Incentives for Medical Workers and Midwives in Very Remote Areas An Experience from Indonesia

By: Anna Kurniati (BPPSDMK, Kemenkes RI)

The health development toward the healthy Indonesia 2010 suggested that health services should be able to provide effective, good quality, and accessible services while supporting the community empowerment and other related sectors to work together. Adequate human resources for health (HRH) in term of quantity and quality are very crucial as 80% of health service activities depending on the HRH. However, the availability of qualified HRH in adequate number and equally distributed have become a constant issue particularly in rural and remote areas.
Rural and remote areas suffer from shortage of essential health workers such as doctors, midwives, nurses, nutritionists and sanitarians. Most of those health workers are not interested in serving those areas, even if they would, mostly in a very short term. The reasons are many; transport and communication problems, lack of basic and social facilities, low salary, low or no compensation, high living cost, lack of security and unclear career options. Early year 2006, the Ministry of Health of the Republic of Indonesia (MoHRI) found out that approximately 30 % out of 7.500 health centers in remote areas were without medical doctors. Further findings were reported during the Identification on the Need of Health Workers conducted by Center for Planning and Management of Human Resources for Health – MoHRI (CPMHRH) in May 2006. The identification process involved 78 districts in 17 provinces of Indonesia (out of 440 districts/municipals in 33 provinces). The report shown that from 1165 health centers there are 364 health centers (31%) located in remote/underdeveloped/borderland/conflict and disaster areas and other undesirable areas. About 50% of 364 health centers reported having no medical doctors, 18% without nurses, 12% without midwives, 42% without sanitarians, and 64% without nutritionists. Compare to the health centers in ordinary areas, the absence of those types of health workers are much lower, for example only 5% health centers without medical doctors.

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