Providing health care to underserved communities in Indonesia has long been a major concern. Lack of health workers particularly in rural remote and very remote areas has hampered community access to good quality of health services, which in turn leads to a poor health status of the people.

1. Viewing Decentralization as an Opportunity: In Improving Availability of Health Workers in Underserved Areas I N D O N E S I A Ferry Efendi & Anna Kurniati Wayangkulit : shadow puppetry

2. 2 OUTLINE BACKGROUND CONCEPTUAL FRAMEWORK THE CASE OF INDONESIA THE LESSONS LEARNT PROPOSAL FOR REGIONAL

3. DECENTRALIZATION The Law 22/1999 Regional Governance The Law 25/1999 Fiscal Balance The Law 32/2004 Regional Governance Change the Roles & Functions of Local Government Affected Human Resources for Health

4. GOVERNMENT HEALTH SYSTEM BEFORE DECENTRALIZATION Source: www.desentralisasi-kesehatan.net

5. GOVERNMENT HEALTH SYSTEM AFTER DECENTRALIZATION Province Health Section Source: www.desentralisasi-kesehatan.net

6. HRH UNDER DECENTRALIZED SYSTEM MENPAN MOH Hiring, Firing & Condition CENTRAL Permanent Civil Servant (PNS) Contracted Doctor (PTT) LOCAL

7. THE HEALTH DEVELOPMENT INDICATORS 7

8. 8 OUTLINE BACKGROUND CONCEPTUAL FRAMEWORK THE CASE OF INDONESIA THE LESSONS LEARNT PROPOSAL FOR REGIONAL

10. Increased motivation

11. Increased job satisfaction

12. Reduced absenteeism Health Workforce Distribution Intervention Recruitment & Selection Deployment Retention Determinants Influencing Retention Decentralization Human Resources for Health in Underserved Area THE CONCEPTUAL FRAMEWORK

13. METHODOLOGY Desk study, literature review from MoH databases, RI One of the wonders of the world

14. 11 OUTLINE INTRODUCTION CONCEPTUAL FRAMEWORK THE CASE OF INDONESIA THE LESSONS LEARNT PROPOSAL FOR REGIONAL

16. The local government has more autonomy in providing and managing public facilities

17. The central level still maintain the power in contracting strategic health workers

19. Problems in excess vs shortage of health workers

21. HEALTH PERSONNEL RECRUITMENT AND SELECTION POLICIES The central level provide guidelines and assistantship on the planning process and methods PNS Local Contract RECRUITMENT & SELECTION Central Contract/PTT Special Assignment Largest Lizard in the world

22. TREND OF THE NUMBER OF FORMASI PNS YEAR 2005-2009 Health promotion activity

23. TREND OF THE NUMBER OF PTT DOCTORS IN REMOTE AND VERY REMOTE AREAS YEAR 2005 – 2009 The largest mosque in SEA

24. DEPLOYMENT AND RETENTION POLICIES Factors influencing: Compulsory service for certain period. Financial incentives and other support facilities (housing, transportation, electricity, water, telecommunications, other social facilities). Dual practice. Safety and security guarantee (law protection) Opportunity for career development. Opportunity to be recruited as civil servants. 18

26. Shortening period of service

28. Doctor/dentist : Rp 5. 000.000,00/month (USD 549)

31. Influence the district governments for improving health facilities and living condition

32. Career opportunitiesRETENTION POLICIES Traditional transportation

33. % OF UNIT REDEPLOYMENT OF PA GRADUATES BY PROVINCE Chart 3. % of Unit Redeployment of PA Graduates by Province Province SS CK CJ CL 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % Previous Unit New Unit NA Gamelan (Traditional instrument music)

35. Improving the health information system

36. Provision of technical guidance on management, deployment and utilization

37. Deployment Policy based on local capacities

38. Privileging policy for nurses and midwives working in less favorable and remote/very remote areas

39. The incentive system clearly links to performance

40. Coordination with other stakeholder RafflesiaArnoldi

41. 25 OUTLINE BACKGROUND CONCEPTUAL FRAMEWORK THE CASE OF INDONESIA THE LESSONS LEARNT PROPOSAL FOR REGIONAL

42. A LESSON LEARNT FROM BELU DISTRICT Financial incentive Non financial incentive: housing, transportation and telecommunication facilities, employee award. Innovative program on outreach service Upgrading the educational level In service training

43. 27 OUTLINE BACKGROUND CONCEPTUAL FRAMEWORK THE CASE OF INDONESIA LESSON LEARNT PROPOSAL FOR REGIONAL

44. 28 4 5 3 6 2 1 HEXAGONAL OF FUTURE ACTION Improved collaboration on HRH Developing a specific health workforce policy and planning Coordination with all relevant professional organization Conducting a study to explore any possibility Develop guidelines for effective and supportive supervision Fairness in incentive system

45. TOGETHER ACHIEVE HEALTHY INDONESIA 2015 THANK YOU AND WELCOME TO INDONESIA 29