Strengthening Indonesia’s health workforce through partnerships

Citation for this: Kurniati, A., Rosskam, E., Afzal, M. M., Suryowinoto, T. B., & Mukti, A. G. (2015). Strengthening Indonesia’s health workforce through partnershipspublic health129(9), 1138-1149.

Indonesia is one of the most populous countries in the world, with a population of 234 million. The country consists of approximately 17,000 islands, situated in a climatic disasterprone region of Asia. About 60% of the population lives on Java Island which covers only around 7% of the country’s total land area. The country is counted as a middle income country. 1) Because of Indonesia’s particular geographic, demographic, socio-cultural diversity, and economic situations, its health system faces serious challenges. After decentralization in 2001, the new health system is now empowering local governments to manage their health services, including the management of Human Resources for Health (HRH). 2) The Indonesian health system is facing critical HRH challenges. 3) The World Health Report 2006 included Indonesia as
one of 57 countries facing a crisis level shortage of HRH. 4) The HRH crisis level shortage impedes the progress that these countries can envisage for strengthening their health systems to be able to provide equitable access to essential and lifesaving primary health care services. The HRH shortages pose serious obstacles for attaining the health-related Millennium Development Goals (MDGs) and Universal Health Coverage (UHC). The most critical HRH challenges in Indonesia include: inadequate quantity and quality of some essential cadres, mismatch between production and demand, and maldistribution
between urban, rural, and remote areas. Deficient information hampers HRH policy development and planning efforts. Other challenges include poor retention strategies, particularly due to low levels of remuneration. 5) Indonesia’s average number of HRH per 100,000 population is below the minimum threshold level required for effective achievement of the health-related MDGs and UHC. 6) The Health System Performance Assessment 2004 indicated that Indonesia suffers from mal-distribution and a shortage of certain kinds of essential HRH which has lowered community access to quality health workers and to quality health services. In 2008, the country had 7.73 specialists, 26.3 general physicians, 7.7 dentists, 43.75 midwives, and 157.75 nurses per
100,000 population.  Most of the health workforce is concentrated in Java Island and in big cities, leaving rural and hardship areas underserved. Hospitals suffer from considerable shortages of nurses and other mid-level cadres. Community health centers face severe shortages of all HRH cadres except nurses. It is estimated that an additional 11,000 midwives are needed to serve in rural areas.

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Factors influencing Indonesian women’s use of maternal health care services

Kurniati, A., Chen, C. M., Efendi, F., & Berliana, S. M. (2017). Factors Influencing Indonesian Women’s Use of Maternal Health Care Services. Health Care for Women International, (just-accepted), 00-00.

At the individual level, variables of education, age at the last childbirth, and attitude towards family planning are the strongest predictors of the utilization of ANC services and postnatal care (PNC) in Nigeria (Babalola & Fatusi, 2009).
In the same vein, several studies in Southeast Asian countries with high maternal
mortality also found that women’s education, household wealth index, and residential
place were among the major determinants for the utilization of ANC and PNC (Prusty, Buoy, Kumar, & Pradhan, 2015; Sein, 2012). In their previous study in Indonesia, Beegle, Frankenberg, & Thomas (2001) reported the significant association between variables of age and the husband–wife educational gap, and the use of prenatal and delivery care. Likewise, another study of Indonesia revealed that several factors, such as living in rural region, lower family income, poor maternal knowledge, and high birth orders with closely spaced births (less than two years), had significant associations with the low utilization of ANC (Titaley, Dibley, & Roberts, 2010).
As the reduction of maternal mortality remains significant in the next global development agenda, it is imperative to have a better understanding of the factors
associated with the utilization of three aspects of maternity care ¡ antenatal, delivery, and postnatal services using the most recent available nationwide data. In this study, therefore, authors aimed to examine factors that affect the use of maternal health care services among Indonesian women. We expect that the results of this study contribute to supporting effective policies and approaches as well as identifying further research for improving the utilization of maternal health care.

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