By: Agus Suwandono, Muharso, Anhari Achadi and Ketut Aryastami
Although at the beginning of program of sending nurses abroad has an objective to solve the problem of ‘surplus’ nurses in Indonesia, the GOI has aware that this program should be seriously manage and prepare in the future. The seriousness of GOI has showed by the MOH new organizational structure in 2005 which has created the Center for Empowering of Profession and HRH for Foreign Countries under the National Board of Development and Empowerment of HRH. Another strength is the efforts of international class for nurse education, sister school system with some Australian Universities and some additional courses for the nurses who want to work at foreign countries. The strengths are also showed by the preparation of mechanism for nurses who want to work abroad in collaboration with nurse professional organization and other related departments in Indonesia, as well as the increasing of the passing rate of the candidates within these 2 years period. Career development after they return to Indonesia has also been prepared. The encouragement of general policy of GOI in supporting the overall manpower development in working abroad is also one of the strengths.
However, several weaknesses are recognized as follows:
1. Ability of speaking and writing in English for Indonesian nurses are still low and vary from one education institution to others, particularly between nurses education institutions in Java and outside of Java,
2. Nursing capabilities (particularly clinical practice and specific nursing procedures) of Indonesian nurses are still weak and unequal,
3. Teaching hospitals for international standard in Indonesia are very limited,
4. Limitation of teachers with international experiences,
5. Due to limited budget, socialization and preparation of information regarding the needs of nurses for foreign countries are inadequate,
6. GOI commitment of budget for international nursing education is still not strong enough, 7. Standard operational procedure for recruitment, selection, empowerment, monitoring and evaluation of Indonesian nurses work abroad is still uncertain, 8. No evaluation and follow up has been taken to the hundreds of Indonesian nurses who worked abroad since 1996, 9. There are still production of nurses with the basic of junior high school carried out by some institution out of Ministry of Health, and 10. Mechanism of coordination and collaboration between national and local is still not effectively carried out.
The opportunities of Indonesian nurses to work in foreign countries are very big, it can be seen by the offers of various countries to Indonesia. However, if Indonesia is not able to fulfill those demands, there will be replaced by nurses from other developing countries who have better capabilities as compared to the Indonesia nurses. These challenges particularly come from other developing countries which are using English as their national language or as their second language.
Based on the above discussion, some Inputs for future policy to the development of nurses for foreign countries are as follows:
1. Nurse for foreign country should not be only a policy to solve the ‘surplus’ problem of nurses, but it should be the sustainable need and policy of the GOI in improving the nurses value, nurses standard quality, nurses technical experience, nurses welfare and country foreign reserved.
2. Nurses for foreign countries should not fully be the responsibility of MOH, but it is also the responsibility of GOI (at least Coordinator Ministry of Social Welfare, Coordinator Ministry of Economics and Finance, Ministry of National Education, Ministry of Manpower, Ministry of Foreign Affairs, Ministry of Law and Human Right and Ministry of Trade), private sectors, professional organization and community organization. High commitment among all of those components needs to be stimulated and created through a policy, implementation and monitoring as well as evaluation team.
3. Quality improvement and create sustainability as well as consistency to the development of international class of nursing schools (academy and health poly-technique for the nurses), sister school system and some additional courses for preparation of nurses for foreign countries.
4. In depth evaluation of nurses who have been experienced in abroad since 1996, use all of their positive and negative experiences as serious inputs for improving the education, training, recruitment and other preparatory mechanism and so forth. Used them as permanent or guess lecturers in the academy of nurses and health poly-technique school of nurses.
5. Improvement of teachers quality and experiences for academy of nurses and health poly-technique school of nurses. For example to give them opportunity to evaluate and monitor the nurses’ performance abroad. This experience is the best way to know what are problems and positive factors of nurses who are working abroad.
6. Improvement the infrastructure of academy of nurse and health poly-technique school of nurses such as nursing laboratory, language laboratory, library, research and development and so forth
7. Creation of standard operational procedure for nurses for foreign countries through regulation and integrated decree of all parties mentioned in the input no 2.
8. Intensive socialization to GOI, private sector, professional organization and community organization about the importance of nursing for foreign countries and the mechanism of participating in this program
9. Improve the commitment of budget allocation of GOI for this program and to solve other weaknesses mentioned in the above discussion such as strengthening the monitoring and evaluation system, placement as well as career development after the nurses return back to Indonesia
The nurse program for foreign countries in Indonesia has been carried out since 1996. At the beginning, this program has attempted to solve the false ‘surplus’ problems of nurses in Indonesia. Recently, however, the MOH seriously concern to this program. It is proven by several efforts to promote the nurse program for foreign countries started from the improvement of education, recruitment and others mechanism related to nurses for foreign countries. Some achievements, strengths, weaknesses, potentials and threats have been discussed in the above paper. Alternative policy inputs for future improvement of this program have also been submitted.
The sub-system of HRH in Indonesia is one of the important sub-systems of NNHSI as one of the stewardship of health development in Indonesia. The objective of this sub-system is mainly the availability of high quality of HRH, the fairness distribution of HRH, and the effectiveness and efficiency HRH utilization to realize the highest achievement of health development in Indonesia. Therefore, although nurses program for foreign countries is very important program and it is really supported, the objective achievements of the HRH sub-system should be firstly prioritized, particularly how the equity and fairness of nurse distribution in Indonesia can be implemented.
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By: Agus Suwandono, Muharso, Anhari Achadi and Ketut Aryastami