Effects of decentralisation and health system reform on health workforce and quality-of-care in Indonesia, 1993-2007.
The impact of decentralisation, socioeconomic changes and healthcare reforms in Indonesia on type and distribution of healthcare providers and quality-of-care has been unclear. We examined workforce trends for healthcare facilities from 1993 to 2007 using the Indonesian Family Life Surveys. Each included a sample of public and private healthcare facilities, used standardised interviews for numbers and composition of staffing, and quality-of-care vignettes. There was an increase in multiprovider facilities and shift in profile of solo providers-increasing proportions of midwives and drop in doctors in rural areas (including facilities with doctors) and nurses in urban areas. Quality-of-care scores were low, particularly for nurses as solo providers. Despite increased numbers of healthcare workers and growth of the private sector, outer Java-Bali and rural areas continued to be disadvantaged in workforce capacity and quality-of-care. The results have implications for accreditation and in-service training requirements, the legal status of nurses and private sector regulation.
School of Population Health, The University of Queensland, Brisbane, Australia.
Aly
A
Diana
Samantha A
SA
Hollingworth
Geoffrey C
GC
Marks
D018166:Health Care Reform / Q000458:organization & administration*; D019538:Health Care Surveys; D006282:Health Personnel / Q000458:organization & administration*; D006801:Humans; D007214:Indonesia; D011057:Politics; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*
decentralisation; health workforce; human resources; quality assessment; quality-of-care