Evaluation of Health Worker Availability in Remote Areas
Ardha Isma Maziyah
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: Distribution, Health worker, Remote area.
Abstract: The problem of quantity and distribution of health personnel is a health policy problem that is often faced in
remote areas. Health development is an effort to fulfil the basic rights of the people, namely the right to
access health services. One of them with the distribution of health workers were evenly certain locations in.
Indonesia is one of 57 countries experiencing World Health Human Resources crisis in the world. Health
crisis is increasingly felt in remote areas resulting in the development of Indonesian dwarfs as a whole. This
condition is exacerbated by the low retention of health workers in the region. The purpose of this study was
to evaluate the inequality of distribution of health workers in remote areas. This research uses qualitative
design with descriptive analysis approach. The imbalance of health personnel is caused by the demand and
supply that do not go hand in hand. Therefore, to improve the distribution of health workers in remote areas,
there needs to be policy support from the government, including compulsory work with adequate
infrastructure support. Incentives both financial and non-financial should also be considered as an effort to
improve access to health workers in remote areas.
1 INTRODUCTION
Human Resources is the key to the success of an
organization because the quality of the
organization's products is influenced by the quality
and productivity of its human resources and the
thing that must now be realized is that human
resources is the highest asset of influence, because
the level of benefits from other resources both
financial and non financially depend on the level of
effectiveness of human resource utilization (Azwar,
1996).
The implementation of health development refers
to the National Health System with 6 sub-systems.
Among them is the human resources (HR) health
subsystem with the aim of making available
competent health human resources as needed,
distributed fairly and equitably and optimally
utilised in supporting the implementation of health
development and as the main element supporting
other health sub-systems. Health Resources refer to
someone who actively works in the field of health,
whether they are educated in formal health or not.
Certain types require authority in executing various
health efforts. Health Resources play the role of
planner, mobiliser and also as the executor of
ongoing health developments (Indonesia Ministry of
Health, 2009).
The availability of health human resources
should be evenly distributed in all areas in
Indonesia, especially in the area of 3T
(Disadvantaged, Leading and Outermost). The
Agency for Development and Empowerment of
Health Human Resources has included 143 districts /
cities included in the 3T (Disadvantaged, Leading
and Outermost). According to Indonesia's health
profile in 2016, the distribution of health workers in
the Regencies / Municipalities of Disadvantaged,
Leading and Outermost Regions, there is still an
unequal distribution of health personnel. There are
some health facilities that do not have certain
specifications of health worker in their areas. Areas
that include 3T are the provinces of West Sumatra,
South Sumatra, Bengkulu, Lampung, Central
Kalimantan, South Kalimantan, East Kalimantan,
North Sulawesi, Central Sulawesi, South Sulawesi,
Southeast Sulawesi Maluku and West Papua. Most
still do not have specialist dentists (Agency for
Development and Empowerment of Health Human
Resources, 2017). Almost all districts belonging to
the 3T areas do not yet have traditional health
workers. The distribution of unequal health
168
Maziyah, A.
Evaluation of Health Worker Availability in Remote Areas.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 168-170
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

personnel means that the area has a low level of
health status.
2 METHODS
The research type was qualitative with a literature
study approach involving secondary data collection.
The type of research conducted was descriptive. The
descriptive analysis was used to analyse the data by
describing phenomenon and events. The main
purpose of qualitative research is to understand the
phenomenon or social phenomena by giving a clear
description in the form of a series of words.
Secondary data collection was obtained through
journals and sites that discuss the topic of health
personnel equality.
3 RESULT
The data on the number of health human resources
utilised in Puskesmas in the 3T (Disadvantaged,
Leading and Outermost) Areas was obtained from
the recapitulation conducted by the Agency for
Development and Empowerment of Health Human
Resources. The availability of Health Human
Resources in 143 districts / municipalities of 3T was
quite varied. Some areas still do not have traditional
health personnel, clinical psychologists and other
specialist health workers.
The government has made a strategic plan to
increase the number, type, quality and even
distribution of health personnel. In the performance
plan, various indicators have been set. In order to
support the achievement of the targeted outcome
indicators, one of the activities to be undertaken is
the Planning and Utilisation of Health Human
Resources which can be seen in Table 1.
Table 1: Targets and Performance Indicators Performance
of Center for Planning and Utilisation of Health Human
Resources 2015 & 2016
Source: Report on the Performance Accountability of
Government Agencies 2016
Table 1 explains that the indicator of the number
of health personnel used in health care facilities by
2015 has reached the target while in 2016 it has not
reached the target set. In 2015 the government set a
target of 950 and has been reached of 3,572. while in
2016 the government set a target of 20,600 and
achievement of only 4,987. This affects the
distribution of health workers, especially in remote
areas. Increased efforts to achieve these targets
continue to be undertaken by local governments by
implementing several work programs that can
address the problem. Unequal distribution of health
workers in remote areas can be caused by many
factors. This report will also evaluate the inequality
of distribution of health workers in remote areas.
This analysis is based on a review of journals and
other scientific papers discussing the distribution of
health workers in remote areas.
4 DISCUSSIONS
Equality of medical personnel in rural areas has been
a challenge for the Indonesian government. Several
innovative policies have been identified that can
help improve the distribution of health workers
geographically. By combining all teams that work
together and complement each other, it will be an
appropriate strategy to improve effective health
services in rural and remote areas. Indonesia needs
to define its health personnel in a manner that is
more in line with changing state health needs. The
difficulty in attracting and maintaining health
workers to rural and remote areas is a common
problem in much of Asia and elsewhere. Based on
international experience, WHO has developed 16
recommendations to improve the distribution of
health workers. These 16 recommendations are
grouped into four broad headings: policy
interventions; education; regulatory environment;
financial incentives and professional and personal
support.
Distribution of health workers who are still not
evenly distributed, especially in rural areas in
general the degree of public health is much lower
than other regions. This in addition to impact on the
health sector will also impact on social conditions
and economic conditions. Several factors are
suspected to be the cause of unequal distribution of
health workers includes environmental conditions,
income and motivation.
In Indonesia there are already some areas that
have programs to improve the fulfilment of the
needs of medical personnel. In Raja Ampat, for
example, to meet the needs of the village midwife,
Number of health personnel utilized in Health Care
Facility
Baseline
(2014)
Year 2015
Year 2016
Target
Achievements
Target
Achievements
-
950
3.572
20.600
4.987
Evaluation of Health Worker Availability in Remote Areas
169

the Morotai Regional Government of North Maluku
will provide scholarships for 15 women's sons of the
female high school / high school graduates who are
married, not more than 30 years old, have the
blessing of their families and husbands devote
himself in the village as a village midwife (each
village 2 people), and pass the selection. In this case,
the local government cooperates with one of the
private obstetric academies in Tobelo. The students
of D3 Midwifery get full scholarship from APBD.
The Government of Indonesia has used several
programs to increase the availability of medical
personnel in rural and remote areas. The program
includes higher financial incentives and shorter
contract periods for rural and remote posts,
recruitment based on ethnicity and location
programs and internships. The distribution of health
workers to remote and rural areas has increased.
Maintaining health workers is a priority of the
Indonesian government. As a result, MOH has
implemented several policies:
1. Scholarships to improve the level of education
(training of medical specialists, public health
midwives, and nursing specialists / medical
specialist assistants).
2. Encourage local governments to use the
Special Allocation Fund from the central level to
improve health facilities (including equipment and
vehicles) and housing for health workers in very
remote areas.
3. Career Opportunities: Upon completion of
PTT services, staff have 3 options: (i) continue their
education to become specialists; (ii) to become a
civil servant (PNS) by taking civil servant
examinations; or (iii) entry into the private sector.
General Practitioners in very remote areas have a
90% chance of entering civil servants after
completing their service; Public practitioners in
remote areas have a 50% chance while those serving
in regular areas only have 10% (Efendi, et al., 2012).
5 CONCLUSIONS
The availability of Human Resource Health is one of
the most important things in the implementation of
public health. Equality in the distribution of health
personnel should be carried out so that all
communities have the same degree of health.
Inequality in relation to the number of health
workers still occurs in various regions, especially in
remote areas. The data on the number of health
human resources utilised in the 3T (Disadvantaged,
Leading and Outermost) Areas was obtained from
the recapitulation conducted by the agency for the
development and empowerment of health human
resources. The availability of Health Human
Resources in the 143 districts / municipalities of 3T
is quite varied. There are still some areas that do not
have traditional health workers, clinical psychology
and other health workers. The government continues
to pursue various policies to address the issue.
REFERENCES
Agency for Development and Empowerment of Health
Human Resources. Recapitulation of Health Human
Resources utilized in Puskesmas in 3T
(Disadvantaged, Leading and Outermost) Areas.
Ministry of Health.
http://bppsdmk.kemkes.go.id/info_sdmk/info/daerah_3
t (online) visited 6 september 2017
Agency for Development and Empowerment of Health
Human Resources. 2016. Annual Report of Center for
Planning and Utilization of Health Human Resources
2016
Azwar. 1996. Introduction to Health Administration, Third
Edition Benerupa Aksara. Jakarta
Dieleman, Marjolein., Cuong, Pham Viet., et all. 2003.
Identifying factors for job motivation of rural health
workers in North Viet Nam. (online) https://human-
resources-
health.biomedcentral.com/articles/10.1186/1478-4491-
1-10, visited 5 september 2017
Efendi, Ferry., Indarwati, Retno., Kurniati, Anna et all.
2012. Retaining and Motivating Health Worker in
Very Remote Area of Indonesia, Do They Respond To
The Incentives?. GSTF International Journal of
BioSciences (JBio) Vol.2 No.1, December 2012
Lestari, Tri R.P. 2013. Health Services In Disadvantaged
Regions, Borders, And Islands. Vol. V, No. 12 / II /
P3DI / June / 2013
MoH RI. 2009. National Health System. Jakarta
National Development Planning Agency. 2014. Policy
brief. Health Sector Review. 44 leaves
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