Ferry Efendi

Berbagi, Peduli dan Menginspirasi

Retaining and Motivating Health Worker in Very Remote Area of Indonesia, Do They Respond To The Incentives?

01 July 2017 - dalam Publikasi Internasional NonScopus Oleh ferry-efendi-fkp

Abstract— Adequate Human Resources for Health (HRH) are 
crucial to the delivery of health care services in very remote areas 
of Indonesia. However, very remote areas suffer shortages in 
terms the number, type and quality of staff. This situation must 
be addressed through innovative policy, planning and 
implementation, such as incentives for retaining and motivating 
health workers. This paper aims to assess the application of an 
incentive scheme based on working location. The role of 
decentralized local government on incentives given to health 
workers also will be discussed. A desk study was performed from 
a relevant published materials, MoH database and online 
literature. The document highlights the importance of financial 
and non financial incentives. However, financial incentives alone 
are insufficient to retain and motivate the health workforce. 
Incentive systems must be integrated within the health system, in 
line with the goal and objective of Indonesia’s health 
development. The role of local leadership under decentralization 
is also crucial to motivate and maintain staff in the workplace. 
Different incentives between contracted and permanent staff in 
very remote areas must be established to ensure sustainability of 
the program. 
Index Terms—health worker, very remote area, incentives, 
Indonesia, human resources for health 
I. INTRODUCTION
Providing health care to very remote 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 impacts on the health status of the 
Manuscript received October 19, 2012. This work was supported in part by 
Faculty of Nursing Airlangga University Surabaya Indonesia. 
F. E., R.I, R.F., A.Y., Author is with Faculty of Nursing Airlangga 
University Surabaya, Jl Mulyorejo Kampus C, Indonesia (e-mail: fefendi@ 
indonesiannursing.com). 
A. K., Author is Head of Sub Division Migrant Health Workers, Ministry 
of Health Indonesia and member of Country Coordination and Facilitation 
(CCF) of National Health Workforce Indonesia (e-mail: 
annakurniati@gmail.com). 
S.N, Author is a Professor of Health Sciences, School of Health and 
Human Sciences Southern Cross University Australia (e-mail: 
susan.nancarrow@scu.edu.au). 
population[1]. One of the main problems is retaining and 
motivating providers to deliver health care services to those 
living in remote and very remote areas. Indonesia, as with 
other asian countries, has critical shortages of health workers, 
particularly physicians, nurses and midwives [2]. Thus, it 
became a priority for the Government of Indonesia to increase 
access to underserved communities as stated in the public 
health reform roadmap [4] . Regarding access to basic health 
care services, of Indonesia’s 497 district/cities, 83 districts 
located within 27 provinces lag behind; and 92 districts in the 
outermost small islands and 34 small outlying islands do not 
have even basic services [3]. 
Data from Ministry of Health of the Republic of 
Indonesia (MoH, 2006) found that approximately 30 % out of 
7,500 health centers in remote areas were without medical 
doctors. Further findings were reported during the 
Identification of the Need of Health Workers conducted by 
Center for Planning and Management of Human Resources for 
Health - MoHRI (CPMHRH) in May 2006 [4]. The study 
involved 78 districts in 17 provinces of Indonesia. The report 
found that of 1165 health centers, 364 health centers (31%) are 
located in remote/underdeveloped/borderland/conflict and 
disaster areas and other undesirable areas. About half of the 
364 health centers reported having no medical doctors, 18% 
were without nurses, 12% were without midwives, 42% were 
without sanitarians, and 64% without nutritionists. Compare to 
the health centers in ordinary areas, the absence of those types 
of health workers are much lower, for example, only 5% 
health centers were without medical doctors [4]. 
The reasons health workers choose not to go to these 
areas include; transportation 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 [1]. 
This paper aims to provide a brief description of the 
application of an incentive scheme for staff working in very 
remote areas. Implementation of a decentralized system and its 
impact on incentives will also be described



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