Human Resources for Health Country Profile of Indonesia

The Public Health Reform Roadmap by the Ministry of Health put priority reforms on financing health care; drugs and health equipment availability; health management in the remote, country borderline areas and outer islands including human resources for health (HRH); and healthcare services. In the Strategic Plan document of the Ministry of Health year 2010-2014, HRH development is one of top eight priorities in health development. It includes several strategic activities such as HRH planning and management, pre-service and in service trainings, HRH quality including registration and certification and other management and technical support for HRH development program. Along with most social sectors, the health sector has been undergoing a process of decentralizing many responsibilities from central ministry to the district level particularly to the Provincial and District Health Offices. This has had implications on human resource planning and management which include the need for accurate and timely data and information on HRH. Most of the data required for this HRH country profile is still limited or incomplete. It has become clear that there is an urgent need to strengthen national health information system. Some key issues in HRH information need to address including weak coordination among stakeholder, inadequate use for decision making, various capacity of human resources in data processing of each level and lack of timely reporting and feedback. Special attention is required at both regional and national levels to create an up-to-date HRH information system. Health services are provided by both public and private institutions. In general, the ratio of health workers per 1000 population has increased from 1,42 per 1000 population in year 2009 to 2,11 per 1000 population in year 2010. The highest number of cadre is nurses with 160,074 and the lowest number is physiotherapist with 2,587. Imbalance distribution remains one of key issues not only between urban and rural but also among regions in Indonesia. The highest number of health workforces remains in Java/Bali . Migration or movement of the health workforce within and across country has become a great attention. So far in 2009 there were approximately 2892 nurses work in United Emirate Arab, United State of America, Saudi Arabia, Kuwait, the Netherlands, Singapore, Japan, and Norway. Distribution of health workers based on gender is also another issue, although the exact data is unavailable. There is a tendency of increasing female medical doctors and dentists, for example in mid 2010 the percentage of contract female doctors was 56% while the contract female dentists was 81%. This document failed to describe the age distribution by cadre and the public � private distribution by cadre due to lack of data. It is estimated 60 to 70 percent of publicly employed health worker engaged in dual practice, mainly in private practice and private facilities. Production of health workforce has been continuously increasing from year 2004 to 2009 especially in private health education institutions. Accreditation of health education institutions was conducted to ensure the quality of graduates. In-service training for health workforce is provided through technical and clinical trainings, management and leadership training and other professional development trainings. Projection of the health workforce requirement was developed for the HRH plan, which involved participation of stakeholders. The method used was the ratio of health workers to the certain value i.e. the health status measured by the life expectancy target. To improve deployment and distribution for HRH especially in remote and underserved areas, the MoH encourage the local government to provide additional incentives, scholarship, and other facilities such as vehicles, housing, telecommunication equipment and electricity as well as safety at workplace. This document showed that Human Resource Information System need to be strengthened both in local and national level

Indonesian Nurses Migration Under Bilateral Agreement: Policy Issues and Responses

The rise of cross-border mobility of nurses has been marked by the creation of unilateral and bilateral agreements among nations. These agreements were intended to establish an ethical framework for the recruitment of professional health workers. Through the Indonesia-Japan Economic Partnership Agreement (IJEPA), Indonesian nurses emigrate to Japan’s health care industry. Despite the potential economic benefits from this migration, Indonesia itself is facing a distinct challenge in managing national nursing workforce. This study reviews the different policy approaches to current movement in promoting sustainability, ethical issues and compliance with the WHO global code of practice on the international recruitment of health personnel. Constructive dialogues between Indonesia and Japan by maximizing benefits, improve retention, brain circulation and alignment with WHO Code should be pursued in ongoing discussions. Comprehensive approaches in three different stages of migration, pre-migration, immigration and post-migration stage need integrated management and align it with Indonesia’s situation

POL IC Y REPOR T Health worker recruitment and deployment in remote areas of Indonesia

Context: Providing health care in remote and very remote areas has long been a major concern in Indonesia. In order to improve access to quality health care for residents in these areas, various policies on recruitment and deployment of health workers have been implemented, among them compulsory service, contracted staff and the Special Assignment of strategic health workers. Issue: Indonesia’s difficult geography presents great challenges to health service delivery and most health workers prefer to serve in urban areas, resulting in an uneven distribution of health workers and shortages in remote areas. Great efforts have been made to mobilize health human resources more equitably, including placement schemes for strategic health workers and contracted staff, combined with an incentive scheme. While these have partially addressed the severe shortage of health workers in remote areas, current government policies were reviewed in order to clarify the current situation in Indonesia. Lessons learned: The Contracted Staff and Special Assignment of Strategic Health Workers programs show have made a significant contribution to improving the availability of health workers in Indonesia’s remote areas. As these two programs used financial incentives as the main intervention, other non-financial interventions should also be trialed. For example, incentives such as the promise of a civil servant appointment or the provision of continuing professional education, as well as the recruitment of ruralbackground health workers may increase the willingness of health staff to serve in the remote and very remote areas of Indonesia. Key words: health policy, health worker, Indonesia, very remote areas

The effectiveness of behavioral change communication (BCC) program to change HIV/AIDS-related behaviors on construction workers

Background: Health education remains the main measure to prevent and control HIV/AIDS particularly in low resource setting. Among vulnerable groups, construction workers are one of the high-risk group infected by this virus. This research was conducted to investigate the construction workers’ behavior before and after the intervention behavioral change communication (BCC) to explore the influencing factors of the high-risk behaviors. Objective: To test the effectiveness of BCC to change the behavior of construction workers toward HIV occurrence. Materials and Methods: The methodology that guided the study was operational research. Sampling was purposeful and consisted of 150 construction workers. The data were collected in questionnaire; the analysis were performed using correlational statistical test. Internal motivation, external motivation, and knowledge, attitude, and practice of construction workers were tested. Result: Construction workers showed less knowledge, positive attitude, and less practice toward the risk of HIV transmission. Spearman correlational test showed a low correlation between internal motivation and utilization behaviorrelated HIV. On the other hand, external motivation showed a sufficient correlation toward utilization behavior-related HIV. Stakeholders concerned with HIV program also reveal that construction workers belong to the vulnerable groups. Conclusion: The result of this study calls for further intervention in supporting minority group such as construction workers to develop program that support them to become less-vulnerable population. BCC can be an exit way to reach this group by coordinating with local stakeholder to implement this program

PERAN DUKUNGAN SOSIAL TEMAN SEBAYA TERHADAP KETAHANAN PSIKOLOGIS REMAJA YANG MENGALAMI KONFLIK

Introduction. Konflik merupakan masalah yang sering kali terjadi pada remaja. Hal ini dapat memberikan dampak psikologis dan gangguan mental emosional pada remaja dan jika berangsur lama dapat menimbulkan efek yang buruk baik dari mental maupun fisik. Ketahanan psikologis tidak secara langsung ada pada diri remaja, melainkan melalui proses pembelajaran dan dukungan. Studi ini menganalisis dukungan sosial teman sebaya dan ketahanan psikologis remaja yang mengalami konflik dan masalah emosional akibat bullying. Methods.  Pendekatan Cross-sectional digunakan dalam penelitian ini. Sampel yang digunakan berjumlah 94 remaja. Data diambil dengan cara  memberikan kuesioner demografi, inform conscent, the Perceived Social Support from Friend (PSS-Fr) Scale dan The Brief Resilience Scale (BRS). Data di proses dengan statistik dekriptif dan dianalisis menggunakan Spearman's rho, menggunkan software SPSS. Results. Usia rata-rata remaja dalam studi ini adalah 14 tahun. Hasilnya menunjukkan bahwa ada korelasi positif antara dukungan sosial teman sebaya dengan ketahanan psikologis remaja (p < 0.05).  Conclusion. Penelitian ini megidentifikasi korelasi antara peran dukukan sosial teman sebaya dengan ketahanan psikologis remaja yang mengalami konflik dan masalah emosional akibat bullying. Hal ini menjaleasakn bahwa dukungan sosial teman sebaya memiliki dampak yang positif terhadap ketahanan psikologis remaja dalam menghadapi konfli

Monitoring the implementation of the WHO Global Code of Practice on the international recruitment of health personnel: the case of Indonesia

Background Indonesia has become one of the international nurse migration players that has supported the Code that was endorsed by the World Health Assembly, year 2010. In reference to the Code, the Minister of Health (MoH) as designated by the national authority, issued the regulation on the management of Indonesian nurses’ migration. This study aimed to monitor the implementation of the Code on state policy changing in facilitating nurse migration. Go to: Materials and methods Qualitative and quantitative data were collected in order to understand the impact of the Code on Indonesian nurse migration. A triangulation approach was achieved through semi-structured interviews with key stakeholders, and records review of nurses’ migration in the last two years. Go to: Results The Global Code of Practice contributed to shape the migration policy at the national level. This regulation provided a shift change of migration policy, which can be conducted by a country that had an agreement with Indonesia or a country that had a law on migrant protection. Acknowledging the importance of the Code, the MoH translated the Code into Indonesian, and disseminated the material to multiple stakeholders. By the spirit of this Code, Indonesia received financial and technical cooperation and agreement with Japan on the improvement of nursing capacity. The challenge faced by the MoH was a need for strong regulation which could accommodate the relevant players to coordinate on the national level, notably for the MoH, National Board for The Placement and Protection of Indonesia Manpower, Ministry of Foreign Affairs and private recruiters. Quantitative data showed that there was a significant flow of nurse migration, especially on nurses’ movement before and after the code was adopted. Nurse migration was increased four-fold between 2010 (567 nurses) to 2012 (2512 nurses) compared to three years before the Code was adopted. Indonesia’s government should carefully assess the flow of migration as the country has suffered a shortage of nurses. Lack of HRH information system and no integrated national HRH observatory hinder the policy maker to promote a strategic approach in nurse migration. Go to: Conclusions The Code has been utilized by the Ministry of Health to manage migration. This guideline at the least provides direction that may be used where appropriate in the formulation and implementation of nurse migration. A stronger regulation which not only ties the MoH, but also other stakeholders in health migrant placement needs to be established. Further, strengthening HRH information system and research on the impact of migration on Indonesia’s health system must be conducted soon

Proposing a Return Migration Policy: Insights from Indonesia Japan Economic Partnership Agreement (IJEPA) Nurses Study

There are few data on return migration of Indonesian nurses from Japan to Indonesia, especially in the context of bilateral agreement. Yet our study results point out that managing return migration needs a holistic approach. We discuss the motivation of ex-IJEPA nurses for coming home, their lived after return, intention to go back to Japan, and any other insights related to return migration. The analysis showed that the decision for return was due to the expiration of the contract; therefore, they were fully aware that they must return to Indonesia. In the origin country, Indonesian nurses face challenges and difficulty for finding a new job and struggle with their current status. We propose that return migration should be managed in comprehensive approach. The role of sending and receiving country is an imperative to maximize the benefit of return and minimize the negative effects. Bilateral agreement or Indonesia Japan Economic Partnership Agreement (IJEPA) may become a good starting point in developing cooperative approach to manage the return migration