By: Agus Suwandono, Muharso, Anhari Achadi and Ketut Aryastami
Based on the above general health policies, several operational stewardships of HRH in Indonesia, especially those related to nurse policy has been developed such as: * Policy of HRH Development 2000 – 2010
* Strategic Plan of National Board of Development and Empowerment of
Basically there are 6 general strategies concerning the nurse policy in Indonesia:
1. Planning improvement of nurse
2. Education improvement of nurse
3. Training improvement of nurse
4. Placement improvement of nurse
5. Empowerment of nurse profession
6. Improvement of integrated management of nurse
Planning improvement of nurse in Indonesia has been carried out through: a. Need analysis of nurse, b. Development model of nurse empowerment, c. Development of planning of total number and type of nurse needed, and d. Development of nurse monitoring and evaluation system
Education improvement of nurse in Indonesia has been implemented by MOH in several programs as follows: a. Management development of nurse education, b. Development of educational process of nurse academy, c. Development of HRH of nurse academy, and d. Development of infrastructure of nurse academy
Training improvement of nurse in Indonesia has been developed through several programs as follows: a. Development of management of nurse training, b. Development of methodology and technology of nurse training, c. Maintenance of quality of nurse training, and d. Development of resources of training centers.
Placement improvement of nurse in Indonesia has been applied through the following programs: a. Development of equity model of nurse placement, b. Improvement of quality and self sufficient of nurse, c. Development of education assistance to poor community and community at the remote areas who are interested to be nurses, d. Development of government regulation for equity of nurse distribution, and e. Empowerment of nurses for abroad placement
Empowerment of nurse profession in Indonesia has been carried out through: a. Improvement of self sufficient in nurse profession, b. Development of nurse regulation, c. Performing a net work collaboration between nurse professional organization and nurse academy, and d. Development of council of health professional including nurse professional organization.
Improvement of integrated management of nurse in Indonesia has been implemented through the following programs: a. Improvement of planning and evaluation of National Board of Development and Empowerment of HRH, b. Development of nurse management at national, province and district levels, c.Enforcement of law and organizational management of nurse, and d. Development of nurse information system as part of overall HRH information system.
Total number of HRH in Indonesia in 2003 was 450,427 persons (53% of them or in exceed of 250,000 persons were nurses) in providing health services to approximately 215 million people in Indonesia (Table 1. Trend of Availability of Various HRH in Indonesia 1983 – 1997 and Its Projection to 2010). With the growing of population estimated at 1.35% per year, it has been expected the total population of Indonesia in 2010 will be approximately 236 million people (Table 2. Proportion and Number of Indonesia Population Based on Age, Census 1961 – 1990 and Projection 2000-2020). This amount of population in 2010 needs approximately 1,097,119 HRH with approximately 583,000 nurses. With the total production of nurse approximately 20,000 nurses/year (in range of 18,000 to 22,000 nurses per year), the expected of nurses can be produced within the period of 2003 – 2010 (7 years) will be approximately 140,000 nurses or by the year of 2010, there will be roughly 390,000 nurses in Indonesia. This figure is actually far behind the projected need of 583,000 nurses in 2010 However, due to some policy changes and several other factors, it seems that the total production of nurse in range of 18,000 to 22,000 nurses are over ‘surplus’ of nurse production. In detail, this ‘surplus’ production of nurse is caused by:
1. Low absorption of government and private health sectors. This low absorption is due to the GOI low formation and budget allocation to placement new nurses in public hospital, public health center and other public health care facilities. The GOI has only able to provide formation and budget allocation for maximum of 3,000 nurses yearly. While at the private health sectors, the placement of new nurses has depended on the needs of each private hospital, clinic and other private health care facilities. It is predicted that the private health sectors can only absorb approximately 2,500–3,000 new nurses yearly. Therefore, only 1/3 of the total production of new nurses in Indonesia can be recruited properly. Placement of remaining 2/3 of the total nurse production is still uncertain.
2. Decentralization policy carried out at once at the beginning of 2001 has created some misunderstanding concerning policy and responsibility between national, province and district levels in HRH placement. This misunderstanding has caused some rejection of the local district to the placement of nurses. However, with the revision of decentralization government regulation with the ‘PP 32 2004’, this problem hopefully can be solved in the near future.
3. Inaccessible geographic conditions and inadequate transportation system to most areas out of Java, Sumatra and Bali islands have also created some rejection of nurses to be placement. Most of hospitals, health centers and other health facilities in the eastern part of Indonesia are located in the small islands or in the remote areas with lack of transportation system. These problems have been attempted to be solved by additional compensation to nurses who want to be placement in those areas. However, due to their basic salaries are low and limited budget of the GOI, these additional compensations are not big enough to motivate them to be placement in those remote areas.
4. Uncertainty of future career of the nurses is another important factor. Due to budget limitation, the GOI cannot provide certain fixed future career improvement to all of nurses. Decentralization also provides some difficulties to nurses to move from remote district to other accessible districts.
Based on the above reasons, some ‘surplus’ of the nurses cannot be avoided, however, some efforts by the GOI has to be taken to solve this problem. The concentration of problem solving is still some efforts for equitable distribution of nurses through out of Indonesia. Alternatively, to send abroad those ‘surplus’ nurses are one of the best solutions decided by the GOI.
By: Agus Suwandono, Muharso, Anhari Achadi and Ketut Aryastami