Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Viewing Decentralization as an Opportunity: In  Improving Availability of Health Workers in Underserved  Areas<br />I  N  ...
2<br />OUTLINE<br />BACKGROUND<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />THE LESSONS LEARNT<br />PROPOSAL ...
DECENTRALIZATION<br />The Law 22/1999<br />Regional Governance<br />The Law 25/1999<br />Fiscal Balance<br />The Law 32/20...
GOVERNMENT HEALTH SYSTEM BEFORE DECENTRALIZATION<br />Source: www.desentralisasi-kesehatan.net<br />
GOVERNMENT HEALTH SYSTEM AFTER DECENTRALIZATION<br />Province Health Section<br />Source: www.desentralisasi-kesehatan.net...
HRH UNDER DECENTRALIZED SYSTEM<br />MENPAN<br />MOH<br />Hiring, Firing & Condition<br />CENTRAL<br />Permanent Civil Serv...
THE HEALTH DEVELOPMENT <br />INDICATORS<br />7<br />
8<br />OUTLINE<br />BACKGROUND<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />THE LESSONS LEARNT<br />PROPOSAL ...
Outcome: Availability Health Worker<br /><ul><li>Increased  retention  to remain in the workplace
Increased  motivation
Increased  job satisfaction
Reduced absenteeism </li></ul>Health Workforce Distribution Intervention<br />Recruitment & Selection<br />Deployment<br /...
METHODOLOGY<br />Desk study, literature review from MoH databases, RI<br />One of the wonders of the world<br />
11<br />OUTLINE<br />INTRODUCTION<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />THE LESSONS LEARNT<br />PROPOS...
IMPACT S OF DECENTRALIZATION ON HEALTH WORKFORCE <br /><ul><li>Transferring the employment status of civil servant from th...
The local government has more autonomy in providing and managing public facilities
The central level still maintain the power in contracting strategic health workers
The break-down of information system including the health workforce information</li></li></ul><li>Continued…<br /><ul><li>...
Problems in excess vs shortage of health workers
The growing number of health workforce education institution (pre service training)</li></li></ul><li>HEALTH WORKFORCE DIS...
HEALTH PERSONNEL RECRUITMENT AND SELECTION POLICIES<br />The central level provide guidelines and assistantship on the pla...
TREND OF THE NUMBER OF FORMASI PNS YEAR 2005-2009<br />Health promotion activity<br />
TREND OF THE NUMBER OF PTT DOCTORS IN REMOTE AND VERY REMOTE AREAS YEAR 2005 – 2009<br />The largest mosque in SEA<br />
DEPLOYMENT AND RETENTION POLICIES <br />Factors influencing:<br />Compulsory service for certain period.<br />Financial in...
NEW POLICIES FOR PTT<br /><ul><li>Offer vacancies only for remote and very remote posts
Shortening period of service
Higher financial incentive for service in very remote areas</li></li></ul><li>Equivalent<br />To ±0.105 USD<br />INCENTIVE...
Doctor/dentist	:  Rp  5. 000.000,00/month (USD 549)
Midwife		:  Rp  2. 500.000,00/month (USD 275)</li></li></ul><li>Continued….<br />Variation in fiscal capacity of local gov...
Upcoming SlideShare
Loading in …5
×

Human Resources for Health in Indonesia

916 views

Published on

Providing health care to underserved communities in Indonesia has long been a major concern. Lack of health workers particularly in rural remote and very remote areas has hampered community access to good quality of health services, which in turn leads to a poor health status of the people.

Published in: Health & Medicine, Business
  • Be the first to comment

  • Be the first to like this

Human Resources for Health in Indonesia

  1. 1. Viewing Decentralization as an Opportunity: In Improving Availability of Health Workers in Underserved Areas<br />I N D O N E S I A<br /> Ferry Efendi<br />&<br />Anna Kurniati<br />Wayangkulit : shadow puppetry<br />
  2. 2. 2<br />OUTLINE<br />BACKGROUND<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />THE LESSONS LEARNT<br />PROPOSAL FOR REGIONAL<br />
  3. 3. DECENTRALIZATION<br />The Law 22/1999<br />Regional Governance<br />The Law 25/1999<br />Fiscal Balance<br />The Law 32/2004<br />Regional Governance<br />Change the Roles & Functions of Local Government<br />Affected Human Resources for Health<br />
  4. 4. GOVERNMENT HEALTH SYSTEM BEFORE DECENTRALIZATION<br />Source: www.desentralisasi-kesehatan.net<br />
  5. 5. GOVERNMENT HEALTH SYSTEM AFTER DECENTRALIZATION<br />Province Health Section<br />Source: www.desentralisasi-kesehatan.net<br />
  6. 6. HRH UNDER DECENTRALIZED SYSTEM<br />MENPAN<br />MOH<br />Hiring, Firing & Condition<br />CENTRAL<br />Permanent Civil Servant (PNS)<br />Contracted Doctor (PTT)<br />LOCAL<br />
  7. 7. THE HEALTH DEVELOPMENT <br />INDICATORS<br />7<br />
  8. 8. 8<br />OUTLINE<br />BACKGROUND<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />THE LESSONS LEARNT<br />PROPOSAL FOR REGIONAL<br />
  9. 9. Outcome: Availability Health Worker<br /><ul><li>Increased retention to remain in the workplace
  10. 10. Increased motivation
  11. 11. Increased job satisfaction
  12. 12. Reduced absenteeism </li></ul>Health Workforce Distribution Intervention<br />Recruitment & Selection<br />Deployment<br />Retention<br />Determinants Influencing Retention<br />Decentralization<br />Human Resources for Health in Underserved Area<br />THE CONCEPTUAL FRAMEWORK<br />
  13. 13. METHODOLOGY<br />Desk study, literature review from MoH databases, RI<br />One of the wonders of the world<br />
  14. 14. 11<br />OUTLINE<br />INTRODUCTION<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />THE LESSONS LEARNT<br />PROPOSAL FOR REGIONAL<br />
  15. 15. IMPACT S OF DECENTRALIZATION ON HEALTH WORKFORCE <br /><ul><li>Transferring the employment status of civil servant from the central to the local level
  16. 16. The local government has more autonomy in providing and managing public facilities
  17. 17. The central level still maintain the power in contracting strategic health workers
  18. 18. The break-down of information system including the health workforce information</li></li></ul><li>Continued…<br /><ul><li>Rotation of health workers among the different administration regions
  19. 19. Problems in excess vs shortage of health workers
  20. 20. The growing number of health workforce education institution (pre service training)</li></li></ul><li>HEALTH WORKFORCE DISTRIBUTION<br />WHO (2006): Indonesia suffer shortage of HW<br />MoH (2008): The shortage number of MD in community HC is about 15% <br />MDs in Java-Bali (Urban 1:3000, rural 1:22000)<br />MDs Outside Java-Bali (Rural area 1:12000, Remote area 1:15000, urban area 1:2430)<br />14<br />The jump stone<br />
  21. 21. HEALTH PERSONNEL RECRUITMENT AND SELECTION POLICIES<br />The central level provide guidelines and assistantship on the planning process and methods<br />PNS<br />Local Contract<br />RECRUITMENT & SELECTION<br />Central Contract/PTT<br />Special Assignment<br />Largest Lizard in the world<br />
  22. 22. TREND OF THE NUMBER OF FORMASI PNS YEAR 2005-2009<br />Health promotion activity<br />
  23. 23. TREND OF THE NUMBER OF PTT DOCTORS IN REMOTE AND VERY REMOTE AREAS YEAR 2005 – 2009<br />The largest mosque in SEA<br />
  24. 24. DEPLOYMENT AND RETENTION POLICIES <br />Factors influencing:<br />Compulsory service for certain period.<br />Financial incentives and other support facilities (housing, transportation, electricity, water, telecommunications, other social facilities). <br />Dual practice. <br />Safety and security guarantee (law protection)<br />Opportunity for career development. <br />Opportunity to be recruited as civil servants.<br />18<br />
  25. 25. NEW POLICIES FOR PTT<br /><ul><li>Offer vacancies only for remote and very remote posts
  26. 26. Shortening period of service
  27. 27. Higher financial incentive for service in very remote areas</li></li></ul><li>Equivalent<br />To ±0.105 USD<br />INCENTIVE<br /><ul><li>Medical Specialist : Rp 7. 500.000,00/month (USD 824)
  28. 28. Doctor/dentist : Rp 5. 000.000,00/month (USD 549)
  29. 29. Midwife : Rp 2. 500.000,00/month (USD 275)</li></li></ul><li>Continued….<br />Variation in fiscal capacity of local governments to finance health services and to hire health professionals<br />Less Favorable<br />Favorable<br />VS<br />
  30. 30. <ul><li>Scholarship for upgrading the educational level
  31. 31. Influence the district governments for improving health facilities and living condition
  32. 32. Career opportunities</li></ul>RETENTION POLICIES<br />Traditional transportation<br />
  33. 33. % OF UNIT REDEPLOYMENT OF PA GRADUATES BY PROVINCE<br />Chart 3. % of Unit Redeployment of PA Graduates <br />by Province<br />Province<br />SS<br />CK<br />CJ<br />CL<br />0%<br />10%<br />20%<br />30%<br />40%<br />50%<br />60%<br />70%<br />80%<br />90%<br />100%<br />%<br />Previous Unit<br />New Unit<br />NA<br />Gamelan (Traditional instrument music)<br />
  34. 34. RECOMMENDATIONS<br /><ul><li>Partnership with the private sector
  35. 35. Improving the health information system
  36. 36. Provision of technical guidance on management, deployment and utilization
  37. 37. Deployment Policy based on local capacities
  38. 38. Privileging policy for nurses and midwives working in less favorable and remote/very remote areas
  39. 39. The incentive system clearly links to performance
  40. 40. Coordination with other stakeholder </li></ul>RafflesiaArnoldi<br />
  41. 41. 25<br />OUTLINE<br />BACKGROUND<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />THE LESSONS LEARNT<br />PROPOSAL FOR REGIONAL<br />
  42. 42. A LESSON LEARNT FROM BELU DISTRICT<br />Financial incentive<br />Non financial incentive: housing, transportation and telecommunication facilities, employee award.<br />Innovative program on outreach service<br />Upgrading the educational level<br />In service training<br />
  43. 43. 27<br />OUTLINE<br />BACKGROUND<br />CONCEPTUAL FRAMEWORK<br />THE CASE OF INDONESIA<br />LESSON LEARNT<br />PROPOSAL FOR REGIONAL<br />
  44. 44. 28<br />4<br />5<br />3<br />6<br />2<br />1<br />HEXAGONAL OF FUTURE ACTION<br />Improved collaboration on HRH<br />Developing a specific health workforce policy and planning <br />Coordination with all relevant professional organization<br />Conducting a study to explore any possibility<br />Develop guidelines for effective and supportive supervision<br />Fairness in incentive system<br />
  45. 45. TOGETHER ACHIEVE HEALTHY INDONESIA 2015<br />THANK YOU AND WELCOME TO INDONESIA<br />29<br />

×