-care and use of pharmacies, although THMPs are preferred for worms and lower respiratory problems. In general, THMPs provide an important though diminishing role in the provision of health care; they are not sought out in situations when inadequate care is dangerous, specifically infant diarrhoea and potential TB. Whilst Human Resources for Health (HRH) policies are urgently required to strengthen the conventional health workforce and increase their accessibility for the poor, policies should not ignore the findings from this study: many of the rural poor currently receive services from a traditional health workforce not linked to, or regulated by, the national government. This paper argues that formal recognition of their role by the government and by the conventional medical associations, and a targeted strategy to strengthen and build on the positive qualities evident in many traditional medicine practices may be beneficial to safeguarding the well-being of the poor.
Users also downloaded
Showing related downloaded files
Publication World Development Report 2006(Washington, DC, 2005)This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.Publication Lebanon Economic Monitor, Fall 2022(Washington, DC, 2022-11)The economy continues to contract, albeit at a somewhat slower pace. Public finances improved in 2021, but only because spending collapsed faster than revenue generation. Testament to the continued atrophy of Lebanon’s economy, the Lebanese Pound continues to depreciate sharply. The sharp deterioration in the currency continues to drive surging inflation, in triple digits since July 2020, impacting the poor and vulnerable the most. An unprecedented institutional vacuum will likely further delay any agreement on crisis resolution and much needed reforms; this includes prior actions as part of the April 2022 International Monetary Fund (IMF) staff-level agreement (SLA). Divergent views among key stakeholders on how to distribute the financial losses remains the main bottleneck for reaching an agreement on a comprehensive reform agenda. Lebanon needs to urgently adopt a domestic, equitable, and comprehensive solution that is predicated on: (i) addressing upfront the balance sheet impairments, (ii) restoring liquidity, and (iii) adhering to sound global practices of bail-in solutions based on a hierarchy of creditors (starting with banks’ shareholders) that protects small depositors.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.