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Indonesia faces shortage of specialized doctors, hindering healthcare services

INDONESIA — The Ministry of Health has reported that Indonesia is still facing a shortage of 31,481 specialized doctors in 2023 to serve its population of 277,432,360.

According to the active Registration Certificates (STR) issued by the Indonesian Medical Council (KKI) in April 2023, there are only 46,200 specialized doctors in the country. This number falls far short of Indonesia’s target ratio of 0.28 specialists per 1,000 population by 2025.

In a virtual press conference on last Monday (26 Jun), Oos Fatimah, the Director of Health Workforce Supply at the Ministry of Health, stated, “To serve Indonesia’s 277 million population, we still lack specialized doctors. With the current availability of 46,200 specialized doctors, we are still short of approximately 31,481 specialized doctors in total.”

Oos compared the ratio of specialized doctors in Indonesia to other developed countries, saying, “If we compare with other countries like the UK, Australia, and the US, we can see that there is still a significant gap. For cardiology and vascular specialists, our ratio is only 0.001, the same goes for anaesthesiology, surgery, and others.”

In the UK, the cardiology specialist ratio is 0.053, a far cry from Indonesia’s 0.001. Similarly, in Australia, the anaesthesiology specialist ratio is 0.226, compared to Indonesia’s 0.011.

Furthermore, Oos stated that only five out of 38 provinces in Indonesia have an adequate number of cardiac specialists, based on the target ratio per 1,000 population per specialty.

Oos further explained that on average, around 30 provinces in Indonesia still lack specialized doctors.

Breaking down the shortages, 29 provinces lack cardiac specialists, while 31 provinces lack pediatric specialists. Additionally, 28 provinces lack internal medicine specialists, 23 provinces lack obstetrics and gynaecology specialists, 33 provinces lack radiology, pulmonary, and thoracic specialists, and 29 provinces lack neurology specialists.

“If we average it out, around 30 provinces in Indonesia still lack specialized doctors,” said Oos.

In terms of healthcare facilities, out of the 415 Regional General Hospitals (RSUD) in districts and cities, 266 hospitals do not have a complete set of specialized doctors for the seven essential specialties: pediatrics, obstetrics and gynaecology, surgery, internal medicine, anaesthesiology, radiology, and clinical pathology.

“At present, 39 percent or 266 RSUD in districts and cities out of 415 RSUD do not have complete specialists. In certain eastern regions, there are districts without any specialized doctors,” revealed Oos.

The Ministry of Health acknowledges that one of the causes of the shortage of specialized doctors in Indonesia is the complex bureaucracy involved in obtaining Registration Certificates (STR; Surat Tanda Regstrasi) and Practice Permits (SIP; Surat Izin Praktik) for doctors to practice medicine.

Siti Nadia Tarmizi, the Head of the Ministry of Health’s Communication and Public Service Bureau, explained, “The STR/SIP application process is hindered by bureaucratic obstacles in the administrative process. This undoubtedly delays the doctors’ practice.”

Siti Nadia Tarmizi, the Head of the Ministry of Health’s Communication and Public Service Bureau

Nadia stated that the STR/SIP application process takes a long time, ranging from three to six months. Often, it is unclear when the process will be completed, and the costs are also considerable.

“However, doctors must have STR/SIP to practice. There is no clear standard time for the STR/SIP process, especially regarding recommendations from professional healthcare organizations. Therefore, there needs to be standardization and transparency in the process, especially regarding the issuance of recommendations,” Nadia added.

Indonesia’s Ministry of Health (Kemenkes) is implementing a healthcare system transformation with six main pillars to expedite the procurement of doctors.

These pillars include primary care transformation, referral service transformation, health resilience system transformation, healthcare financing system transformation, health workforce transformation, and health technology transformation. The transformation of the health workforce is expected to support all existing pillars.

One of the flagship programs under the health workforce transformation pillar is the enhancement of scholarships for specialized doctor training. Scholarships and fellowships are also provided to improve the specialized competencies of healthcare professionals.

Oos Fatimah, the Director of Health Workforce Supply at the Ministry of Health, explained, “To transform the health workforce, we have implemented flagship programs such as increasing the number of specialized doctors and providing scholarships. We facilitate the utilization of health diaspora regulations for Indonesian citizens abroad, improving quality, and more.”

In 2021, Kemenkes offered only 600 scholarships for specialized doctors. However, the quota increased significantly in 2022 to 1,676 scholarships, which included scholarships from Kemenkes and the Education Fund Management Agency (LPDP; Lembaga Pengelola Dana Pendidikan).

The quota further rose to 2,170 scholarships in 2023 from Kemenkes and LPDP. The scholarship quota is expected to increase again in 2024.

Kemenkes has already implemented the acceptance of scholarships for Specialized Doctor Education Programs (PPDS; Program Pendidikan Dokter Spesialis), subspecialties, and Professional Expertise and Service Groups (KKLP; Kelompok Kepakaran dan Layanan Profesional) in the first period.

As of now, 583 scholarships have been granted, and participants have started their studies.

Additionally, in the second period, 417 scholarships were added for PPDS, subspecialties, and KKLP. In terms of LPDP scholarships, the government has disbursed 401 scholarships in the first period and 599 scholarships in the second period.

The scholarship programs offered by Kemenkes in 2023 include several initiatives:

  1. Assistance Program for Specialized Doctors-Subspecialists or Specialized Dental Education, which has been available since 2008. To date, 9,527 participants from all provinces in Indonesia, especially from Papua and West Papua, including the Indonesian National Defense Forces (TNI) and National Police (Polri), have benefitted from this program.
  2. Fellowship Scholarships for Specialized Doctors to fulfill the needs of cancer, heart, stroke, and uro-nephrology (KJSU) services. Participants can be specialized doctors from both civil servants (PNS) and non-civil servant backgrounds who will be utilized in government hospitals requiring fellowship services (KJSU). The target for fellowship scholarships for specialized doctors in 2023 is 170 individuals.
  3. Scholarships for Prospective Doctors and Dentists, prioritizing remote, border, island, underdeveloped, and health-challenged areas where there is a lack or absence of doctors and dentists. Participants include high school graduates, medical/dental undergraduate students, and medical/dental professional students. In 2022, Kemenkes provided 512 affirmative scholarships to local residents. The target for affirmative scholarships for doctors or dentists in 2023 is 800 new participants. Affirmative scholarship participants will receive educational, living, and operational expenses, as well as book or reference costs according to the current Ministry of Health budget for research purposes.
  4. Education Scholarships for Healthcare Human Resources to improve their qualifications, especially for civil servants. Scholarship assistance is provided for all levels of education (D4, S1, professional, S2, and S3).
  5. Affirmative Higher Education for Healthcare Professionals (Padinakes) is a program that provides educational financial assistance, primarily for individuals from remote, border, and island areas (DTPK) and Troubled Health Areas (DBK) who wish to pursue higher education at Health Polytechnics (Poltekkes). The Padinakes program started in 2021 and recruits participants from high school graduates (freshmen) and final-year students at Poltekkes Kemenkes.

Emanuel Melkiades Laka Lena, Deputy Chairperson of the House of Representatives Commission IX, also raised concerns about the shortage of specialized doctors and the uneven distribution of doctors.

During the submission of the Inventory of Problems (DIM; Daftar Inventaris Masalah) and public discussion on the Health Bill at the Ombudsman Building in South Jakarta on 11 April, he revealed that according to data from the Health Human Resources Information System (SISDMK) in 2020, there was still 6.9 per cent of Community Health Centers (Puskesmas) in Indonesia without doctors.

The provinces with the highest percentages of Puskesmas without doctors are Papua (48.18 per cent), followed by West Papua (42.07 per cent), and Maluku (23.45 per cent).

However, this is not the case in urban areas and non-under-served regions, including DKI Jakarta, DI Yogyakarta, Bali, Central Java, and Bangka Belitung Islands.

In these five regions, there are no Puskesmas without doctors. This highlights the ongoing issue of the uneven distribution of medical and healthcare professionals in Indonesia.

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