THE INDONESIA HEALTH WORKFORCE QUANTITY AND DISTRIBUTION

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ABSTRACT Background Indonesia, the world’s largest archipelago, faces unique challenges in distributing its health workforce across its diverse geographic barriers, leading to disparities in health worker number and distribution. By dissecting the distribution patterns and identifying areas of critical need, the research seeks to inform policy interventions that can more effectively bridge the gap on health worker quantity and inequity. Methods We conducted a descriptive analysis of healthcare workforce data across all 514 districts in Indonesia. The study focused on five categories of health workers: General Practitioners (GPs), medical specialists, dentists, nurses, and midwives. We calculated the health worker ratio to determine the availability of healthcare workers relative to the population. To evaluate the distribution of these workers, we employed the Gini Index as a measure of distribution equality. Additionally, we conducted a comparative metric approach to assess both the quantity and the equity of healthcare worker distribution across the districts. Results In Indonesia, the current health worker ratio stands at 3.84 per 1000 population, falling short of the WHO’s threshold of 4.45 for achieving 80% Universal Health Coverage. This shortfall translates to a need for an additional 166,000 health workers. Our analysis reveals a varied distribution of health worker categories: while midwives show a relatively equitable distribution, specialists and dentists exhibit significant inequality, especially at the district level. The Gini Index, used to measure this inequality, indicates greater disparities at the district level compared to 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 suffer not only in quantity but also in distribution. Our finding underscores the importance of considering inter-province and inter-district disparities to tailor policies to tackle unique problems each region faces. Evidence Before Study Prior research has established that the quantity and distribution of health workers are critical factors in improving life expectancy and are fundamental components of the health system. Following Indonesia’s constitutional changes in 2001, which included the autonomy and decentralization of healthcare services, assessing the number of health workers at the district level has gained significant importance for determining national healthcare needs. There has been a notable gap in studies analyzing the quantity and distribution of health workers in Indonesia’s district level. Previous research often missed the nuances of district-level challenges, focusing instead on broader, national-level assessments. What This Study Adds First National Study on Health Workforce: This is the first study of health workforce quantity and distribution at Indonesia’s National level. so this paper serves as a basic reference for future research Quantitative Analysis of Distribution Equity: Utilizing the Gini Index, the study quantifies the level of inequality in the distribution of healthcare workers, offering a clear metric to guide policymakers in assessing and addressing regional disparities. Identification of Regional Variations: The study highlights significant regional variations, with some provinces showing an inequitable distribution of health workers, demonstrating a critical need for increased healthcare personnel and better distribution strategies. Dual-dimensional assessment: The study introduces a quadrant comparative approach that simultaneously evaluates the quantity of healthcare workers and the equity of their distribution across Indonesian provinces. This dual-dimensional analysis is a significant methodological advancement, providing a more holistic understanding of healthcare workforce allocation. How This Study Might Affect Research, Practice, and/or Policy This study has the potential to become the basis of policy-making related to the distribution of health workers and provide constructive feedback and strategical insights that could be utilized to decrease the gap between health workers and their maldistribution.

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