Human Resources For Health Country Profile of Indonesia 2019

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Human Resources for Health
Country Profiles
Indonesia
2019
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Table of content
Table of content iv
Annex vi
List of Tables vii
List of Figures viii
Acknowledgment ix
Acronyms x
Executive Summary xi
Introduction 1
Purpose 1
Methodology 1
Scope of the HRH profile 2
1. Country Context 3
1.1 Geography and demography 3
1.2 Economic context 4
1.3 Political context 5
1.4 Health status 5
2. Country Health System 7
2.1 Governance 7
2.2 Service provision 9
2.3 Health care financing 9
2.4 Health information system 10
3. Health Workforce Situation 12
3.1 Health workforce stock and trends 12
3.2 Distribution of health workforce by category/cadre 15
3.2.1 Gender distribution by health workforce categories/cadre 16
3.2.2 Age distribution by occupation/cadre 18
3.2.3 Region/province/district distribution by occupation/cadre 19
3.2.4 Urban/rural distribution by occupation/cadre 20
3.2.5 Public/private distribution by occupation/cadre 22
4. HRH Production 25
4.1 Pre-service education 25
4.2 In-service and continuing education 28
4.3 Health workforce requirements 28
5. HRH Utilization 31
5.1 Recruitment 31
5.2 Deployment and distribution mechanisms 31
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5.3 The work environment 32
5.4 Employment of health workers in the private sector 32
6. Governance for HRH 33
6.1 HRH policies and plans 33
6.2 Policy development, planning and managing for HRH 33
6.3 Professional Regulation 34
6.4 HRH information 34
6.5 HRH research 34
6.6 Stakeholders in HRH 35
References 36
Annexes 37
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Annex
Annex 1: Classification of health workforce of the WHO South-East Asia Region 37
Annex 2: Description on qualification of health workers in Indonesia 39
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List of Tables
Table 1.1 Percent Population Distribution by Age Group and year 4
Table 1.2 Percent Distribution by Sex 4
Table 1.3 Economic Indicators 4
Table 1.4 Economic Indicators 6
Table 1.5 Health Indicators 6
Table 3.1 Number and ratios of registered health workers per 1000 population in 2018 and the
targeted ratio by 2025 13
Table 3.1.1 Number and ratios of health worker per 1000 population ratios as reported by health
facilities (hospitals, health centers, and some primary clinics) in 2017 and 2018 13
Table 3.2 Distribution of health workers during 2015-2018 (for past 4 years of available data) 15
Table 3.3 Gender distribution by health workforce category/cadre 17
Table 3.4 Workers by age group and cadre 18
Table 3.5 Regional/District/province distribution of workers 19
Table 3.6 Urban/Rural Distribution of Workforce 21
Table 3.7 Public/Private for profit/Faith based organization/private not for profit distribution of
health workers 22
Table 4.1 Number of Training Institutions by Type of Ownership 25
Table 4.2 Number of Entrants and Graduates by year 2010 26
Table 4.3 Number of Teachers by Profession and Teachers/Student Ratios 28
Table 4.4 Projections for Health Workforce Requirements for The Coming Years 29
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List of Figures
Figure 1. Map of Indonesia 3
Figure 2.The framework of the 2012 National Health System 8
Figure 3. Decentralized health service delivery system 8
Figure 4 Total Health Expenditure (in Trillion Indonesia Rupiahs) and the proportion of health
financing (MoH, 2018) 10
Figure 5 Trend of the health workers density from 2010 - 2018 13
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Acknowledgment
The Indonesia Human Resources for Health Country Profile, an updated version 2019, was developed by
Ferry Efendi, PhD, researcher and Assistant Professor in Airlangga University, Indonesia. Editorial support
was provided by Anna Kurniati, PhD, Deputy Director for International Management of Health Workforce,
Center for Planning and Management of Human Resources for Health (CPMHRH), Ministry of Health,
Indonesia.
Leadership support was fully granted by Dr. Untung Suseno Sutarjo and Drg. Usman Sumantri, Senior
Health Policy Analysts, Ministry of Health, Indonesia, Dr. Trisa Wahjuni Putri, Secretary to the Board for
Development and Empowerment of Human Resources for Health (BDEHRH), Ministry of Health,
Indonesia, and Dr. Maxi Rein Rondonuwu, Director of CPMHRH, Ministry of Health, Indonesia.
Center for Planning and Management of Human Resources for Health, Ministry of Health, Indonesia
provided logistics and technical supports from data collection through to the synthesis of this report. Those
involved include: Lita D. Astari, Lis Prifina, Aditya B. Sasmita, Dwiasih K. Ningrum, Ifrani Yuan, and
other staffs. Recognition is also made to all the departments and units within the Ministry of Health and the
Ministry of Research, Techology and Higher Education, Indonesia, as well as to the World Health
Organization Indonesia Country Office.
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Acronyms
Askes Social Health Insurance
Askeskin Health Insurance Scheme for Poor People
BDEHRH Board of Development and Empowerment on Human Resources for Health
BPJS Kesehatan Healthcare and Social Security Agency
BPS Central Statistics Agency
BKN National Civil Servant Agency
BKD Local Civil Servant Agency
CPMHRH Centre for Planning and Management of Human Resources for Health
CCF Country Coordination and Facilitation
DHO District Health Office
GoI Government of Indonesia
HRIS Human Resources Information System
HRH Human Resources for Health
JKN National Health Insurance
KKI Indonesia Medical Council
MoH Ministry of Health
MoF Ministry of Finance
MENPAN Ministry for The Empowerment of State Apparatus
MRTHE Ministry of Research, Technology and Higher Education
MTKI / KTKI Indonesia Health Professional Council
NCDs Non-Communicable Diseases
NHS National Health System
PHO Provincial Health Office
PTT Contracted Staff
PNS Civil Servant
RPJP-N Long Term National Development Plan
SEARO South-East Asia Regional Office
UHC Universal Health Coverage
WHO World Health Organization
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Executive Summary
Indonesia is a South-East Asian nation of about 265 million people. Indonesia is a lower-middle-income
country with a gross domestic product (GDP) of about US$ 3927 per capita per year. Following the
decentralization of the national health system, the health-care service and management system is organized
into three administrative levels: central, provincial, and district.
This Country Profile was updated in 2019 to provide a comprehensive and most recent overview of the
human resources for health (HRH) situation in Indonesia to be used in the national development of the
HRH. The policy and strategy are designed to guide government, partners and other stakeholders in
prioritizing, developing and implementing activities for improving HRH.
In accordance with the Long-Term National Development Plan (RPJPN) 2005-2025, the medium-term
development target of 2020-2024 is to create fair, prosperous, dignified, economically independent through
accelerating development in various fields including health sector. The public health agenda led by the
Ministry of Health put priority on health provision, community empowerment on health initiatives, drugs
and health equipment availability, human resources for health (HRH), research and development, health
financing, and health information system. In the Strategic Plan document of the Ministry of Health, HRH
development is one of priorities in health development. It includes several strategic activities such as HRH
planning and management, pre-service and in-service trainings, HRH quality including registration and
certification and other management and technical support for HRH development program.
Along with most social sectors, the health sector is a decentralized public affair which delegates
responsibilities especially on health service delivery from the central to the sub national (province) and the
local level (district). This has had implications on human resource planning and management which include
the need for accurate and timely data and information on HRH. It has become clear that there is an urgent
need to strengthen national health information system. Special attention is required at both regional and
national levels to create an up-to-date HRH information system.
Human resources for health (HRH) supply

By 2018, the Indonesia Medical Council and the Indonesia Health Professional Council reported that
1,530,696 health workers have been registered (medical doctors, dentist, nurses, midwives, public health
officers, nutritionists, and environmental health officers). This data provides an estimated composite ratio
of registered health workers (doctors, nurses, and midwives) at 5.25 per 1000 population by 2018. During
the same year, the Ministry of Health reported approximately 1,072,598 health workers from all categories
working in public and private hospitals as well as community health centers. Medical, pharmacy and
nursing-midwifery practitioners account for 85% of the health workforce. Based on those who are reported
currently working in health facilities, the staffing ratio of doctors, nurses, and midwives in Indonesia is
approximately 2.83 per 1000 population. This is a significant double increase from 1.42 per 1000
population in year 2009.
The 2006 World health report by the World Health Organization (WHO) identified a minimum health
worker density of 2.3 skilled health workers (physicians and nurses/midwives) per 1000 population. The
current health worker density informed that Indonesia has successfully moved out from the critical shortage
of health workers. In reference to the target of the Sustainable Development Goals (SDG), WHO has set up
a new threshold of 4.45 health workers per 1000 population by 2030. There is much to be done in optimizing
the utilization of the HRH supply to support the Universal Health Coverage policy, by ensuring the
employment of registered health workers in health sector.
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HRH distribution
Imbalance distribution remains one of key issues across regions in Indonesia, especially between urban and
rural areas. Compared to other regions in Indonesia, Java region has the largest number of health workforces
in all categories. Migration or movement of the health workforce within and across country has become a
great attention. The high number of annual fresh graduates of health workers especially nurses and
midwives are the potential human capital to compete in the global market. Up to December 2018, Indonesia
has cumulatively sent out around 114,945 human resources for health to foreign countries which were
dominated by caregivers and nurses. Distribution of health workers based on gender is also another issue.
Women dominate almost every cohort of health workforce. More than 60% general practitioners,
pharmacist and nursing professionals are female. About one-third of health workers age between 31-40
years old.
Health professions education

Production of health workforce has been continuously increasing from the last decade especially in private
health-education institutions. 1,781 of 2,168 health workforce education institutions are private schools.
During 2015-2018, medical, nursing and midwifery education institutions have produced approximately
658,298 medical doctors, 1,506,614 nurses and 1,02,187 midwives. Accreditation of health education
institutions is conducted to ensure the quality of graduates. In-service training for health workforce is
provided through technical and clinical trainings, management and leadership training and other
professional development training.
HRH utilization
Recruitment of health care professionals is conducted through several schemes, including civil servant,
special assignment as a temporary contract by the central government, and the local or institutional hiring.
By 2019, about 18,475 health workers are recruited to be assigned in public health facilities. Since 2015,
the MoH also has implemented the special assignment program called the Nusantara Sehat to deploy health
workers in remote and very remote community health centers. From 2015-2018, the MoH recruited 11,816
health workers and additionally 2,215 health workers are being recruited in 2019 to be sent to rural
community health centers. To support the referral facilities, the MoH also implements the assignment of
medical specialists. Between 2015 and 2018, 4,150 medical specialists (obstetric-gynecologist,
pediatrician, internist, surgery, and anesthetist) were recruited and sent mostly to district hospitals for a
minimum two-year assignment.
HRH financing
Government-employed health workers are paid a monthly salary. The MoH has stipulated incentive system
based on service performance and remoteness of the working place. Another incentive scheme was also in
place in the form of a fellowship program for pursuing a higher level of education. The local government
also provided additional financial incentives based on their fiscal capacities.
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Introduction
The Government of Indonesia has committed to provide health services accessible for all people through
the enactment of Universal Health Coverage (UHC) policy by introducing national social health insurance
since 2014. Implementation of this policy require a robust health system with human resources for health
(HRH) at the core of the system. This profile document, therefore, is expected to become a significant
contribution in strengthening HRH through the improvement of the HRH information system. The data can
be used as the baseline information for evidence-based decision making and policy development at national
and sub-national levels.
HRH information provided in this document is also intended to support the MoH and its stakeholders in
developing the HRH plan. The HRH policy and strategy were designed to guide the government, partners
and other stakeholders in prioritizing, developing and implementing activities geared toward improving
HRH to support the universal health coverage (UHC). Furthermore, the HRH profile can be seen as a
national resource for producing, sharing and utilizing health workforce information and evidence to support.
Purpose
The document on the Indonesia Human Resources for Health profile 2019 aims to provide a comprehensive
picture of the health workforce situation in Indonesia. It is designed to assist health sector managers and
policymakers in making decisions that may require statistical evidence on the current situation and trend of
the health workforce in the country. Specifically, the purpose of the HRH country profile is to serve as a
tool for:
● Providing a comprehensive picture of the Health Workforce situation;

● Systematically presenting the HRH policies and management situation to help monitoring the HRH
stock and trends;
● Communication with and between policy-makers and stakeholders;
● Strengthening the HRH information system by establishing evidence for baselines and trends;
● Facilitating information sharing and cross-country comparisons.
The study has shed light on:

● The current composition of the health workforce and future requirements for meeting the priority
goals of the health sector development strategy;
● The geography, demography, and economic situation of the country;
● The country’s system of health services, and its governance and policies;
● A comprehensive picture of the health workforce situation in the country;
● HRH stock and trends by category and distribution.
Methodology
This document was written mainly using secondary data obtained from the reports at the Ministry of Health,
the Republic of Indonesia such as the annual health profile, the annual BDEHRH profile and the document
of brief information on HRH published by the BDEHRH. The information collection was done basically
using desk review of the key documents in the line ministries namely, health, local government, finance,
and education.
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Scope of the HRH profile
The HRH profile provides a summary of the following elements:
● A comprehensive picture of the Health Workforce situation in the country;
● Geography, demography, and economic situation;
● Country’s health services system, its governance, and policies;
● HRH stock and trends;
● HRH production including pre-service and post-basic training processes;
● HRH utilization.
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1. Country Context
1.1 Geography and demography
Indonesia is located on the equator and situated between Asia and Australia continent and between
the Pacific and the Indian Ocean. Indonesia is an archipelagic country extending 5,120 kilometers
from east to west and 1,760 kilometers from north to south. The country shares land borders with
Papua New Guinea, East Timor, and Malaysia. Indonesia consists of 17,508 islands and becomes the
largest archipelago country in the world (Figure 1). Indonesia's terrain is mainly coastal lowland with
mountains on some of the larger islands. The climate is tropical with high humidity. The rainy season
is from October to April.
Administratively Indonesia has 34 decentralized regions and 415 districts. The nation's capital city
is Jakarta. Results of the 2015 intercensal population census (BPS, 2015) show that Indonesia has a
population of 255 million with an annual growth rate of 1.43%. By 2019, the estimated number of
populations reaches over 260 million people making it as the world's fourth most populous country.
Jawa Barat region has the largest population of 46 million.
Indonesia includes numerous ethnic, cultural and linguistic groups, some of which are related to each
other. Since independence, Indonesian is the language of most written communication, education,
government, and business.
One of the characteristics of Indonesian Population is the uneven growth between islands and
provinces. Most of the Indonesian population lives in Java Island, even though the total land area is
less than 7 percent from the total land area of Indonesia. However gradually Indonesian population
percentage that live in Jawa region decreases from about 59.1 percent in year 2000 and predicted
55.5% in year 2025 (BPS, 2015).
Figure 1. Map of Indonesia
According to the Central Statistics Agency (BPS, 2015), approximately 54% of population lives in
urban areas while the remaining 46% lives in rural areas. It has a population growth rate of
approximately 1.07% and a population density of 134 persons per square kilometer. The fertility rate
reported at 2.41 births per woman in 2010 and decline to 2.28 in 2015 (BPS, 2015). In term of the
age groups, about 66% of the population belonged to the age group of 15-64 years of age. For detailed
information please see tables 1.1. and 1.2.
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Table 1.1 Percent Population Distribution by Age Group and year
Age Group 2013 2015 2018
0–14 years 28.9% 48.4% 26.6%
15–64 years 66.1% 47.8% 67.6%
65+ years 5.1% 3.8% 5.8%
Total (%) 100% 100% 100%
Total (n) in million 248 255 265
Source: Kementerian Kesehatan (2018; 2013; 2015)
According to table 1.1 the total population of Indonesia in 2013, 2015, 2018 has increased
significantly from 235 million, 255 million and 265 million. Indonesia population based on age
group was dominated by 15-64 years old age group or 67% in 2018. The average of Indonesian
population growth each year increases between 2010 and 2018 period respectively from 1.1% to
1.14% (Table 1.2).
Table 1.2 Percent Distribution by Sex
Year Total* Male* Female* Male/Female (%) Growth rate (%)

2018 265 133 131 102 1.14
2015 255 128 127 72 1,31
2013 218 110 108 102 1,37
*unit in million
Source: Kementerian Kesehatan (2018; 2013; 2015)
1.2 Economic context

Indonesia experienced severe economic depression in late 1998. Since 2004, the national economy
has recovered and undergone another period of rapid economic growth. Indonesia's overall
macroeconomic picture is stable. By 2004, real GDP per capita returned to pre-financial crisis levels
and income levels are rising. In 2009, domestic consumption continued to account for the largest
portion of GDP at 58.6%, followed by investment at 31.0%, government consumption at 9.6%, and
net exports at 2.8%. Investment realization had climbed in each of the past several years, until the
global slowdown in 2009. It resumed its rebound in 2010 (USDS, 2011). By 2018, Indonesia's GDP
has risen to 1,042 trillion which was indicated prospective and promising growth on economic
development.
Table 1.3 Economic Indicators

Indicators 2013 2015 2018
912,524 860,864 1,042
Gross domestic product (GDP) in US Dollar
billion billion Trillions
National debt as % of GDP 24.8 27.5 29.8
Proportion of budget spent on health as % of
5 5 5
GDP
Income per capita (in PPP) 14,755 15,802 17,971
Proportion of population living below
11.37 11.22 9.82
poverty line
Proportion of under 5 with severe
16.3 14.2 13.8
malnutrition
Unemployment rate 6.2 6.1 5.3
Inflation rate 7.72 3.35 3.13
Source: World Bank (2019)
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1.3 Political context
Indonesia is a unitary state, headed by an executive President and Vice President who are directly
elected for a five-year term by popular vote. The President and Vice President govern with the
assistance of an appointed Cabinet.
Indonesia has transformed to become South-East Asia's largest and most vibrant democracy. A robust
media and civil society and direct and fair elections are at the heart of its strengthening democracy.
It has also undergone a process of decentralization since 1999, which has seen control of large
amounts of public expenditure and service delivery transferred from the central government to
provincial and local governments. Municipality and district leaders and provincial governors win
office through direct elections. Voters are also able to select provincial and district-level
parliamentarians.
Enactment of the law on local autonomy in 1999 marked the beginning of the decentralization system
in Indonesia. Since 2005, heads of local government (governors, regents, and mayors) have been
directly elected by popular election. Villages are the smallest political-administrative units. The
village’s parliamentary body is the political voice of communities in the identification, discussion
and prioritization of problems and actions to be taken at village level. It can also refer to any relevant
issue to higher levels.
At the national level, the current government has also continued placing health sector as one of the
national interests through its Nawacita or the nine pillars of national development agenda (President
of Indonesia, 2015) in which the National Health Insurance program or Jaminan Kesehatan Nasional
(JKN) was included as one of the goals set by the government. This political commitment on health
was implemented through the 2015-2019 mid-term planning on health sector which includes the
Healthy Indonesia Program that aims to improve health status through financial protection and
equitable health service provision (Bappenas, 2019) as well as promotive and preventive-focused
initiatives such as the Community Healthy Life Movement (Germas).
1.4 Health status

Indonesia health status is striving to meet the Sustainable Development Goals (SDGs) target,
therefore, all efforts have been deployed to secure all the 17 indicators of SDGs. The delivery of
basic human services at the local level is critical to the health of Indonesians. Under Indonesia’s
decentralization law, local governments are responsible for the delivery of health care, water, and
sanitation.
Table 1.4 showed that currently Indonesia has double burden in mortality and morbidity caused by
non-communicable and communicable disease. While diarrhea and gastroenteritis represent 21% of
national health morbidity. These indicators may reflect a double burden between communicable and
non-communicable diseases.
Currently, an integrated effort is going on to develop the National Strategy on NCD Control, adapting
the Global and Regional Strategy. The three major components are adopted, i.e., surveillance of risk
factors, integrated health promotion, and reform of service delivery. Main causes of morbidity taken
from 10 top diseases in the inpatient hospital and main causes of mortality taken from non-
communicable disease (WHO, 2016).
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Table 1.4 Main Causes of morbidity and mortality
Main causes of morbidity Value Main causes of mortality Value
(%) (%)
Diarrhea and gastroenteritis 21% Cardiovascular disease 35%
Dengue hemorrhagic fever 17% Communicable, maternal, 21%
perinatal and nutritional
conditions
Typhoid fever Other NCDs 15%
12.3%
Labor and pregnancy problem 12% Cancer 12%
Dyspepsia 7.4% Injuries 6%

Injury 6.5% Respiratory diseases 6%
Essential hypertension 5.9% Diabetes 6%
In line with the decreasing of infant mortality rate, life expectancy has increased from 71.4 years in
2013 to 72.2 years in 2017. The Indonesian government has set up the target of 102 maternal
mortality deaths in 2015 as in 2015 there were 216 maternal deaths per 100,000 live births.
HIV/AIDS prevalence was estimated at 3.67% in 2017 with substantial differences between
geographical areas and population groups (Table 1.5).
Table 1.5 Health Indicators

Indicators Both sex Source and year
Life expectancy 72.2 (World Bank, 2017a)
Crude mortality rate 7.62 (World Bank, 2017c)
Under-5 mortality rate 39.1 (World Bank, 2017b)
Maternal mortality rate 216 (World Bank, 2015b)
HIV AIDS prevalence rate 3.67 (Kementerian Kesehatan, 2017)
% with access to safe water 71.16 (World Bank, 2015)
% with access to sanitation 77 (MoH, 2018)
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2. Country Health System
2.1 Governance
The organization structure administratively followed the governance levels i.e. the central level, the
province level and the district level. In the central level, the highest level is Echelon I (Director
General) which have some echelon II levels (Director level) and several functional units such as
national and other vertical hospitals, national training centers and so on. At the province and the
district levels, the organization structure of public sector is mostly at the level of echelon II and
below.
The most recent Indonesian National Health System (NHS) was released in year 2012, containing
basic principles including human rights, synergism and dynamic partnership among stakeholders,
commitment and good governance, regulation and law enforcement, anticipative and proactive for
strategic environmental changes, gender-responsive and local wisdom. The governance of NHS
consists of seven subsystems as follow:
1. Health service delivery

The provision of health services comprises of promotion, prevention, curative and rehabilitation
components.
2. Research and health development
Management of research and development of health to support evidence-based data toward the
highest level of community health.
3. Health financing
Health financing for community health service is public good under the responsibility of the
government, while health financing for individual health care is private good under the
responsibility of individual. Relevance with the UHC strategy to remove financial barrier in
accessing health care services, as of 2014, the Government of Indonesia started to implement a
mandatory social insurance for health known as Jaminan Kesehatan Nasional (JKN) or the
national health insurance.
4. Human resources for health
The development and empowerment of HRH emphasizes on four strategies i.e. strengthening the
HRH planning, increasing HRH supply (production), improving HRH management (distribution
and utilization), and strengthening supervision and control the quality of HRH
5. Pharmaceutical supplies, health equipment and food
This subsystem is to include aspects of quality, efficacy, distribution, drug rational usage etc.
6. Health Management, information and health regulation.
This subsystem covers health policy, health administration, health regulation and health
information.
7. Community empowerment
The last subsystem within the NHS is community participation including the private sector, which
is the subject to play important roles in health development.
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Figure 2 The framework of the 2012 National Health System
Further on February 2015, the Ministry of Health released the Strategic Plan document of the
Ministry of Health year 2015-2019, HRH development is one of priorities in health development. It
includes several strategic activities such as HRH planning and management, pre-service and in-
service training, HRH quality including registration and certification and other management and
technical support for HRH development program.
HRH had become the main concern of the government as well as the political leader especially at the
country level. The President instructed through decree number 1/2010 which emphasized on the need
to increase the number of qualified health personnel for remote, underserved, country borderline
areas and outer islands with certain incentive. Further, in the decree number 3/2010, the President
instructed to improve HRH information through HRH mapping, increase the permanent job vacancy
allocation for the remote, underserved, country borderline areas and outer islands especially for the
most strategic health personnel.
Figure 3. Decentralized health service delivery system
Under decentralization system, provincial and district level have broader authority in the regional
development. In the other hand, Ministry of Health providing guidance, supervision and policy
formulation. According to health law number 36 year 2009, government responsibility in health
sector including planning, actuating, controlling, supervising and monitoring health provision to
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achieve equitable and affordable health care services. Health service delivery was provided following
the health care referral system from the primary level to secondary and tertiary level. Further, in 2014
Indonesia has issued the law number 36 that regulated the health workforce over the country.
Along with most social sectors, the health sector has been undergoing a process of decentralizing
many responsibilities from central ministries to the district level particularly to the office of the
Provincial and District Health Officer. This has had implications on human resource planning and
recruitment. For example, to meet their need they can recruit and hire the health workforce under
district civil servant.
2.2 Service provision

The concept of community health centers or in Indonesia “Puskesmas” was introduced in 1968. They
were expected to be available in every sub-district and a public referral hospital should be located
within each district. Currently, at least one Puskesmas is generally available per 30,000 people, and
additional sub-health centers (Pustu) can be accessed at the village level. The number of Puskesmas
is approximately 9,993 health centers (Kementerian Kesehatan, 2018). This center headed by either,
doctor or nurses or other qualified health workers. The main tasks of Puskesmas have been basic care
services, immunization, antenatal and postnatal care, health environment and dental services. Some
Puskesmas have inpatient facility.
To improve community access to health services, since year 2006 the MoH have launched the Alert
Village (Desa Siaga) and Village Health Posts (Poskesdes) as the community base health program
(UKBM), to cover more than 74,000 villages throughout Indonesia. Every village must be served by
at least one midwife. A village health post must be served by one midwife and one nurse. By 2014,
only 2% of 76,026 villages have no midwives (MoH, 2015).
In addition to public facilities, private practices are operated by doctors, nurses and midwives, in
many cases by the same personnel as are employed in public facilities. Based faith organization such
as Muhammadiyah and Aisyiyah Health care showed a consistent engagement in the health sector.
Community health workers are an active participation of community in the health development. They
were chosen by their community to assist health staff deliver the health services (UNICEF, 2010).
For referral, hospitals are available at the district level, provincial level and at national level. About
63.3% out of the 2,813 hospitals owned by private institutions and state for profit enterprises
(Kementerian Kesehatan, 2018). The hospitals are classified into class A, class B, class C and class
D based on the national standard for hospitals as regulated by the Ministry of Health.
2.3 Health care financing

Health care services have been financed from several resources, inclusive of government allocation,
private sector, direct out of pocket payment and aid from other countries. Government has remained
the biggest source of health financing. As shown in Figure 4, the total health expenditure has a steady
increase from 211.2 trillion IDR in 2010 to 436.5 trillion IDR in 201. Social health insurance plays
an important role in the total health expenditure with a significant increase from 5.5% in 2010 to
21.1% in 2017. Conversely, the proportion of household out-of-pocket payments was lower at 31.8%
in 2017 compared to 54.8% in 2010. Despite the reduced proportion of the household payment for
health care, the increased total health expenditure in 2017 implies the growth of the health care
market. Additionally, the MoH also reported that the health expenditure per capita has increased from
97 USD in 2010 to 125 USD in 2017.
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Figure 4 Total Health Expenditure (in Trillion Indonesia Rupiahs) and the proportion of
health financing (MoH, 2018)
Since 2014, Indonesia has implemented the mandatory National Health Insurance (JKN) program
which is administered by the BPJS Kesehatan (Healthcare and Social Security Agency). Previously,
to remove the financial barrier for the poor in using health care service, the Government of Indonesia
(GoI) implemented the Health Insurance program for the poor called Askeskin in 2005 and then
repackaged into an improved scheme known as Jamkesmas to cover health financing for the poor
and the near-poor in 2008. Under the JKN program, the beneficiaries of Jamkesmas continue as the
recipients of Government fee support known as Penerima Bantuan Iuran (PBI). Generally, the JKN
program integrates separated health insurance programs into a single-payer system, including PBI,
the previous social health insurance scheme (Askes) for civil servants, the police, the military
including veterans and retirees, the private employee social health insurance scheme (Jamsostek),
and the health insurance for the poor (Askeskin/Jamkesmas).
By the end of 2018, with a membership comprising of 208 million people, the JKN program
became one of the largest national health insurance schemes in the world (Kementerian Kesehatan,
2018). Currently, the number of JKN membership continues to increase covering more than 80% of
the total Indonesia population.
2.4 Health information system

Decentralization of the health sector according to Law no. 22/1999 which has been amended by Law
no. 32/2004 requires the renewal of health information system. This system demands an integration
system between central level, provincial and district health office either from public and private
sector. All available data including health facility, health promotion, health financing, HRH,
community participation and health management must be integrated.
Ministry of health have made a new platform to integrate all HRH data into one platform. Presidential
decree (Perpres) 95/2018 concerning Electronic-Based Government Systems (SPBE) is a policy of
integration between central government and regional government development. The acceleration of
SPBE implementation prioritizes the principles of security, interoperability and cost-effectiveness
through the use of shared facilities for data centers, government communication networks and general
applications. As one of the applications used as a media for data and information dissemination, the
Ministry of Health platform connects the government and the community. The greater the community
interaction with the website, the greater the information security needs for the web. Website is one
of the media used by the Ministry of Health to disseminate information on health. In addition to
deliver high-quality resources, good website management is also determined by the content that is
10
always updated and reliable (reliable). Reliable health information system governance encourages
accelerated implementation of One Health data.
Extensive support has gone towards providing information technology support to districts, provinces
and national levels. Presence of statisticians depends on the policy of each health unit, this made
information system not optimal. Most of the district using computers and having access to internet
but some in remote or border areas has difficulty on it. It has become clear that there is an urgent
need to strengthen national health information system. Key challenges on implementing health
information system in health sector include:
● Weak coordination between central, provincial and district health office
● Inadequate use of information system for decision making
● Various capacity of human resources in data processing of each administrative level
● Lack of timely reporting and feedback
Special attention is required at both regional and national levels to create an up-to-date HRH
information system.
11
3. Health Workforce Situation
3.1 Health workforce stock and trends
To ensure the quality of health service delivered by health workers, the Government of
Indonesia stipulated regulations on certification, registration and licensing for medical staffs and
other health workers. The certification and registration of medical and dental practitioners and other
health practitioners are conducted by the Indonesia Medical Council (KKI) and the Indonesia Health
Professional Council (MTKI) respectively. Table 3.1 shows the current stock of Indonesia health
workforce based on the number of health workers having registered as practitioners in KKI and
MTKI which also reflects the most recent density of health workforce to the population. In 2011, the
Government of Indonesia has set up the target of the density of health workforce to the population
up to 2025 to achieve the goal of improved the life expectancy from 69 years in 2006 to 74 years in
2025. It is interesting to note that the current density of medical specialists, medical doctors, nurses,
midwives and public health officers have met the 2025 target health workforce ratio. It indicates that
Indonesia’s effort to scale up the number of health workers in addressing the critical shortage of
health staffs have generated positive results.
Table 3.1 Number and ratios of registered health workers per 1000 population in 2018 and the
targeted ratio by 2025
Number of Health workers ratio per 1000 population

Category of health workers
registered HW
As of 2018 Target of 2025
Medical specialist 38,782 0.15 0.12
Medical doctors 134,459 0.52 0.50
Dentists 29,194 0.11 0.14
Nurses 639,356 2.46 2.00
Midwives 590,920 2.27 1.30
Public Health Officer 54,138 0.21 0.18
Nutritionists 41,021 0.16 0.18
Environmental health officer 2,826 0.01 0.20
Total 1,530,696 5.89
Source: (Kementerian Kesehatan, 2019)
The WHO threshold of 2.28 health workers (doctors, nurses, midwives) per 1000 population
has played significant role in determining the minimum sufficiency of health workers stock of
developing nations. Tremendous efforts have been done by Indonesia to improve the availability and
the equity distribution of health workers across the country regions. As shown in Figure 5, the health
worker density as reflected from the combined number of registered doctors, nurses and midwives
to population has been significantly increasing in the last decade from 1.28 to 5.25 per 1000
population between 2010 and 2018. Improvement of health workforce information system by
utilizing the information technology may contribute to the increased health worker density as the
data of health workers can be provided more accurately. With this achievement, Indonesia can
confirm being out of the list of countries with critical shortage of health workers.
12
Figure 5 Trend of the health workers density from 2010 - 2018
The increased number of health workers is also reflected from the health workforce data as
reported by health facilities to the MoH. The following health workers data presented in Table 3.1.1
were collected from health facilities including 9,993 community health centers and 2779 hospitals
(1,012 public hospitals and 1,767 private hospitals). The data shows an increased numbers and ratios
of medical practitioners, dental practitioners, pharmacy practitioners, nursing and midwifery
practitioners, non-medical public health practitioners and medical technologist over the two year by
available stocks. It should be noted however, that the number of medical specialists as reported by
the hospitals especially in 2017 might not reflect the actual number of medical specialist due to
double counting. From Table 3.1.1, the number of medical specialists practicing in the hospitals is
observed 1.4 times higher than the number of registered medical specialists presented in Table 3.1
above. This reflects the dual practice policy is being implemented among the medical specialist
cadres. To improve data accuracy and avoid double counting, since 2018 the MoH has no longer
used the aggregated data from the health facilities but the individual data of health workers instead.
As a result, the data of medical specialists is reduced from 54,042 specialists in 2017 to 29,518
specialists in 2018. The MoH need to continuously improve the individual health workers database
to provide more consistent data.
In general, the availability of health workforce is steadily improving over time in term of
number and ratios. The ratio of general practitioners have improved from 0.17 in 2017 to 0.18 in
2018 per 1000 population. During the same period, the number of nursing and midwifery
practitioners also slightly increases although the ratio remains at 2.02 per 1000 population. Again, as
the data of nursing and midwifery staffs were aggregated by the health facilities in 2017, each
professional level and associate level of the nursing and midwifery data could not be separated before
2018.
Table 3.1.1 Number and ratios of health worker per 1000 population ratios as reported by
health facilities (hospitals, health centers, and some primary clinics) in 2017 and 2018
2017 2018 2017 2018
Category Sub-category
Number Ratio Number Ratio Number Ratio Number Ratio
Medical General Practitioner 0.17 0.18

99,341 0.38 76,807 0.43 45,299 47,289
Practitioners
Medical Specialists 54,042 0.21 29,518 0.25
Dentists 12,788 0.05 13,030 0.05

Dental Dental Specialists 1,938 0.01 1,720 0.01
14,726 0.06 16,505 0.06
Practitioners
Dental Technicians - - 1,755 0.01
13
2017 2018 2017 2018
Category Sub-category
Number Ratio Number Ratio Number Ratio Number Ratio
Pharmacists 12,349 0.05 15,935 0.06

Pharmacy
39,594 0.15 50,603 0.19
practitioners Pharmaceutical technicians/
27,245 0.10 34,668 0.13
assistants
Nursing professionals 332,811 1.27 78,894 0.30
Midwifery Professionals - - 3,059 0.01
Nursing and Nursing Specialists - - - -

Midwifery 528,096 2.02 535,459 2.02
practitioners Midwifery Specialists - - - -
Nursing Associate
- - 241,878 0.91
professionals
Midwifery Associate
195,285 0.75 211,628 0.80
professionals
Public Health Generalists 20,714 0.08 25,809 0.10
Public Health Specialists - - - -
Food and Nutrition

18,298 0.07 22,141 0.08
Professionals
Environmental and
Non-Medical Occupational Health 14,933 0.06 16,501 0.06
Public Health 53,945 0.21 64,451 0.24 Professionals
Practitioners
Environment and occupational
health inspectors and - - - -
associates
Community Health workers - - - -
Community Health Volunteers - - - -
Medical Imaging Technicians - - - -
Medical Medical Technicians 11,300 0.04 12,500 0.05

34,640 0.13 45,954 0.17
Technologists
Laboratory Assistants 23,340 0.09 25,864 0.10
Biomedical technologists - - 7,590 0.03

Traditional
Traditional Medicine
Medicine - - 273 0.00 - - 273 0.00
Practitioner
Practitioner
Veterinary Public Health
- - - -
Veterinary Specialists
- - - -
practitioners
Veterinary technicians and
- - - -
assistants
Optometrists - - 759 0.00
Physiotherapists 6,187 0.02 5,052 0.02
Physiotherapy Assistants - - - -
Occupational Therapists 309 0.00

Other Health
6,187 0.02 7,839 0.03 Occupational Therapy
Workers - - - -
Assistant
Other health professionals not

- - 1,719 0.01
elsewhere classified
Other health associate

professionals not elsewhere - - - -
classified
Health Service Manager - - 3,414 0.01
Health
management
- - 274,707 1.04 Medical Records Technicians - - 10,531 0.04
and support
staff
Support staff - - 260,762 0.98
TOTAL 776,529 2.97 1,072,598 4.25 776,529 2.97 1,072,598 4.25

14
Migration or movement of the health workforce within and across country has become a great
attention. Urban areas are more attractive for most health workers compared to rural areas. Similarly,
health workers are prefer to work in more prosperous or populous regions than less developed
regions. As a result, imbalance distribution of health workers across the provinces exists with the
highest number of health workforces in Java/Bali region.
As for Indonesia, international migration is not a new issue particularly for nurses. Nurses have
sought employment abroad for many reasons, including high unemployment in the domestic health
care labour market. The domestic supply of nurses is higher than the capacity of domestic health care
market to absorb. Several countries have been offering opportunities for nurses to work there. Japan,
Taiwan and some middle eastern countries have become the major destination countries among
Indonesia health workers. For example Japan through Indonesia Japan Economic Partnership
Agreement (IJEPA) required about 1000 Indonesian nurses. Up to year 2019, there were 2,445
Indonesian nurses sent to work as nurses/assistant nurses in Japan under IJEPA framework. During
2014-2018, approximately 114,945 Indonesia health workers were recruited to work overseas.
3.2 Distribution of health workforce by category/cadre
MoH has put emphasis on increasing the number, type and quality of health workers over the region.
Recruitment of health workers was done using formation of civil servants, contract medical doctors
and midwives (Pegawai Tidak Tetap/PTT) and some special assignment (Nusantara Sehat team and
individual). The launching of new health workforce deployment program through Nusantara Sehat
by the MoH in 2015 also mark the end of recruitment of medical doctors and midwives through the
PTT program. From 2015-2018, the MoH recruited 11,816 health workers and additionally 2,215
health workers are being recruited in 2019 to be sent to rural community health centers. To support
the referral facilities, the MoH also implements the assignment of medical specialists. Between 2015
and 2018, 4,150 medical specialists (obstetric-gynecologist, pediatrician, internist, surgery, and
anesthetist) were recruited and sent mostly to district hospitals for a minimum two-year assignment.
For the last two years, the total number of the health workforce in service has shown a significant
increase of about 57% from 608,203 staffs in 2015 to 1,072,598 staffs in 2018. In particular, the
number of general practitioner has increased from 42,168 doctors to 47,289 doctors within this
period, with the same trend of increment happened to other cadres except medical specialist.
Table 3.2 Distribution of health workers during 2015-2018 (for past 4 years of available data)
Category Sub-category Cadre* 2015 2016 2017 2018
General
General Practitioner Medical 42,168 42,108 45,299 47,289
Practitioners
Medical
Medical
Practitioners Medical Specialists 47,800 48,942 54,042 29,518
Specialists
Medical
Medical Assistants - - - -
Assistants
Dentists Dentists 11,939 11,906 12,788 13,030
Dental
Dental Specialists 1,159 1,553 1,938 1,720
Specialists
Dental
- - -
Dental Assistants
Practitioners Dental
- - -
Dental Technicians Hygienists 1,755
Dental nurses - - -
Dental lab
- - -
technicians
Pharmacists 12,107 11,835 12,349 15,935
Pharmacy
practitioners Pharmaceutical
19,859 19,489 27,245 34,668
technicians/ assistants
Nursing professionals 254,830 257,870 332,811 78,894
15
Category Sub-category Cadre* 2015 2016 2017 2018
Midwifery Professionals - - - 3,059
Nursing- Midwifery
- - - -
Professionals
Nursing Specialists - - - -
Nursing and Midwifery Specialists - - - -
Midwifery Nursing Associate
practitioners - - - 241,878
professionals
Midwifery Associate
133,095 118,689 195,285 211,628
professionals
Nursing-Midwifery
- - - -
Associate professionals
Public Health Generalists 24,725 20,909 20,714 25,809
Public Health Specialists
Food and Nutrition
15,020 14,654 18,298 22,141
Professionals
Environmental and
Non-Medical Occupational Health 13,591 11,853 14,933 16,501
Public Health Professionals
Practitioners Environment and
occupational health - - - -
inspectors and associates
Community Health
- - - -
workers
Community Health
- - - -
Volunteers
Medical Imaging
- - - -
Technicians
Medical Medical Technicians 10,873 9,557 11,300 12,500
Technologists
Laboratory Assistants 16,502 17,833 23,340 25,864
Biomedical technologists - - - 7,590
Traditional
Medicine - - - 273
Practitioner
Practitioner
Veterinary Public Health
- - - -
practitionersVeterinary technicians and
- - - -
assistants
Optometrists - - - 759
Physiotherapists 4,535 5,372 6,187 5,052
Physiotherapy Assistants - - - -
Occupational Therapists - - - 309
Other Health Occupational Therapy
- - - -
Workers Assistant
Other health professionals
- - - 1,719
not elsewhere classified
professionals not - - - -
Health Service Manager - - - 3,414
Health
Medical Records
management and - - - 10,531
Technicians
support staff
Support staff - - - 260,762
TOTAL 608,203 592,570 776,529 1,072,598
3.2.1 Gender distribution by health workforce categories/cadre

Health sector has been known for the female dominated employment. Indonesia health sector is not
the exception. As shown in Table 3.3, the gender distribution confirms that of 1,072,598 health
workers, 70.9% are female. Only two sub-categories are dominated by male, including medical
specialist (60.8%) and biomedical technologist (51.1%). Midwifery category employs female only
16
(100%). The gender distribution of medical doctors and dentists showed the female domination at
63.6% and 79.4% respectively. This description may indicate the need of gender sensitive approach
in the management of HRH.
Table 3.3 Gender distribution by health workforce category/cadre
Category Sub-category Total % Male % Female

General Practitioner 47,289 36.4 63.6
Medical
Medical Specialists 29,518 60.8 39.2
Practitioners
Medical Assistants - - -
Dentists 13,030 20.6 79.4
Dental Dental Specialists 1,720 34.9 65.1
Practitioners Dental Technicians 1,755 21.1 78.9
Dental Assistant and Therapist - - -
Pharmacy Pharmacists 15,935 20.1 79.9
practitioners Pharmaceutical technicians/ assistants 34,668 16.7 83.3
Nursing professionals 78,894 32.1 67.9
Midwifery Professionals 3,059 0.0 100.0
Nursing- Midwifery Professionals - - -
Nursing and Nursing Specialists - - -
Midwifery Midwifery Specialists - - -
practitioners Nursing Associate professionals 241,878 29.9 70.1
Midwifery Associate professionals 211,628 0.0 100.0
Nursing-Midwifery Associate
- - -
professionals
Public Health Generalists 25,809 27.1 72.9
Food and Nutrition Professionals 22,141 13.9 86.1
Non-Medical Environmental and Occupational Health
16,501 33.9 66.1
Practitioners Environment and occupational health
- - -
Community Health workers - - -
Community Health Volunteers - - -
Medical Imaging Technicians - - -
Medical Medical Technicians 12,500 27.4 72.6
Technologists Laboratory Assistants 25,864 22.2 77.8
Biomedical technologists 7,590 51.1 48.9
Traditional
Medicine Traditional Medicine Practitioner 273 32.5 67.5
Practitioner
Veterinary Veterinary Public Health Specialists - - -
practitioners Veterinary technicians and assistants - - -
Optometrists 759 42.7 57.3
Physiotherapists 5,052 33.2 66.8
Physiotherapy Assistants - - -
Occupational Therapists 309 29.5 70.5
Other Health
Occupational Therapy Assistant - - -
Workers
Other health professionals not elsewhere
1,719 48.8 51.2
classified
Other health associate professionals not
- - -
Health Health Service Manager 3,414 42.7 57.3
management Medical Records Technicians 10,531 28.1 71.9
and support
Support staff 260,762 49.4 50.6
staff
TOTAL 1,072,598 29.1 70.9
17
3.2.2 Age distribution by occupation/cadre
According to the civil service rules and regulations (Government regulation No. 11 year 2017), civil
servants in Indonesia should retire by the age of 65, 60 and 58 years old which depend on the
functional or structural position at the government office. For civil servants who hold non functional
positions or structural positions below echelon II, the retirement age should not exceed 58 years old.
The details of health workers data by age group and cadre as depicted on Table 3.4. Most health
workers are at young age which consist of 35.5% of workers age between 31 and 40 years old and
31.3% of workers age 30 years old or younger.
Table 3.4 Health workers by age group and cadre

Category Sub-category ≤30 Yrs 31-40 Yrs 41-50 Yrs ≥51 Yrs TOTAL
General Practitioner 13,749 19,210 8,455 5,875 47,289
Medical Practitioners Medical Specialists 314 8,617 9,988 10,599 29,518
Medical Assistants -
Dentists 2,380 4,944 2,997 2,709 13,030
Dental Practitioners Dental Specialists 47 624 487 562 1,720
Dental Technicians 429 730 444 152 1,755
Pharmacists 6,277 6,912 1,707 1,039 15,935
Pharmacy
practitioners Pharmaceutical technicians/
16,316 11,506 4,313 2,533
assistants 34,668
Nursing professionals 24,848 31,312 13,233 9,501 78,894
Midwifery Professionals 1,047 907 550 555 3,059
Nursing- Midwifery - - - - -
Professionals
Nursing and
Nursing Specialists - - - - -
Midwifery Midwifery Specialists - - - - -
practitioners Nursing Associate
79,601 101,705 39,742 20,830
professionals 241,878
Midwifery Associate
82,353 70,240 44,674 14,361
professionals 211,628
Nursing-Midwifery - - - - -
Public Health Generalists 7,941 9,539 5,480 2,849 25,809
Public Health Specialists - - - - -
Food and Nutrition
7,443 7,063 5,010 2,625
Professionals 22,141
Environmental and
Occupational Health 3,993 5,078 4,695 2,735
Non-Medical Public
Professionals 16,501
Health Practitioners
Environment and - - - - -
occupational health
Community Health workers - - - - -
Community Health - - - - -
Volunteers
Medical Imaging - - - - -
Technicians
Medical Medical Technicians 3,190 4,707 2,948 1,655 12,500
Technologists
Laboratory Assistants 10,631 8,814 4,441 1,978 25,864
Biomedical technologists 3,516 2,387 1,146 541 7,590
Traditional Medicine Traditional Medicine
114 72 46 41
Practitioner Practitioner 273
Veterinary Public Health - - - - -
practitioners Veterinary technicians and - - - - -
assistants
18
Category Sub-category ≤30 Yrs 31-40 Yrs 41-50 Yrs ≥51 Yrs TOTAL
Optometrists 152 348 190 69 759
Physiotherapists 1,905 1,871 844 432 5,052
Physiotherapy Assistants -
Occupational Therapists 141 133 34 1 309
Other Health Occupational Therapy - - - - -
Workers Assistant
422 542 487 268
not elsewhere classified 1,719
Other health associate - - - - -
professionals not elsewhere
classified
Health Service Manager 1,077 694 732 911 3,414
Health management Medical Records
6,089 3,207 680 555
and support staff Technicians 10,531
Support staff 61,898 79,601 65,068 54,195 260,762
TOTAL 335,873 380,763 218,391 137,571 1,072,598
Percentage 31.3 35.5 20.4 12.8
3.2.3 Region/province/district distribution by occupation/cadre
Health workforce distribution in Indonesia is presented in the proportion across six regions namely
Sumatera, Jawa, Bali-Nusa Tenggara, Kalimantan, Sulawesi and Maluku-Papua. Higher proportions
of health workers are observed in the Jawa and Sumatera regions compared to other regions (Table
3.5). However, Jawa and Sumatera are recognized as the most densely populated regions that may
explain the high number of health workers available in these regions. On the other hand, Maluku and
Papua regions have the least number and proportion of health workers because of geographically
having more health facilities located in remote and very remote areas which are usually less attractive
to health workers.
Table 3.5 Distribution of heath workers by regions

% Bali- %
Total % % %
Sub-category % Jawa Nusa Maluku-
Number Sumatera Kalimantan Sulawesi
Tenggara Papua
General Practitioner 47,289 22.98 54.48 5.93 6.28 7.71 2.62
Medical Specialists 29,518 15.45 65.96 6.88 4.45 5.91 1.35
Dentists 13,030 23.21 54.30 5.88 5.67 9.37 1.57
Dental Specialists 1,720 8.55 80.28 3.72 4.01 2.97 0.47
Dental Technicians 1,755 30.20 29.97 10.31 10.77 15.10 3.65
Pharmacists 15,935 17.02 55.81 4.61 7.05 11.83 3.68
Pharmaceutical technicians/
34,668 21.66 55.57 4.96 7.33 8.28 2.20
assistants
Nursing professionals 78,894 16.49 50.98 10.46 7.74 10.77 3.56
Midwifery Professionals 3,059 34.23 56.42 0.00 4.12 3.50 1.73
Nursing- Midwifery Professionals - - - - - - -
Nursing Specialists - - - - - - -
Midwifery Specialists - - - - - - -
Nursing Associate professionals 241,878 25.99 45.75 5.41 8.24 10.09 4.52
Midwifery Associate professionals 211,628 36.37 36.15 6.28 7.27 10.79 3.14
Nursing-Midwifery Associate - - - - - -
-
professionals
19
% Bali- %
Total % % %
Sub-category % Jawa Nusa Maluku-
Number Sumatera Kalimantan Sulawesi
Tenggara Papua
Public Health Generalists 25,809 34.13 24.35 5.53 7.25 22.27 6.47
Public Health Specialists - - - - - - -
Food and Nutrition Professionals 22,141 23.49 39.22 7.86 9.64 14.45 5.34
Environmental and Occupational
16,501 27.77 31.19 9.56 9.28 16.93 5.27
Health Professionals
Environment and occupational - - - - - -
-
health inspectors and associates
Community Health workers - - - - - - -
Community Health Volunteers - - - - - - -
Medical Imaging Technicians - - - - - - -
Medical Technicians 12,500 26.08 42.34 8.58 10.52 11.04 1.44

Laboratory Assistants 25,864 23.71 48.77 6.69 9.01 7.97 3.85
Biomedical technologists 7,590 21.38 55.99 7.13 6.67 6.77 2.06
Traditional Medicine Practitioner 273 10.25 56.41 4.76 3.30 0.37 24.91
Veterinary Public Health Specialists - - - - - - -
Veterinary technicians and - - - - - -
-
assistants
Optometrists 759 36.10 50.46 3.56 7.11 0.79 1.98
Physiotherapists 5,052 22.39 55.60 5.42 5.29 9.30 2.00
Physiotherapy Assistants - - - - - - -
Occupational Therapists 309 13.27 74.43 5.50 5.83 0.97 0.00

Occupational Therapy Assistant - - - - - - -
Other health professionals not
1,719 0.00 0.00 0.00 0.00 0.00 0.00
Other health associate professionals - - - - - -
-
Health Service Manager 3,414 16.22 60.11 6.62 7.82 6.24 2.99
Medical Records Technicians 10,531 20.46 61.01 5.54 5.43 6.49 1.07
Support staff 260,762 21.10 54.23 6.94 7.94 6.71 3.08
TOTAL 1,072,598 25.36 47.29 6.55 7.65 9.52 3.47
3.2.4 Urban/rural distribution by occupation/cadre
Urban/rural distribution of health workers in this document refers to the location of the place of work
below the sub-district level which is established by the National Bureau of Statistics (BPS).
Urban/rural classification is determined based on the population density, the proportion of
agricultural household, public transportation access and public facilities. As shown in the table 3.6
below, in the sub category of general practitioner, of 47,289 doctors approximately 58.2 % work in
urban areas while 41.8% work in rural areas. Rural areas are dominated by midwives, public health
officers and environmental health officers. This is in line with the national policy on the deployment
of midwives at the village level with particular attention to improve maternal and child health, and
the health promotion program. The improved availability of health workers at rural areas is also
contributed by the Nusantara Sehat program which focuses on remote and very remote locations for
a short-term assignment.
20
Table 3.6 Urban/Rural Distribution of Workforce
%
HW/ HW/
Total Total % Total
Category Sub-category Rural 1000 Pop in 1000 Pop in
Number Urban Urban Rural
urban rural
General Practitioner 47,289 27,502 58.2% 19,787 41.8% 0.19 0.17

Medical
Practitioners Medical Specialists 29,518 18,176 61.6% 11,342 38.4% 0.12 0.10
Medical Assistants - - - - - - -
Dentists 13,030 7,673 58.9% 5,357 41.1% 0.05 0.05
Dental Dental Specialists 1,720 1,228 71.4% 492 28.6% 0.01 0.00
Practitioners
Dental Technicians 1,755 881 50.2% 874 49.8% 0.01 0.01
Pharmacists 15,935 8,953 56.2% 6,982 43.8% 0.06 0.06

Pharmacy
34,668 19,632 56.6% 15,036 43.4% 0.13 0.13
Nursing professionals 78,894 41,461 52.6% 37,433 47.4% 0.28 0.32
Midwifery Professionals 3,059 1,903 62.2% 1,156 37.8% 0.01 0.01

Nursing- Midwifery - - - - - - -
Professionals
- - - - - - -
Nursing and Nursing Specialists
Midwifery
- - - - - - -
practitioners Midwifery Specialists
Nursing Associate
241,878 130,569 54.0% 111,309 46.0% 0.88 0.96
professionals
Midwifery Associate
211,628 105,287 49.8% 106,341 50.2% 0.71 0.91
professionals
Nursing-Midwifery - - - - - - -
Public Health Generalists 25,809 11,909 46.1% 13,900 53.9% 0.08 0.12
- - - - - - -
Food and Nutrition
22,141 11,296 51.0% 10,845 49.0% 0.08 0.09
Professionals
Non-Medical Environmental and
Public Health Occupational Health 16,501 8,068 48.9% 8,433 51.1% 0.05 0.07
Practitioners Professionals
Environment and - - - - - - -
occupational health
Community Health - - - - - - -
workers
Community Health - - - - - - -
Volunteers
Medical Imaging - - - - - - -
Technicians
Medical Medical Technicians 12,500 6,691 53.5% 5,809 46.5% 0.05 0.05
Technologists
Laboratory Assistants 25,864 13,959 54.0% 11,905 46.0% 0.09 0.10
Biomedical technologists 7,590 4,374 57.6% 3,216 42.4% 0.03 0.03
Traditional
Medicine 273 158 57.9% 115 42.1% 0.00 0.00
Practitioner
Practitioner
21
%
HW/ HW/
Total Total % Total
Category Sub-category Rural 1000 Pop in 1000 Pop in
Number Urban Urban Rural
urban rural
Veterinary Public Health - - - - - - -

practitioners Veterinary technicians - - - - - - -
and assistants
Optometrists 759 433 57.0% 326 43.0% 0.00 0.00
Physiotherapists 5,052 2,879 57.0% 2,173 43.0% 0.02 0.02
Physiotherapy Assistants - - - - - - -
Occupational Therapists 309 203 65.7% 106 34.3% 0.00 0.00
Other Health Occupational Therapy - - - - - - -
Workers Assistant
1,719 - 0.0% - 100.0% - -
Other health associate - - - - - - -
professionals not
Health Health Service Manager 3,414 2,020 59.2% 1,394 40.8% 0.01 0.01
management Medical Records
10,531 5,988 56.9% 4,543 43.1% 0.04 0.04
and support Technicians
staff Support staff 260,762 146,849 56.3% 113913 43.7% 0.99 0.98
TOTAL 1,072,598 578,092 54.1% 492,787 45.9%
3.2.5 Public/private distribution by occupation/cadre

The distribution of health workers between the public and private sector as presented in Table 3.7 is
based on data from 9,993 community health centers (public), 1,012 public hospitals, 1,203 private
hospitals, 388 private not-for-profit hospitals and 176 faith-based hospitals. Majority of the highly
skilled health workers are in public sector across the categories (80.1%), followed by private sector,
faith-based hospitals and private not-for-profit hospitals. Therefore, much higher proportion of health
workers working in the public sector is not surprising as the sources of health workers data are mostly
from the public facilities.
In reference to Table 3.7, general practitioner account for 70% of health workers working in the
public sector, while medical specialists (41.3%) a mostly work in the private sector (private
hospitals). The proportion of dental specialists work in public sector is slightly higher than those in
private sector. This data indicates that the individual data is very useful to provide a more accurate
description on the primary employment of medical and dental staffs considering those staff categories
have the dual practice privilege. Other categories of health workers showed higher proportions of
employment in the public sector than in the private sector.
Table 3.7 Public/Private for profit/Faith based organization/private not for profit
distribution of health workers
%
% % Faith
Total % Public Private
Category Sub-category Private based
Number sector not-for-
sector organization
profit
General Practitioner 47,289 70.0% 19.3% 3.7% 7.0%

Medical
Practitioners Medical Specialists 29,518 38.3% 41.3% 6.7% 13.7%
Medical Assistants - - - - -
22
%
% % Faith
sector organization
profit
Dentists 13,030 76.3% 16.6% 2.6% 4.5%

Dental
Dental Specialists 1,720 47.5% 40.8% 4.4% 7.4%
Practitioners
Dental Technicians 1,755 45.7% 28.5% 14.7% 11.1%
Pharmacists 15,935 50.9% 32.9% 6.6% 9.7%

Pharmacy
34,668 76.1% 16.4% 2.4% 5.2%
Nursing professionals 78,894 76.9% 14.2% 3.5% 5.3%
Midwifery
3,059 94.6% 2.6% 1.9% 0.9%
Professionals
Nursing- Midwifery
Professionals
- - - - -
Nursing and Nursing Specialists - - - - -

Midwifery
practitioners Midwifery Specialists - - - - -
Nursing Associate
241,878 82.5% 6.9% 6.7% 3.9%
professionals
Midwifery Associate
211,628 90.8% 6.3% 0.9% 2.0%
professionals
Nursing-Midwifery
- - - - -
Public Health
25,809 92.9% 4.9% 0.5% 1.7%
Generalists
Public Health
Specialists
- - - - -
Food and Nutrition

22,141 88.4% 7.3% 1.8% 2.5%
Professionals
Environmental and
Non-Medical Occupational Health 16,501 92.1% 5.2% 0.9% 1.9%
Practitioners Environment and
occupational health
inspectors and
- - - - -
associates
Community Health
workers
- - - - -
Community Health
Volunteers
- - - - -
Medical Imaging
Technicians
- - - - -
Medical
Technologists Medical Technicians 12,500 55.8% 28.7% 5.9% 9.6%
Laboratory Assistants 25,864 72.4% 18.2% 3.4% 6.0%
23
%
% % Faith
sector organization
profit
Biomedical
7,590 83.1% 8.0% 6.9% 2.0%
technologists
Traditional
Medicine
Practitioner
273 100.0% - - -
Practitioner
Veterinary Public
Health Specialists
- - - - -
Veterinary
practitioners Veterinary technicians
and assistants
- - - - -
Optometrists 759 83.1% 8.0% 6.9% 2.0%
Physiotherapists 5,052 54.8% 29.9% 5.3% 10.0%
Physiotherapy
Assistants
- - - - -
Occupational
Other Health Therapists
309 100.0% - - -
Workers
Occupational Therapy
Assistant
- - - - -
Other health
professionals not 1,719 73.4% 11.0% 8.0% 7.6%
professionals not - - - - -
Health Service
3,414 78.4% 10.4% 7.3% 3.8%
Health Manager
management
Medical Records
and support 10,531 83.4% 7.1% 6.1% 3.4%
Technicians
staff
Support staff 260,762 79.2% 8.9% 8.0% 3.8%
TOTAL 1,072,598 80.1% 10.8% 4.9% 4.2%

24
4. HRH Production
4.1 Pre-service education
Implementation of the higher education system is under the responsibility of the Ministry of
Research, Technology and Higher Education (MRTHE) including pre-service training for health
workforce. MRHTE has the authority to regulate and implement the higher education licensure,
education operational standard, standard of curriculum, academic rank system, and the higher
education quality assurance. The MoH shared the responsibility in technical aspects especially in
relation to professionals’ competency required in the health care delivery.
As of August 2019, there are 2,168 health workforce education institutions in Indonesia, among those
(377 schools) are public institutions (Table 4.1). This number of schools is an increase from 2,043
schools in 2009. The MoH runs 38 health polytechnics or schools which provide vocational education
program on nursing, midwifery, pharmacy, traditional medicine, environmental health, nutrition,
physical therapy, technical medic, technical biomedic and health insurance. The vocational program
is provided at undergraduate level consisting of the Diploma 3 and Diploma 4 (Bachelor degree
level), and Applied Master degree. The health polytechnics are available across 34 provinces in
Indonesia.
To ensure the quality of education, the education institutions must be accredited. The accreditation
of higher education institutions is undertaken by BAN-PT (The National Accreditation Body for
Higher Education). The higher education institutions majoring in health may also be accredited by
LAM-PTKes (the independent accreditation body for higher education institutions in health).
Table 4.1 Number of Training Institutions by Type of Ownership
Type of ownership
Private not for Total
Type of training institution Public Private for Profit
profit, FBOs
Medicine 36 - 49 85
Dentistry 16 - 15 31
Pharmacy 56 - 324 380
Nursing & Midwifery* 144 3 1,036 1,183
Health sciences 9 - - 9
Public health 78 1 246 325
Medical technology 36 6 108 150
Traditional Medicine 2 - 3 5
Other Allied Health (indicate
- - - -
the type of cadre)
Total 377 10 1,781 2,168
Source: MRTHE, 2019
FBO=Faith based Organization

Public = All government owned/funded training institutes under health, education and other related ministries.
The following table 4.2 shows the number of students and the number of graduates of health
education institutions. The data of medical practitioners, dentists, nurses, midwives, and public health
practitioners were generated from the MRTHE database, while the data of other categories of health
workers were obtained from the Ministry of Health (the Diploma 3 level only). The capacity to
produce health professionals in Indonesia was heavily impacted by growing number of health
institution, particularly for nursing and midwifery. The cumulative number of graduates from health
education institutions from 2015 to 2018 reach more than 3.9 million health workers. The highest
25
cohorts of health workers are contributed from three categories including medicine, nursing, and
midwifery. The cumulative production of general medical practitioners in the last four years is
658,298. Nursing workforce is the highest cohort among other health workforce with the total
production of nursing workforce (professional nurses and associate nurses) approximately 1.5
million between 2015 and 2018, while the total production of midwifery workforce is over one
million within the same period. In addition to the health workforce data, Indonesia also produce
health worker assistants from 4,544 vocational high schools. Approximately 180 thousand health
workers assistants including 20 thousand nursing assistants graduate from those vocational high
schools annually.
In reference to the current stock of health workers in the health facilities, the high annual production
of health workforce as presented in Table 4.2 indicates the mismatch between supply and demand of
health workers in the domestic health market. The MoH estimates that the steady high annual
production of medical doctors, nurses, and midwives has resulted in temporary surplus due to the
lower demand of health care facilities and the capacity of domestic labor market to absorb graduates.
Another challenge is ensuring the quality of graduates that meet the demand of healthcare facilities.
Most of health education institutions are available in big cities and western regions of Indonesia
which contribute to the complex issues of health workforce distribution, skill mix, interprofessional
collaboration, and effective supervision as part of the management and quality control system.
Table 4.2 Number of Entrants and Graduates between 2015-2018
Number of entrants Number of graduates

Category Sub-category Total
Total
output
2015 2016 2017 2018 input 2015 2016 2017 2018
General
148,749 142,634 100,095 50,082 441,560 155,919 171,005 164,459 166,915 658,298
Medical Practitioner
Practitioners Medical
- - - - - - - - - -
Assistants
Dentists 511 549 362 195 1.617 754 903 866 811 3,334
Dental
Practitioners Dental
11,047 12,475 7,358 3,420 34,300 8,654 9,473 9,778 12,196 40,101
Technicians
Pharmacists 3,184 5,754 2,530 744 12,212 2,509 4,087 2,404 662 9,662
Pharmacy Pharmaceutical
practitioners technicians/ 152,978 572 3,339 233 157,122 102,423 539 2,509 218 105,689
assistants
Nursing
181,224 130,992 88,472 34,958 435,646 213,477 207,597 196,192 195,620 812,886
professionals
Midwifery
2,241 2,755 3,406 2,358 10,760 1,603 1,348 2,765 4,192 9,908
Professionals
Nursing and
Nursing
Midwifery
Associate 178,287 160,777 84,869 36,449 460,382 193,686 177,559 156,865 165,618 693,728
practitioners
professionals
Midwifery
Associate 195,843 139,668 73,703 27,771 436,985 350,998 291,679 235,630 193,972 1,072,279
professionals
Public Health
99,762 74,065 54,237 25,645 253,709 112,729 112,065 107,739 105,275 437,808
Generalists
Food and
Nutrition - - - - - 1,425 1,477 3,620 3,827 10,349
Professionals
Non-Medical
Environmental
Public Health
and
Practitioners
Occupational - - - - -
Health
Professionals
Environmental
5,249 4,060 2,952 1,713 13,974 4,078 4,512 3,913 4,888 17,391
and
26
Number of entrants Number of graduates
Category Sub-category Total
Total
output
2015 2016 2017 2018 input 2015 2016 2017 2018
occupational
health
inspectors and
associates
Food and
nutrition - - - - - 1,727 2,070 3,577 3,757 11,131
associates
Medical
Imaging NA NA NA NA NA NA NA NA NA NA
Technicians
Medical
Medical - - - - - 2,500 2,824 4,529 4,217 14,070
Technicians
Technologists
Laboratory
NA NA NA NA NA NA NA NA NA NA
Assistants
Biomedical
- - - - - 6,418 5,994 11,788 11,668 35,868
technologists
Traditional Traditional
Medicine Medicine - - - - - 44 48 53 109 254
Practitioner Practitioner
Veterinary
Public Health NA NA NA NA NA NA NA NA NA NA
practitioners Veterinary
technicians and NA NA NA NA NA NA NA NA NA NA
assistants
Optometrists NA NA NA NA NA NA NA NA NA NA
Physiotherapists - - - - - 580 649 1,084 789 3,102
Physiotherapy
- - - - - 902 1,056 2,229 2,229 6,416
Assistants
Occupational
Therapists
Occupational
Therapy NA NA NA NA NA NA NA NA NA NA
Other Health Assistant
Workers Other health
professionals
not elsewhere
classified
Other health
associate
professionals NA NA NA NA NA NA NA NA NA NA
not elsewhere
classified
TOTAL 979,075 674,301 421,323 183,568 2,258,267 1,160,426 994,885 910,000 876,963 3,942,274
Source: Ministry of Research and Higher Education 2019 and Ministry of Health 2019
Note: NA: data is not available at the time of data collection, but does not imply the non existense of the
education/training program for those particular sub categories.
There is no data available for the total number of teachers for each type of training and the ratio
between teachers and students. The data from MOH year 2019 only describe the availability teachers
by their professions in health or not in health disciplines. According for the table 4.3 shows the total
number of teachers with various educational background in health was 43,074 teachers in health
disciplines.
Table 4.3 Number of Teachers by Profession and Teachers/Student Ratios
27
Teachers’ profession
Type of Teachers/
Total Professionals Total
training Professionals within student
teachers* outside the students*
institution the discipline ratios
discipline
Medicine 5.264 54.459 0,10
Dentistry 1.209 16.419 0,07
Pharmacy 4.708 112.762 0,04
Nursing &
23.862 388.864 0,06
Midwifery
Health
291 4.694 0,06
sciences
Public health 5.854 118.954 0,05
Medical
1.847 36.228 0,05
technology
Traditional
39 946 0,04
Medicine
TOTAL 43.074 733.326 0,06
Source: MRTHE, 2017

Note: * Based on 2017/2018 report
4.2 In-service and continuing education
The MoH recognizes the importance of staff development and skills updates for its staff in its HRH
policy. Under supervision of the Board for Development and Empowerment of Human Resources
for Health, there are centers to provide the in-service training of health workforce, training for health
apparatus (civil servants) and continuing professional development (CPD). The trainings provided
include technical and clinical trainings, management and leadership training and professional
trainings with credit points.
Health professional associations such as medical associations, nurse associations, midwife

associations and others were encouraged to conduct regular CPD for their members in order to attain
minimum credit points required for their certification and licensing as professionals. Indonesian
Medical Council (KKI) as an actualization of Medical Practice Law no. 29 year 2004 also has
functions to supervise and to improve the quality of medical practices through continuing
professional development.
4.3 Health workforce requirements
Universal health coverage requires sufficient and qualified health workers who are well motivated
and evenly distributed across regions. Health workers should be easily accessible and acceptable to
the community to improve the use of health service with the goal to improve people’s health status.
Staffing shortage, lack of competency and imbalance distribution of health workers should be
addressed to minimize health inequity.
Developing the health workforce requirement is to estimate the number and type of health workers
required to meet the population demand on health service. Indonesia has implemented several
methods to better estimate the health workforce requirement, including workload indicator staffing
need analysis, health workers to population ratio projection, and health workforce requirement based
on the minimum requirement standard of health facilities. The table 4.4 shows the projected number
of health workforce requirement for the coming years based on the minimum requirement standard
of health facilities. Based on the current health workforce stock and requirement, by 2020 the number
of health workforce required is 1,074,338 workers. In 2021, the number of health workforce
28
requirements is 1,089,341 workers. In 2022, the number of health workforce requirements is
1,103,347 workers. The next year on 2023, the number of health workforce requirements is 1,116,859
workers.
Table 4.4 Projections for Health Workforce Requirements for The Coming Years
Category Sub-category Cadre* 2019 2020 2021 2022 2023
General Practitioner 47,289 47,366 48,027 48,645 49,241
Medical
Medical Specialists 29,518 29,566 29,979 30,364 30,736
Practitioners
Medical Assistants - - - - -
Dentists 13,030 13,051 13,233 13,403 13,567
Dental
Dental Specialists 1,720 1,723 1,747 1,769 1,791
Practitioners
Dental Technicians 1,755 1,758 1,783 1,806 1,828
Pharmacists 15,935 15,961 16,184 16,392 16,593
Pharmacy
34,668 34,724 35,209 35,662 36,099
Nursing professionals 78,894 79,022 80,125 81,155 82,149
Midwifery
211,628 211,971 214,931 217,694 220,359
Professionals
Nursing- Midwifery
- - - - -
Professionals
Nursing and Nursing Specialists - - - - -
Midwifery Midwifery Specialists - - - - -
practitioners Nursing Associate
241,878 242,270 245,653 248,812 251,858
professionals
Midwifery Associate
3,059 3,064 3,107 3,147 3,186
professionals
Nursing-Midwifery
- - - - -
Public Health
25,809 25,851 26,212 26,549 26,874
Generalists
Public Health
- - - - -
Specialists
Food and Nutrition
22,141 22,177 22,487 22,776 23,055
Professionals
Environmental and
Non-Medical Occupational Health 16,501 16,528 16,759 16,974 17,182
Practitioners Environmental and
occupational health
- - - -
inspectors and
associates
Community Health
- - - - -
workers
Community Health
- - - - -
Volunteers
Medical Imaging
- - - - -
Technicians
Medical Medical Technicians 12,500 12,520 12,695 12,858 13,015
Technologists Laboratory Assistants 25,864 25,906 26,268 26,606 26,932
Biomedical
7,590 7,602 7,708 7,807 7,903
technologists
Traditional
Medicine 273 273 277 281 284
Practitioner
Practitioner
Veterinary Public
- - - - -
Veterinary Health Specialists
practitioners Veterinary technicians
- - - - -
and assistants
Other Health Optometrists 759 760 771 781 791
Workers Physiotherapists 5,052 5,060 5,131 5,197 5,261
29
Category Sub-category Cadre* 2019 2020 2021 2022 2023
Physiotherapy
- - - - -
Assistants
Occupational Therapists 309 310 314 318 322
Occupational Therapy
- - - - -
Assistant
Other health
professionals not 1,719 1,722 1,746 1,768 1,790
professionals not - - - - -
Health Health Service Manager 3,414 3,420 3,468 3.513 3,556
management Medical Records
10,531 10,548 10,695 10,833 10,966
and support Technicians
staff Support staff 260,762 261,185 264,832 268,237 271,521
TOTAL 1,072,598 1,074,338 1.089,341 1,103,347 1,116,859
Source: Kementerian Kesehatan, 2019
30
5. HRH Utilization
5.1 Recruitment
Recruitment and selection is a chain of process in searching for personnel to enter a particular job or
position to increase the number of personnel or to substitute the loss of personnel. The following
methods are for recruitment and selection of health personnel:
a) Permanent Civil Servant (PNS)
The number of vacancy quota for PNS is determined by Ministry for The Empowerment of
State Apparatus (MENPAN) based on the workload staffing analysis of every units or
organizations and the availability of the state budget allocated by the Ministry of Finance
(MoF). The overall process of recruitment and selection is conducted at each central unit (for
central PNS) and at each local government levels coordinated by the local government staffing
bureau (BKD). The result of selection will be then finalized for administration purpose by the
National Civil Servant Agency (BKN).
b) Local hiring.
The local governments (province and district level) could use their own resources to hire staffs.
Government health facilities including some hospitals and community health centers with
semi-autonomous status as having public service and budgetary agency (BLUD) are provided
with autonomy to recruit and hire staffs using their own revenue.
c) Temporary employment (PTT/Pegawai tidak Tetap).
The MoH has implemented the tecmporary employment scheme or PTT in short to
assign medical and dental staffs as well as midwives working in community health
centers and village health posts. The duration of a single assignment is ranging from
one year to three years and can be prolonged once. This scheme has been discontinued
since 2015.
d) Special assignment
MOH also implement the special assignment program to recruit and deploy health workers in
the neediest health facilities on temporary basis. The special assignment including the team-
based health workers and the individual assignment of health workers under the Nusantara
Sehat program, the deployment of medical specialist and residents of medical specialist
training. The recruitment process is conducted by MoH using the online application. Selection
was done at the central and regional base using skill test and psychological test. The number
and type of health workers recruited is determined in collaboration between the MoH as the
employer and the local health office as well as the health facilities as users. Successful
applicants also receive technical skills and surviving skills trainings involving the Indonesia
military service prior to the assignment.
5.2 Deployment and distribution mechanisms
Deployment and distribution of civil servants across health facilities is conducted by the local
government at different level. Following the decision from the Ministry of State Apparatus at the
central level, the administrative process for the deployment and distribution of staffs is done by the
Local Personnel Agency (BKD) at the province and district levels under supervision of the national
personnel agency (BKN).
The MoH is responsible for the deployment and distribution of health workers recruited on temporary
basis under the special assignment policy. The process involved several stakeholders at the national
levels and province/district levels including health workforce education institutions especially
medical and dental schools. The duration of the contract ranges from 3 months to three year
31
depending on the program and the location. Priority placement was located in very remote, borderline
areas and the outer small islands that are considered as severe underserved areas.
5.3 The work environment
The MoH provided financial incentives which vary depending on the qualification of health workers
and the place of assignment. Upon completion of the service, health workers are also given
opportunity to pursue higher educational degree using the MoH financial allowance support
(scholarship) with a certain years of service in return. These supports are given by the MoH as a
strategy to attract more health workers to serve underserved areas in a longer term. It is common for
remote and underserves areas to have difficulty in recruiting and retaining health workers due to
transport and communication problems, lack of basic and social facilities, low salary, low or no
compensation, high living cost, lack of security and unclear career options. Therefore, the MoH also
strongly encourage the local government to provide additional financial incentive and other facilities
using the local budget such as vehicles, housing, telecommunication equipment and electricity as
well as safety and security at the workplace. These strategies, despite the short duration of
assignment, have shown a significant improvement in increasing the availability of qualified health
workers in disadvantage areas.
5.4 Employment of health workers in the private sector
An estimated 60 to 70 percent of health service providers who are publicly employed have second
jobs or operate a private practice after hours (World Bank, 2009). The number estimated will be
increased as private sector offer higher salary and facility than public sector. The opening of the
health sector to foreign investment also increase the number of private health providers in the future.
32
6. Governance for HRH
6.1 HRH policies and plans
The Board of Development and Empowerment of Human Resources for Health (BDEHRH) have the
main task to formulate appropriate policies that will ensure production of appropriate number and
type of health workers, equitable distribution of staff and quality improvement. The main functions
of BDEHRH are:
● HRH policy, strategy and formulation
● HRH planning and distribution
● Coordination of pre-service and in-service training
● HRH monitoring and evaluation
The development of the HRH policy involved various levels and stages of consultations with
stakeholders, at the national and regional levels. Such meetings provided opportunity to elicit input
from various sources. The draft policy document gathered from this source and will be discussed
until the final one.
6.2 Policy development, planning and managing for HRH
Prior to decentralization, the central Ministry of Health had complete responsibility for the health
sector, including human resources, and decided how resources were to be allocated in the districts.
After the decentralization was implemented, the HRH planning and management is under direct
responsibility of each administrative level. However, the central level still maintain authority to hire
certain strategic staffs for areas the most in need, such as through the PTT scheme and the Nusantara
Sehat program for the temporary assignment.
Some policies implemented to support the health workforce development are as follows:
a) The Coordinating Minister of People’s Welfare stipulate the national health workforce
development plan for the period of 2011 to 2025 by promoting the implementation of HRH
strategies including planning, production, management, and quality control of health worker
competency with involvement of all stakeholder from public and private agencies.
b) The MoH provided the HRH requirement planning guidelines and tools to help the province
and district health offices selecting the best method in determining the heath workforce
requirement. The results of HRH requirement plan is also used to advocate the local
personnel agency (BKD) in proposing the civil service vacancy quota.
c) Presidential instructions are used as the policy tool to recruit special assignment staffs in
order to improve the availability and distribution of health workers in health facilities
affected by geographical difficulty or disasters. This policy is also used to enforce the
appropriate salary and incentives for health workers from the central and local budgets.
d) Reinforce the WHO global code of practice on the international recruitment of health
personnel into the ministerial regulation related to the deployment of health workers at the
domestic health facilities as well as international management for foreign health workers and
Indonesian migrant health workers. This strategy is aimed to sustain the robust national
health system.
33
e) Indonesia has recognized the importance of coordination among stakeholder to work on
health development. The spirit of HRH country coordination and facilitation (CCF) which
was established in September 2010 by the Coordinating Minister of People Welfare as the
chairman and Minister of Health as the co-chairman. CCF is the process which brings all the
key stakeholders in the country to develop and implement a comprehensive HRH plan. The
CCF committee is consist of professional organization, hospital association, ministry of
home affairs, ministry of defence, ministry of national education, ministry of law and Human
Right, ministry of foreign affairs, ministry of social, ministry of religious affairs, ministry of
finance, ministry of administrative reforms, ministry of manpower and transmigration,
ministry of Accelerated Development of Disadvantaged Regions, National Development
Planning Agency, Indonesian national police, Indonesian national armed forces,
Indonesian State Board of Administration Office, Indonesian population and family
information network, national agency of drug and food control, education association, and
The Indonesian medical council.
6.3 Professional Regulation
Professional regulation undertaken by Indonesian Medical Council for doctor and dentist which was
authorized to require the registration of all medical doctors and dentist before licensing. With Law
No. 29/2004 on Medical Practice, the Indonesian Medical Council (KKI) was created and charged
with curriculum development and the registration and certification of graduates. The law states that
KKI has three functions; (i) to register doctors and dentists, (ii) establish medical education standards
for health professionals and (iii) to supervise and improve the quality of medical practices.
Following the enactment of Law No. 36/2014 concerning health workers and Law No. 38/2014
concerning the nursing practice, Indonesia has further established the Indonesian Health Workforce
Council (KTKI) which will be followed by establishment of the similar councils at the province level.
This council also has the function to control the quality of health workforce other than medical
practitioners and dentists through registration, certification and licensing.
6.4 HRH information
HRH information system is an integral part of the national health information system. The MoH has
the responsibility to standardize, manage and develop the health information system at the national
level as well as to assist the integration with the local health information systems. The advanced
digital technology has encouraged the use of digital applications for various purposes in HRH
development and management. However, the massive use of HRH application systems is not
followed by the easy integration of the system which results in ineffective use of the system and work
duplication. Therefore, currently the MoH has started to identify available digital applications to
ensure operability and integration within the single health information system to enhance the
effective utilization and the quality of data.
6.5 HRH research
Research on some HRH issues are conducted by the National Institute of Health Research and
Development (NIHRD/Balitbangkes) under the MoH in collaboration with the implementing units
of BDEHRH. The research are broad and ranges from national scale such as research of health
workforce (Risnakes) and local scale such as incentive for doctor in rural and remote area. Another
research activities such as Basic Health Research (Riskesdas), Health Facility Research (Rifaskes),
National Health Survey (Surkesnas) and specific research as requested by government has been part
of national agenda. Though there is local capacity for determining HRH priorities and conducting
relevant researches, funding poses a major challenge. Research findings are seldom used to improve
the HRH systems and processes particularly at local level. Another players of HRH research include
universities, health institutes/polytechnics and research agencies who concern with HRH issues.
34
6.6 Stakeholders in HRH
The following are the national and international stakeholders in HRH and their respective roles.
Stakeholders in HRH Roles

BDEHRH MoH HRH Policy Formulation, Strategic Planning,
Recruitment, Resource Mobilization and allocation,
Deployment, Utilization, Pre-Service Training,
Monitoring and Evaluation
NIHRD (Balitbangkes) MoH Health workforce survey and research on HRH issues to
support the evidence base policy making
Universities and other Health Training Training, Research
Institutions
The Board of National Development Setting the National Development and HR Agenda
Professional Regulatory Bodies Accrediting Training Institutions, setting standards for

practice, Monitoring, examination, licensing and
registration
Parliament Passage of relevant bills on HRH into law. Approval of
health sector budget including personnel emoluments
Professional Associations including: IDI, PPNI, Continuing professional Development of Members
IBI, IAKMI
National Accreditation Board Inspection and accreditation of training institutions
Ministry of Education Training and accreditation

MENPAN Allocation and formation for civil servant in health sector
Ministry of Finance Release of financial clearance for recruitment of new

Entrants
World Health Organization Global Health Determining global HRH priorities, training, technical
workforce Alliance support Assisting the development and planning of HRH
Asia Pacific Action Alliance of HRH
JICA Training, Technical Assistance, performance

GIZ management
USAID
AUSAID
World Bank
ADB
Non-governmental organizations in health Training
35
References
Bappenas. (2019). RPJMN 2015 - 2019. Jakarta: Kementerian Perencanaan Pembangunan Nasional
Kementerian Kesehatan. (2013). Profil kesehatan Indonesia 2013. Jakarta: Kementerian Kesehatan.
Kementerian Kesehatan. (2015). Profil Kesehatan Indonesia 2015. Jakarta: Kementerian Kesehatan
Kementerian Kesehatan. (2018). Profil kesehatan Indonesia 2018. Jakarta: Kementerian kesehatan.
Kementerian Kesehatan. (2017). Kajian Epidemiology HIV Indonesia 2016. Jakarta: Kementerian
Kesehatan
Kementerian Kesehatan. (2018). Pembiayaan Kesehatan. Jakarta: Kementerian Kesehatan
Kementerian Kesehatan. (2019). Sumber Daya Manusia Kesehatan. Jakarta: Kementerian Kesehatan
MoH. 2018. Monitoring Data Sanitasi Total Berbasis Masyarakat. Jakarta: Kementerian Kesehatan.
MoH. 2018. Pembiayaan Kesehatan di Indonesia. Jakarta: Kementerian Kesehatan.
MRTHE. 2019. Pangkalan data jumlah institusi pendidikan kesehatan. Jakarta: Kemristekdikti
MRTHE. 2017. Pangkalan data jumlah dosen pendidikan kesehatan. Jakarta: Kemristekdikti
WHO. (2016). Profile of non-communicable and communicable diseases in Indonesia. Geneva: WHO
World Bank. (2015a). A Water-Secure World for All. Washington DC: World Bank.
World Bank. (2015b). Estimates of maternal mortality ratio. Washington DC: World Bank.
World Bank. (2017a). World Bank Annual Report 2017 : Life expectancy. Washington DC: World Bank.
World Bank. (2017b). World Bank Annual Report 2017 : Mortality rate. Washington DC: World Bank.
World Bank. (2017c). World Bank Annual Repot 2017 : Death rate crude. Washington DC: World Bank.
World Bank. (2019). Historic inflation – CPI inflation year pages. Washington DC: World Bank.
36
Annexes
Annex 1: Classification of health workforce of the WHO
South-East Asia Region
The health workforce of the WHO South-East Asia Region is grouped into the following 10
categories:
1. Medical practitioners
Includes general practitioners, medical specialists and medical assistants.
2.Dental practitioners
Includes dentists, dental specialists and dental technicians (e.g. dental assistants, dental hygienists,
dental nurses).
3. Pharmacy practitioners
Includes pharmacists, pharmaceutical technicians/assistants (e.g. pharmacy assistants,
pharmaceutical technicians).
4. Nursing and midwifery practitioners
Includes nursing professionals, midwifery professionals, nursing-midwifery professionals, nursing
specialists, midwifery specialists, nursing associate professionals (e.g. public health midwives,
community midwives, assistant midwives, community-based skilled birth attendants), and nursing-
midwifery associate professionals (e.g. auxiliary nurse-midwives).
5. Non-medical public health practitioners
Includes public health generalists, public health, specialists, food and nutrition professionals (e.g.
nutritionists, food science specialist, dieticians), environmental and occupational health professions
(e.g. environmental health officer, sanitarians, occupational health officers), environmental and
occupational health inspectors and associates (e.g. public health inspectors, food inspectors),
community health workers (e.g. basic health workers, family welfare assistants, family welfare
visitors, health assistants, lady health visitors), and community health volunteers.
6. Medical technologists
Includes medical imaging technicians (e.g. radiographers, mammographers), medical technicians
(e.g. medical laboratory technicians, blood bank technicians), laboratory assistants (e.g. medical
laboratory assistants, assistant radiographers, assistant blood bank technician), and biomedical
technologists (e.g. medical equipment technicians, medical equipment engineers, biomedical
technologist, biomedical engineers).
7. Traditional medicine practitioners
Includes traditional medicine practitioners (e.g. Ayurvedic Practitioner, Homeopath, Koryo
Medicine Practitioners, Unani Practitioners).
8. Veterinarian practitioners (working for human health aspects)
Includes veterinary public health specialists, and veterinary technicians.
9. Other health workers
Includes a large number of health workers such as optometrists, physiotherapists, physiotherapy
assistants, occupational therapists, occupational therapy assistant, and other health professional and
health associate professionals not elsewhere classified.
10. Health management and support staff
37
Includes a large number of non-health professional workers such as health service managers,
medical records technicians, health statisticians, clerical, accounting and other general support staff
(e.g. ward clerks, medical secretary, medical store keepers
38
Annex 2: Description on qualification of health workers
in Indonesia
1. Medical practitioners
General practitioners are those graduates from the undergraduate program of the medical faculty and
has completed the medical internship program.
Medical specialist are doctors who have completed the medical specialist training.
2.Dental practitioners
Dental practitioners are those graduates from the undergraduate program of the dentistry faculty and
has completed the internship program.
Dental specialist are dentists who have completed the dental specialist training.
Dental technicians include dental nurse and dental hygienists graduating from the diploma 3 level of
education.
3. Pharmacy practitioners
Includes pharmacists with at least bachelor degree in pharmacy and pharmaceutical technicians who
graduated from diploma 3 in pharmacy.
4. Nursing and midwifery practitioners
Nursing professionals and midwifery professionals are nurses and midwives with minimum bachelor
degree or diploma 4.
Nursing associate professionals and nursing- midwifery associate professionals include nurses and
midwives graduated from diploma 3 level.
5. Non-medical public health practitioners
Includes public health generalists, public health, specialists, food and nutrition professionals (e.g.
nutritionists, food science specialist, dieticians), environmental and occupational health professions
(e.g. environmental health officer, sanitarians, occupational health officers), environmental and
occupational health inspectors with the minimum bachelor degree level. Those who are at groups of
associates in this category are graduates from the diploma 3 level.
6. Medical technologists
Includes medical technicians, laboratory analysists and biomedical technologists with qualification
of diploma 3 level.
7. Traditional medicine practitioners
Includes traditional medicine practitioners (acupuncture and traditional herbalists).
8. Veterinarian practitioners (working for human health aspects)
Not available
9. Other health workers
Includes a large number of health workers such as optometrists, physiotherapists, physiotherapy
assistants, occupational therapists, occupational therapy assistant, and other health professional with
the diploma 3 level of qualification.
10. Health management and support staff
Includes a large number of non-health professional workers such as health service managers,
medical records technicians, health statisticians, clerical, accounting and other general support staff
(e.g. ward clerks, medical secretary, medical store keepers)
39
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2

Human resources for health (HRH) supply

Health professions education

● Providing a comprehensive picture of the Health Workforce situation;

The study has shed light on:

Figure 1. Map of Indonesia

Table 1.2 Percent Distribution by Sex

Year Total* Male* Female* Male/Female (%) Growth rate (%)

1.2 Economic context

Table 1.3 Economic Indicators

1.4 Health status

Dyspepsia 7.4% Injuries 6%

Table 1.5 Health Indicators

1. Health service delivery

Figure 3. Decentralized health service delivery system

2.2 Service provision

2.3 Health care financing

2.4 Health information system

Number of Health workers ratio per 1000 population

Medical General Practitioner 0.17 0.18

Dentists 12,788 0.05 13,030 0.05

Pharmacists 12,349 0.05 15,935 0.06

Nursing professionals 332,811 1.27 78,894 0.30

Midwifery Professionals - - 3,059 0.01

Nursing and Nursing Specialists - - - -

Public Health Generalists 20,714 0.08 25,809 0.10

Public Health Specialists - - - -

Food and Nutrition

Community Health workers - - - -

Community Health Volunteers - - - -

Medical Imaging Technicians - - - -

Medical Medical Technicians 11,300 0.04 12,500 0.05

Biomedical technologists - - 7,590 0.03

Optometrists - - 759 0.00

Physiotherapists 6,187 0.02 5,052 0.02

Occupational Therapists 309 0.00

Other health professionals not

Other health associate

TOTAL 776,529 2.97 1,072,598 4.25 776,529 2.97 1,072,598 4.25

3.2 Distribution of health workforce by category/cadre

3.2.1 Gender distribution by health workforce categories/cadre

Table 3.3 Gender distribution by health workforce category/cadre

Category Sub-category Total % Male % Female

Table 3.4 Health workers by age group and cadre

3.2.3 Region/province/district distribution by occupation/cadre

Table 3.5 Distribution of heath workers by regions

Community Health Volunteers - - - - - - -

Medical Imaging Technicians - - - - - - -

Medical Technicians 12,500 26.08 42.34 8.58 10.52 11.04 1.44

Occupational Therapists 309 13.27 74.43 5.50 5.83 0.97 0.00

3.2.4 Urban/rural distribution by occupation/cadre

General Practitioner 47,289 27,502 58.2% 19,787 41.8% 0.19 0.17

Pharmacists 15,935 8,953 56.2% 6,982 43.8% 0.06 0.06

Midwifery Professionals 3,059 1,903 62.2% 1,156 37.8% 0.01 0.01

Veterinary Public Health - - - - - - -

3.2.5 Public/private distribution by occupation/cadre

General Practitioner 47,289 70.0% 19.3% 3.7% 7.0%

Dentists 13,030 76.3% 16.6% 2.6% 4.5%

Pharmacists 15,935 50.9% 32.9% 6.6% 9.7%

Nursing professionals 78,894 76.9% 14.2% 3.5% 5.3%

Nursing and Nursing Specialists - - - - -

Food and Nutrition

Laboratory Assistants 25,864 72.4% 18.2% 3.4% 6.0%