Adequacy and Distribution of the Health Workforce in Indonesia.

Abstract

Background: Indonesia faces the challenges in distributing its health workforce across its diverse geographic barriers, leading to disparities in health status. By examining the distribution patterns and identifying the areas of critical need, the study seeks to inform policy interventions that can more effectively address the health worker (HW) distribution.

Methods: We conducted a descriptive analysis of healthcare workforce data across all 514 districts in Indonesia. The study focused on five categories of HWs: General practitioners (GPs), medical specialists, dentists, nurses, and midwives. We calculated the HW-to-population ratio to quantify the availability of healthcare workers. We employed the Gini Index as a measure of distribution equality. In addition, we conducted a comparative metric approach to assess the quantity and the equity of healthcare worker distribution across the districts.

Results: In Indonesia, the current HW ratio stands at 3.84 per 1000 people, falling short of the World Health Organization's threshold of 4.45 for achieving 80% universal health coverage. This shortfall translates to a need for an additional 166,000 HWs. While midwives show a relatively equitable distribution, specialists and dentists exhibited significantly unequal distribution, especially at the district level. There were greater disparities at the district than at the provincial level. There has been notable progress in the distribution of medical specialists across provinces, with the between-provinces Gini Index for specialists decreasing from 0.57 in 1993 to 0.44 in 2022. However, the inter-district Gini Index remains high at 0.53 in 2022, signifying a concentration of specialists in major cities and provincial capitals.

Conclusion: This study shows that human resources for health in Indonesia are both inadequate in terms of quantity, and unevenly distributed. Our finding underscores the importance of considering inter-province and inter-district disparities to tailor policies to tackle each region's unique problems.