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. Keywords: Health Workforce; Quantity; Distribution; Gini Index