Human resources for health at the district level in Indonesia: the smoke and mirrors of decentralization
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BioMed Central
Open Access
Research
Human resources for health at the district level in Indonesia: the smoke and mirrors of decentralization Peter F Heywood*1 and Nida P Harahap2 Address: 1Australian Health Policy Institute, University of Sydney, Sydney, NSW, Australia and 2Jalan Bukit Dago Selatan, Bandung, West Java Province, Indonesia Email: Peter F Heywood* - [email protected]; Nida P Harahap - [email protected] * Corresponding author
Published: 3 February 2009 Human Resources for Health 2009, 7:6
doi:10.1186/1478-4491-7-6
Received: 26 September 2008 Accepted: 3 February 2009
This article is available from: http://www.human-resources-health.com/content/7/1/6 © 2009 Heywood and Harahap; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: In 2001 Indonesia embarked on a rapid decentralization of government finances and functions to district governments. One of the results is that government has less information about its most valuable resource, the people who provide the services. The objective of the work reported here is to determine the stock of human resources for health in 15 districts, their service status and primary place of work. It also assesses the effect of decentralization on management of human resources and the implications for the future. Methods: We enumerated all health care providers (doctors, nurses and midwives), including information on their employment status and primary place of work, in each of 15 districts in Java. Data were collected by three teams, one for each province. Results: Provider density (number of doctors, nurses and midwives/1000 population) was low by international standards – 11 out of 15 districts had provider densities less than 1.0. Approximately half of all three professional groups were permanent public servants. Contractual employment was also important for both nurses and midwives. The private sector as the primary source of employment is most important for doctors (37% overall) and increasingly so for midwives (10%). For those employed in the public sector, two-thirds of doctors and nurses work in health centres, while most midwives are located at village-level health facilities. Conclusion: In the health system established after Independence, the facilities established were staffed through a period of obligatory service for all new graduates in medicine, nursing and midwifery. The last elements of that staffing system ended in 2007 and the government has not been able to replace it. The private sector is expanding and, despite the fact that it will be of increasing importance in the coming decades, government information about providers in private practice is decreasing. Despite the promise of decentralization to increase sectoral "decision space" at the district level, the centra
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