Mr. Ferry is an Associate Professor in the Department of Community Health Nursing at the Faculty of Nursing, Airlangga University, Surabaya, Indonesia. He is an active member of the Association of Community Health Nursing Educators (ACHNE) based in Dayton. His PhD in community health nursing focuses on Indonesian migrant nurses, addressing challenges such as ethical recruitment, fair labor practices, and health equity. Mr. Ferry has also collaborated with Indonesia's Ministry of Health and developed *Pasar Kerja Perawat*, an Android-based application with over 6,000 users from Indonesia and abroad.
Penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini bertujuan untuk memfasilitasi para ... more Penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini bertujuan untuk memfasilitasi para perawat yang ingin mengembangkan karir di luar negeri, sebagai alternatif pendayagunaan selain di dalam negeri. Pendayagunaan tenaga kesehatan ke luar negeri dapat memberi manfaat bagi tenaga kesehatan Indonesia untuk mendapatkan pengalaman kerja, peningkatan pengetahuan dan keterampilan yang dapat menjadi sumbangsih kesehatan di Indonesia. Diharapkan dengan adanya buku saku ini dapat memberikan informasi yang lengkap dan komprehensif kepada para perawat maupun mahasiswa jurusan keperawatan dari berbagai Poltekkes maupun perguruan tinggi lainnya. Ucapan terima kasih kami sampaikan kepada seluruh pihak yang telah menyumbangkan pikiran, tenaga, dan waktunya dalam penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini. Kami mengharapkan adanya masukan dan saran dari semua pihak dalam menyempurnakan buku saku ini. Direktur
Anemia is a globally widespread condition in women and is associated with reduced economic produc... more Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.
Achieving universal health coverage (UHC) is one of essential targets of the
Sustainable Developm... more Achieving universal health coverage (UHC) is one of essential targets of the Sustainable Development Goals. It is fundamental for every nation to ensure that no one is left behind from receiving proper health care by building financial risk protection and promoting access to quality health service and adequate medical supplies including vaccine. UHC is definitely unachievable without having sufficient well-trained and well-performed health workers at all health. Three years after the implementation of the national health insurance in 2014, the Indonesia UHC service coverage index has achieved 57/100 based on the WHO report. This is a good start for a country with a newly established mandatory social health insurance, but also poses a real challenge on how to accelerate the health services being accessible for all people. When Indonesia was listed by WHO among countries with critical shortage of health workers in 2006, the Government of Indonesia has recognized that this issue should be strategically addressed. Policies to improve the availability of health workforce, qualification and competency of health workforce, and the distribution of health workers in underserved areas were enforced to strengthen the national health system. Indonesia also adopted the Global Code of Practice on The International Recruitment of Health Personnels one of references for the national health policy in managing the international migration. To understand how well the health workforce policies implemented, we recognize the importance of having a reliable and timely data on health workforce situation. In response, MOH developed a health workforce country profile to provide a comprehensive picture of the health workforce situation in Indonesia based on education, availability, distribution and the projection supply of each type of health workforce. This 2019 Human Resources for Health Country Profile provides an updated information on the Indonesia health workforce situation from the similar report published in 2012. This 2019 Human Resources for Health country profile was developed collaboratively between Center for Planning and Deployment of HRH and Faculty of Nursing, Airlangga University. The purpose of this document is to inform the global and national stakeholders about the health workforce situation in Indonesia. The document provide a comprehensive and the most recent overview of the health workforce situation in Indonesia in relation to the national development of the human resources for health. We appreciate the hard work done by the team in collecting and compiling pieces of data in developing this document. We do welcome any feedback from stakeholder who have interest in the Indonesia health workforce. . Finally I also thank to all contributors from the Ministry of Health and from other ministries and national agencies who spend their time and thoughts in participating during the development process.
1. Sektor Pendidikan
a. Pendidikan dan Pelatihan
Pada tahun 2019 di Indonesia tercatat jumlah ins... more 1. Sektor Pendidikan a. Pendidikan dan Pelatihan Pada tahun 2019 di Indonesia tercatat jumlah institusi pendidikan keperawatan sebanyak 534 institusi. Secara keseluruhan terdapat 1.058 program pendidikan keperawatan di Indonesia yang terdiri dari D3 sebanyak 413 program studi, D4/S1 sebanyak 342 program studi dan profesi sebanyak 280 program studi, sisanya sebanyak 23 adalah program studi S2 keatas. Kurikulum pendidikan dan pelatihan sudah diperbarui oleh kementerian terkait dan berbagai asosiasi pendidikan baik vokasi ataupun ners. Kurikulum tersebut mengacu dan selaras dengan regulasi yang ada, diantaranya adalah kompetensi inti Association of Southeast Asian Nations (ASEAN) serta kebutuhan stakeholder yang telah diimplementasikan ke mahasiswa keperawatan di Indonesia. b. Regulasi Pendidikan dan Pelatihan Peraturan yang menjadi pedoman dalam proses akreditasi yaitu: UU 12/2012, Permendikbud Nomor 3/2020, PerBan-PT Nomor 5/2019, PerBan-PT Nomor 4/2017, Permendikbud Nomor 5/2020, Peraturan LAM PTKes Nomor 2/2020, Permendikbud Nomor 7/2020. Ketetapan akreditasi berlaku dalam 5 tahun merujuk pada Permendikbud Nomor 5/2020 dan persetujuan standar akreditasi ditetapkan oleh rapat anggota, yang merupakan struktur organisasi tertinggi dalam LAM PTKes (terdiri dari ketua organisasi asosiasi profesi dan institusi pendidikan bidang kesehatan). Sementara itu Standar Nasional Profesi Keperawatan telah disusun oleh Persatuan Perawat Nasional Indonesia (PPNI), akan tetapi masih dalam proses penetapan (termasuk lingkup standar pendidikan interprofesionalisme). Jenjang karir perawat sendiri telah memiliki regulasi yaitu PMK 40/2017, tetapi belum semua fasilitas pelayanan kesehatan menerapkan hal ini. Terkait dengan pengembangan karir perawat pola karir di Indonesia ada dua pola, yaitu jabatan fungsional perawat dan jenjang karir. Untuk jenjang karir sudah dijalankan di Rumah Sakit, meskipun belum semua. c. Pembiayaan Pendidikan Biaya pendidikan telah diatur didalam Permendikbud Nomor 25 Tahun 2020 yang menetapkan Standar Satuan Biaya Operasional Pendidikan Tinggi pada Perguruan Tinggi Negeri di Lingkungan Kementerian Pendidikan dan Kebudayaan. Akan tetapi besaran nominal biaya bergantung pada kebijakan universitas masing-masing dengan mengacu pada batas kewajaran pembiayaan. 2. Angkatan kerja a. Ketersediaan perawat Secara garis besar ketersediaan perawat di Indonesia sudah dapat mencukupi kebutuhan sesuai dengan jumlah penduduk dengan rasio diatas target nasional yaitu mencapai 2,46 per 1.000 penduduk. Jumlah perawat yang terdaftar dan memiliki STR hingga akhir tahun 2020 adalah 985.889 dengan sejumlah 592.342 STR berstatus aktif. Sebanyak 384.464 perawat dilaporkan bekerja pada Rumah Sakit, Puskesmas dan fasilitas kesehatan lainnya di seluruh Indonesia. b. Pergerakan Pasar Kerja Tenaga Keperawatan 1) Dinamika tenaga perawat dalam pasar kerja dalam negeri Pasar kerja perawat merupakan sistem yang dinamis dan kompleks untuk melihat ketersediaan dan kebutuhan perawat di tingkat nasional beserta faktor kontekstual lainnya. Tantangan terbesar adalah pada data serapan tenaga keperawatan di lapangan yang bersifat sektoral serta pelacakan lulusan keperawatan di pasar kerja beserta jumlah pengangguran bidang keperawatan. Ketersediaan lowongan keperawatan baik dalam negeri maupun luar negeri dilakukan baik oleh pemerintah ataupun swasta. Berdasarkan proyeksi target kebutuhan tenaga perawat, diperkirakan pada tahun 2021 Indonesia mengalami surplus 176.470 perawat dan kemungkinan akan terus meningkat jumlahnya hingga 695.217 perawat pada tahun 2025. 2) Migrasi Perawat Indonesia ke Luar Negeri Selama periode tahun 20015-2020, sebanyak 6.393 perawat ditempatkan diluar negeri baik menduduki jabatan sebagai perawat maupun sebagai tenaga asisten perawat atau careworker di institusi perawatan lansia. Beberapa isu yang sering muncul dalam penjajakan Kerjasama luar negeri yaitu Bahasa, rekognisi, kompetensi dan sertifikasi. Isu lain yang kemudian muncul adalah terkait kontrak kerja yang meliputi hak dan kewajiban, perlindungan terhadap Perawat Migran Indonesia (PMI). Penempatan dan perlindungan tenaga perawat Indonesia ke luar negeri dilakukan oleh Badan Perlindungan Pekerja Migran Indonesia (BP2MI). Telah terdapat Kebijakan yang mengatur penempatan tenaga kerja luar negeri melalui berbagai macam mekanisme baik pemerintah ataupun swasta. 3) Migrasi Balik: Pendayagunaan Perawat Pasca Migrasi Selain perluasan peluang kerja, Kemenkes mendorong pendayagunaan perawat keluar negeri untuk alih ilmu pengetahuan dan teknologi melalui optimalisasi strategi brain circulation. Hal ini ditempuh dengan mengupayakan pendayagunaan kembali para tenaga Kesehatan yang telah selesai bekerja di luar negeri atau dikenal dengan istilah returnee. Untuk mengoptimalkan terjadinya brain circulation Kemenkes sedang mengupayakan solusi untuk mengatasi deskilling serta menyusun kebijakan reintegrasi untuk mendorong pendayagunaan kembali untuk penguatan pelayanan kesehatan. 4) Karakteristik dan Kondisi Kerja Karakteristik dan kondisi kerja bidang keperawatan bervariasi tergantung dari status kepemilikan fasilitas kesehatan (pemerintah/ swasta atau organisasi kesehatan non-profit). Distribusi tenaga keperawatan menurut jam kerja dan karakteristik pasar tenaga kerja sangat penting untuk memahami dinamika ketenagakerjaan, dan sebagai dasar menjaga keseimbangan antara pekerjaan dan kehidupan. Di Indonesia sudah terdapat aturan yang mengatur standar jam kerja, tenaga kontrak, regulasi upah minimum beserta perlindungan sosial terhadap Perawat. 5) Penghasilan dan Remunerasi Penghasilan, remunerasi dan pengembangan karir perawat diatur oleh pemerintah dengan mengikuti upah minimum yang ditetapkan oleh pemerintah pusat atau daerah. Penentuan upah minimum ini juga mempertimbangkan tingkat pendidikan, masa kerja serta berbagai tunjangan yang melekat. Pengembangan karir keperawatan saat ini sedang dikembangkan dan diuji coba di beberapa Rumah Sakit yang akan menjadi dasar penentuan pengembangan karir kedepan. 6) Pengembangan Karier Perawat Setiap tenaga perawat berhak untuk memperoleh pengembangan karir yang jelas. Kementerian Kesehatan telah menerbitkan Permenkes Nomor 40 tahun 2017 tentang jenjang karir perawat, dan bagi tenaga perawat dengan status ASN telah terbit pula Permenpan RB Nomor 35 tahun 2019 tentang Jabatan Fungsional Perawat. Namun dalam pelaksanaannya belum optimal. Tidak ada kewajiban dari RS untuk menerapkan PMK 40/2017 karena ada perbedaan persyaratan tiap tipe RS. 3. Pelayanan Kesehatan pada masyarakat a. Komposisi Tenaga Perawat di Rumah Sakit Perawat merupakan salah satu jenis tenaga kesehatan dengan jumlah mayoritas dibanding jenis tenaga kesehatan lainnya. Berdasarkan spesialisasi, Perawat terbagi menjadi Ners spesialis keperawatan baik itu maternitas, medikal bedah, jiwa dan anak. Pengembangan Ners spesialis sangat dimungkinkan dengan melihat kebutuhan dari pengguna dan industri kesehatan. b. Kebijakan Terkait Praktik Keperawatan Kebijakan pemerintah dalam dunia keperawatan telah diatur dalam Undang-Undang (UU) Nomor 38 tahun 2014 tentang Keperawatan. Dalam UU tersebut, jenis perawat terdiri atas perawat profesi dan vokasi. Perawat profesi dibagi lagi menjadi Ners dan Ners spesialis. Perawat yang menjalankan praktik keperawatan wajib memiliki izin atau Surat Tanda Registrasi dan perawat yang menjalankan praktik mandiri harus memasang papan nama Praktik Keperawatan. Dalam menyelenggarakan Praktik Keperawatan, perawat bertugas sebagai pemberi asuhan keperawatan, penyuluh dan konselor bagi klien, pengelola pelayanan keperawatan, peneliti keperawatan, pelaksana tugas berdasarkan wewenang dan atau pelaksana tugas sesuai dengan ketentuan yang berlaku. Terdapat mekanisme penyusunan kebijakan perawat yang melibatkan semua stakeholder terkait untuk mengembangkan jenjang karir perawat yang berkelanjutan. c. Sistem Informasi SDM Kesehatan Sistem Informasi SDM Kesehatan telah dibangun oleh pemerintah dengan kerjasama Internasional yang salah satunya membangun National Health Workforce Account (NHWA). Sistem Informasi SDM Kesehatan digunakan untuk pelaporan Kesehatan Internasional, pelaporan produksi perawat melalui pendidikan dan pelatihan dan pelaporan tenaga Perawat di pasar kerja.
Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM... more Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM). Foot complications can be prevented by routine foot exercises. Group support is needed to increase the routine of foot exercise. The effects of foot exercise can be seen by measuring the Ankle Brachial Pressure Index and foot sensation. The objective of this systematic review was to identify the prevention of DM foot complications in an easy way so then he patient can do it independently.
The Public Health Reform Roadmap by the Ministry of Health put priority reforms on financing heal... more The Public Health Reform Roadmap by the Ministry of Health put priority reforms on financing health care; drugs and health equipment availability; health management in the remote, country borderline areas and outer islands including human resources for health (HRH); and healthcare services. In the Strategic Plan document of the Ministry of Health year 2010-2014, HRH development is one of top eight 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 has been undergoing a process of decentralizing many responsibilities from central ministry to the district level particularly to the Provincial and District Health Offices. This has had implications on human resource planning and management which include the need for accurate and timely data and information on HRH. Most of the data required for this HRH country profile is still limited or incomplete. It has become clear that there is an urgent need to strengthen national health information system. Some key issues in HRH information need to address including weak coordination among stakeholder, inadequate use for decision making, various capacity of human resources in data processing of each level and 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. Health services are provided by both public and private institutions. In general, the ratio of health workers per 1000 population has increased from 1,42 per 1000 population in year 2009 to 2,11 per 1000 population in year 2010. The highest number of cadre is nurses with 160,074 and the lowest number is physiotherapist with 2,587. Imbalance distribution remains one of key issues not only between urban and rural but also among regions in Indonesia. The highest number of health workforces remains in Java/Bali . Migration or movement of the health workforce within and across country has become a great attention. So far in 2009 there were approximately 2892 nurses work in United Emirate Arab, United State of America, Saudi Arabia, Kuwait, the Netherlands, Singapore, Japan, and Norway. Distribution of health workers based on gender is also another issue, although the exact data is unavailable. There is a tendency of increasing female medical doctors and dentists, for example in mid 2010 the percentage of contract female doctors was 56% while the contract female dentists was 81%. This document failed to describe the age distribution by cadre and the public – private distribution by cadre due to lack of data. It is estimated 60 to 70 percent of publicly employed health worker engaged in dual practice, mainly in private practice and private facilities. Production of health workforce has been continuously increasing from year 2004 to 2009 especially in private health education institutions. Accreditation of health education institutions was 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 trainings. Projection of the health workforce requirement was developed for the HRH plan, which involved participation of stakeholders. The method used was the ratio of health workers to the certain value i.e. the health status measured by the life expectancy target. To improve deployment and distribution for HRH especially in remote and underserved areas, the MoH encourage the local government to provide additional incentives, scholarship, and other facilities such as vehicles, housing, telecommunication equipment and electricity as well as safety at workplace. This document showed that Human Resource Information System need to be strengthened both in local and national level.
The International Journal of Health Planning and Management , 2024
Introduction: To address domestic shortages, high-income countries are increasingly recruiting he... more Introduction: To address domestic shortages, high-income countries are increasingly recruiting health workers from low-and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. Method: We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. Results: All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Introduction: COVID-19 spreads quickly, especially in densely populated countries like Indonesia.... more Introduction: COVID-19 spreads quickly, especially in densely populated countries like Indonesia. Understanding transmission factors can support in reducing transmission rates. The purpose of this study is to analyze the various factors that may contribute to the transmission of COVID-19 in Indonesia, especially in the first wave of pandemic. Methods: This was a cross sectional study design. The sample was selected from the new all record data or the database for recording COVID-19 cases at the health office at the research location by online system. The research was conducted in seven districts and cities across three provinces to obtain an overview of transmission in each regional characteristic. The number of samples was as high as 2,010, with confirmed cases and close contacts in
Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both i... more Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both in developed and developing countries. Prevalence of anemia in WRA is higher by fourfold in developing countries, based on extensive studies and surveys conducted by WHO and UNICEF. However, there is limited studies that conducted pooled analysis of anemia prevalence in low resource countries. This study aimed to assess the prevalence and factors associated with anemia among women of reproductive age in low-and middle-income countries (LMICs). This study used secondary data from the Demographic and Health Survey (DHS) in 46 low-and middle-income countries during 2010-2021. Descriptive statistics of proportions between pregnant and non-pregnant mothers were assessed. Multilevel binary logistic regression was used to test the factors associated with anemia among women of reproductive age. A total of 881,148 women of childbearing age in LMICs were included. This study found a high prevalence of 45.20% (95% CI 41.21, 49.16) of anemia was observed in among pregnant women and 39.52% (95% CI 33.88, 45.15) anemia was observed in non-pregnant women. Educational status, wealth status, family size, media exposure, and residence were common factors significantly associated with anemia in both pregnant and non-pregnant women. The high global burden of anemia in LMICs continues to underline the need for unusual approaches and target interventions on an individual basis. Global commitment and movement to reduce the prevalence of anemia need to be revisited and redesigned for current circumstances. Anemia is one of the global health problems faced by people around the world, especially in developing countries as a large contributor 1,2. The three regions most contributing to anemia worldwide are West Africa, South Asia, and Central Africa 3. Recent data shows that anemia among women of reproductive age in 82 low and middleincome countries remains a significant challenge 1. One study noted that the prevalence rate of anemia was 9% in developed countries 4 while in contrast, in developing countries, the prevalence rate reached 43%, with children and women of reproductive age (WRA) at a greater risk of contracting anemia 5. The rates of anemia among pregnant women in developed countries such as Australia and the United States of America have been reported at 20% and 18% respectively 6,7 , while in developing countries the number is much higher, for example in Ethiopia
Penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini bertujuan untuk memfasilitasi para ... more Penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini bertujuan untuk memfasilitasi para perawat yang ingin mengembangkan karir di luar negeri, sebagai alternatif pendayagunaan selain di dalam negeri. Pendayagunaan tenaga kesehatan ke luar negeri dapat memberi manfaat bagi tenaga kesehatan Indonesia untuk mendapatkan pengalaman kerja, peningkatan pengetahuan dan keterampilan yang dapat menjadi sumbangsih kesehatan di Indonesia. Diharapkan dengan adanya buku saku ini dapat memberikan informasi yang lengkap dan komprehensif kepada para perawat maupun mahasiswa jurusan keperawatan dari berbagai Poltekkes maupun perguruan tinggi lainnya. Ucapan terima kasih kami sampaikan kepada seluruh pihak yang telah menyumbangkan pikiran, tenaga, dan waktunya dalam penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini. Kami mengharapkan adanya masukan dan saran dari semua pihak dalam menyempurnakan buku saku ini. Direktur
Anemia is a globally widespread condition in women and is associated with reduced economic produc... more Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.
Achieving universal health coverage (UHC) is one of essential targets of the
Sustainable Developm... more Achieving universal health coverage (UHC) is one of essential targets of the Sustainable Development Goals. It is fundamental for every nation to ensure that no one is left behind from receiving proper health care by building financial risk protection and promoting access to quality health service and adequate medical supplies including vaccine. UHC is definitely unachievable without having sufficient well-trained and well-performed health workers at all health. Three years after the implementation of the national health insurance in 2014, the Indonesia UHC service coverage index has achieved 57/100 based on the WHO report. This is a good start for a country with a newly established mandatory social health insurance, but also poses a real challenge on how to accelerate the health services being accessible for all people. When Indonesia was listed by WHO among countries with critical shortage of health workers in 2006, the Government of Indonesia has recognized that this issue should be strategically addressed. Policies to improve the availability of health workforce, qualification and competency of health workforce, and the distribution of health workers in underserved areas were enforced to strengthen the national health system. Indonesia also adopted the Global Code of Practice on The International Recruitment of Health Personnels one of references for the national health policy in managing the international migration. To understand how well the health workforce policies implemented, we recognize the importance of having a reliable and timely data on health workforce situation. In response, MOH developed a health workforce country profile to provide a comprehensive picture of the health workforce situation in Indonesia based on education, availability, distribution and the projection supply of each type of health workforce. This 2019 Human Resources for Health Country Profile provides an updated information on the Indonesia health workforce situation from the similar report published in 2012. This 2019 Human Resources for Health country profile was developed collaboratively between Center for Planning and Deployment of HRH and Faculty of Nursing, Airlangga University. The purpose of this document is to inform the global and national stakeholders about the health workforce situation in Indonesia. The document provide a comprehensive and the most recent overview of the health workforce situation in Indonesia in relation to the national development of the human resources for health. We appreciate the hard work done by the team in collecting and compiling pieces of data in developing this document. We do welcome any feedback from stakeholder who have interest in the Indonesia health workforce. . Finally I also thank to all contributors from the Ministry of Health and from other ministries and national agencies who spend their time and thoughts in participating during the development process.
1. Sektor Pendidikan
a. Pendidikan dan Pelatihan
Pada tahun 2019 di Indonesia tercatat jumlah ins... more 1. Sektor Pendidikan a. Pendidikan dan Pelatihan Pada tahun 2019 di Indonesia tercatat jumlah institusi pendidikan keperawatan sebanyak 534 institusi. Secara keseluruhan terdapat 1.058 program pendidikan keperawatan di Indonesia yang terdiri dari D3 sebanyak 413 program studi, D4/S1 sebanyak 342 program studi dan profesi sebanyak 280 program studi, sisanya sebanyak 23 adalah program studi S2 keatas. Kurikulum pendidikan dan pelatihan sudah diperbarui oleh kementerian terkait dan berbagai asosiasi pendidikan baik vokasi ataupun ners. Kurikulum tersebut mengacu dan selaras dengan regulasi yang ada, diantaranya adalah kompetensi inti Association of Southeast Asian Nations (ASEAN) serta kebutuhan stakeholder yang telah diimplementasikan ke mahasiswa keperawatan di Indonesia. b. Regulasi Pendidikan dan Pelatihan Peraturan yang menjadi pedoman dalam proses akreditasi yaitu: UU 12/2012, Permendikbud Nomor 3/2020, PerBan-PT Nomor 5/2019, PerBan-PT Nomor 4/2017, Permendikbud Nomor 5/2020, Peraturan LAM PTKes Nomor 2/2020, Permendikbud Nomor 7/2020. Ketetapan akreditasi berlaku dalam 5 tahun merujuk pada Permendikbud Nomor 5/2020 dan persetujuan standar akreditasi ditetapkan oleh rapat anggota, yang merupakan struktur organisasi tertinggi dalam LAM PTKes (terdiri dari ketua organisasi asosiasi profesi dan institusi pendidikan bidang kesehatan). Sementara itu Standar Nasional Profesi Keperawatan telah disusun oleh Persatuan Perawat Nasional Indonesia (PPNI), akan tetapi masih dalam proses penetapan (termasuk lingkup standar pendidikan interprofesionalisme). Jenjang karir perawat sendiri telah memiliki regulasi yaitu PMK 40/2017, tetapi belum semua fasilitas pelayanan kesehatan menerapkan hal ini. Terkait dengan pengembangan karir perawat pola karir di Indonesia ada dua pola, yaitu jabatan fungsional perawat dan jenjang karir. Untuk jenjang karir sudah dijalankan di Rumah Sakit, meskipun belum semua. c. Pembiayaan Pendidikan Biaya pendidikan telah diatur didalam Permendikbud Nomor 25 Tahun 2020 yang menetapkan Standar Satuan Biaya Operasional Pendidikan Tinggi pada Perguruan Tinggi Negeri di Lingkungan Kementerian Pendidikan dan Kebudayaan. Akan tetapi besaran nominal biaya bergantung pada kebijakan universitas masing-masing dengan mengacu pada batas kewajaran pembiayaan. 2. Angkatan kerja a. Ketersediaan perawat Secara garis besar ketersediaan perawat di Indonesia sudah dapat mencukupi kebutuhan sesuai dengan jumlah penduduk dengan rasio diatas target nasional yaitu mencapai 2,46 per 1.000 penduduk. Jumlah perawat yang terdaftar dan memiliki STR hingga akhir tahun 2020 adalah 985.889 dengan sejumlah 592.342 STR berstatus aktif. Sebanyak 384.464 perawat dilaporkan bekerja pada Rumah Sakit, Puskesmas dan fasilitas kesehatan lainnya di seluruh Indonesia. b. Pergerakan Pasar Kerja Tenaga Keperawatan 1) Dinamika tenaga perawat dalam pasar kerja dalam negeri Pasar kerja perawat merupakan sistem yang dinamis dan kompleks untuk melihat ketersediaan dan kebutuhan perawat di tingkat nasional beserta faktor kontekstual lainnya. Tantangan terbesar adalah pada data serapan tenaga keperawatan di lapangan yang bersifat sektoral serta pelacakan lulusan keperawatan di pasar kerja beserta jumlah pengangguran bidang keperawatan. Ketersediaan lowongan keperawatan baik dalam negeri maupun luar negeri dilakukan baik oleh pemerintah ataupun swasta. Berdasarkan proyeksi target kebutuhan tenaga perawat, diperkirakan pada tahun 2021 Indonesia mengalami surplus 176.470 perawat dan kemungkinan akan terus meningkat jumlahnya hingga 695.217 perawat pada tahun 2025. 2) Migrasi Perawat Indonesia ke Luar Negeri Selama periode tahun 20015-2020, sebanyak 6.393 perawat ditempatkan diluar negeri baik menduduki jabatan sebagai perawat maupun sebagai tenaga asisten perawat atau careworker di institusi perawatan lansia. Beberapa isu yang sering muncul dalam penjajakan Kerjasama luar negeri yaitu Bahasa, rekognisi, kompetensi dan sertifikasi. Isu lain yang kemudian muncul adalah terkait kontrak kerja yang meliputi hak dan kewajiban, perlindungan terhadap Perawat Migran Indonesia (PMI). Penempatan dan perlindungan tenaga perawat Indonesia ke luar negeri dilakukan oleh Badan Perlindungan Pekerja Migran Indonesia (BP2MI). Telah terdapat Kebijakan yang mengatur penempatan tenaga kerja luar negeri melalui berbagai macam mekanisme baik pemerintah ataupun swasta. 3) Migrasi Balik: Pendayagunaan Perawat Pasca Migrasi Selain perluasan peluang kerja, Kemenkes mendorong pendayagunaan perawat keluar negeri untuk alih ilmu pengetahuan dan teknologi melalui optimalisasi strategi brain circulation. Hal ini ditempuh dengan mengupayakan pendayagunaan kembali para tenaga Kesehatan yang telah selesai bekerja di luar negeri atau dikenal dengan istilah returnee. Untuk mengoptimalkan terjadinya brain circulation Kemenkes sedang mengupayakan solusi untuk mengatasi deskilling serta menyusun kebijakan reintegrasi untuk mendorong pendayagunaan kembali untuk penguatan pelayanan kesehatan. 4) Karakteristik dan Kondisi Kerja Karakteristik dan kondisi kerja bidang keperawatan bervariasi tergantung dari status kepemilikan fasilitas kesehatan (pemerintah/ swasta atau organisasi kesehatan non-profit). Distribusi tenaga keperawatan menurut jam kerja dan karakteristik pasar tenaga kerja sangat penting untuk memahami dinamika ketenagakerjaan, dan sebagai dasar menjaga keseimbangan antara pekerjaan dan kehidupan. Di Indonesia sudah terdapat aturan yang mengatur standar jam kerja, tenaga kontrak, regulasi upah minimum beserta perlindungan sosial terhadap Perawat. 5) Penghasilan dan Remunerasi Penghasilan, remunerasi dan pengembangan karir perawat diatur oleh pemerintah dengan mengikuti upah minimum yang ditetapkan oleh pemerintah pusat atau daerah. Penentuan upah minimum ini juga mempertimbangkan tingkat pendidikan, masa kerja serta berbagai tunjangan yang melekat. Pengembangan karir keperawatan saat ini sedang dikembangkan dan diuji coba di beberapa Rumah Sakit yang akan menjadi dasar penentuan pengembangan karir kedepan. 6) Pengembangan Karier Perawat Setiap tenaga perawat berhak untuk memperoleh pengembangan karir yang jelas. Kementerian Kesehatan telah menerbitkan Permenkes Nomor 40 tahun 2017 tentang jenjang karir perawat, dan bagi tenaga perawat dengan status ASN telah terbit pula Permenpan RB Nomor 35 tahun 2019 tentang Jabatan Fungsional Perawat. Namun dalam pelaksanaannya belum optimal. Tidak ada kewajiban dari RS untuk menerapkan PMK 40/2017 karena ada perbedaan persyaratan tiap tipe RS. 3. Pelayanan Kesehatan pada masyarakat a. Komposisi Tenaga Perawat di Rumah Sakit Perawat merupakan salah satu jenis tenaga kesehatan dengan jumlah mayoritas dibanding jenis tenaga kesehatan lainnya. Berdasarkan spesialisasi, Perawat terbagi menjadi Ners spesialis keperawatan baik itu maternitas, medikal bedah, jiwa dan anak. Pengembangan Ners spesialis sangat dimungkinkan dengan melihat kebutuhan dari pengguna dan industri kesehatan. b. Kebijakan Terkait Praktik Keperawatan Kebijakan pemerintah dalam dunia keperawatan telah diatur dalam Undang-Undang (UU) Nomor 38 tahun 2014 tentang Keperawatan. Dalam UU tersebut, jenis perawat terdiri atas perawat profesi dan vokasi. Perawat profesi dibagi lagi menjadi Ners dan Ners spesialis. Perawat yang menjalankan praktik keperawatan wajib memiliki izin atau Surat Tanda Registrasi dan perawat yang menjalankan praktik mandiri harus memasang papan nama Praktik Keperawatan. Dalam menyelenggarakan Praktik Keperawatan, perawat bertugas sebagai pemberi asuhan keperawatan, penyuluh dan konselor bagi klien, pengelola pelayanan keperawatan, peneliti keperawatan, pelaksana tugas berdasarkan wewenang dan atau pelaksana tugas sesuai dengan ketentuan yang berlaku. Terdapat mekanisme penyusunan kebijakan perawat yang melibatkan semua stakeholder terkait untuk mengembangkan jenjang karir perawat yang berkelanjutan. c. Sistem Informasi SDM Kesehatan Sistem Informasi SDM Kesehatan telah dibangun oleh pemerintah dengan kerjasama Internasional yang salah satunya membangun National Health Workforce Account (NHWA). Sistem Informasi SDM Kesehatan digunakan untuk pelaporan Kesehatan Internasional, pelaporan produksi perawat melalui pendidikan dan pelatihan dan pelaporan tenaga Perawat di pasar kerja.
Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM... more Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM). Foot complications can be prevented by routine foot exercises. Group support is needed to increase the routine of foot exercise. The effects of foot exercise can be seen by measuring the Ankle Brachial Pressure Index and foot sensation. The objective of this systematic review was to identify the prevention of DM foot complications in an easy way so then he patient can do it independently.
The Public Health Reform Roadmap by the Ministry of Health put priority reforms on financing heal... more The Public Health Reform Roadmap by the Ministry of Health put priority reforms on financing health care; drugs and health equipment availability; health management in the remote, country borderline areas and outer islands including human resources for health (HRH); and healthcare services. In the Strategic Plan document of the Ministry of Health year 2010-2014, HRH development is one of top eight 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 has been undergoing a process of decentralizing many responsibilities from central ministry to the district level particularly to the Provincial and District Health Offices. This has had implications on human resource planning and management which include the need for accurate and timely data and information on HRH. Most of the data required for this HRH country profile is still limited or incomplete. It has become clear that there is an urgent need to strengthen national health information system. Some key issues in HRH information need to address including weak coordination among stakeholder, inadequate use for decision making, various capacity of human resources in data processing of each level and 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. Health services are provided by both public and private institutions. In general, the ratio of health workers per 1000 population has increased from 1,42 per 1000 population in year 2009 to 2,11 per 1000 population in year 2010. The highest number of cadre is nurses with 160,074 and the lowest number is physiotherapist with 2,587. Imbalance distribution remains one of key issues not only between urban and rural but also among regions in Indonesia. The highest number of health workforces remains in Java/Bali . Migration or movement of the health workforce within and across country has become a great attention. So far in 2009 there were approximately 2892 nurses work in United Emirate Arab, United State of America, Saudi Arabia, Kuwait, the Netherlands, Singapore, Japan, and Norway. Distribution of health workers based on gender is also another issue, although the exact data is unavailable. There is a tendency of increasing female medical doctors and dentists, for example in mid 2010 the percentage of contract female doctors was 56% while the contract female dentists was 81%. This document failed to describe the age distribution by cadre and the public – private distribution by cadre due to lack of data. It is estimated 60 to 70 percent of publicly employed health worker engaged in dual practice, mainly in private practice and private facilities. Production of health workforce has been continuously increasing from year 2004 to 2009 especially in private health education institutions. Accreditation of health education institutions was 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 trainings. Projection of the health workforce requirement was developed for the HRH plan, which involved participation of stakeholders. The method used was the ratio of health workers to the certain value i.e. the health status measured by the life expectancy target. To improve deployment and distribution for HRH especially in remote and underserved areas, the MoH encourage the local government to provide additional incentives, scholarship, and other facilities such as vehicles, housing, telecommunication equipment and electricity as well as safety at workplace. This document showed that Human Resource Information System need to be strengthened both in local and national level.
The International Journal of Health Planning and Management , 2024
Introduction: To address domestic shortages, high-income countries are increasingly recruiting he... more Introduction: To address domestic shortages, high-income countries are increasingly recruiting health workers from low-and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan. Method: We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature. Results: All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Introduction: COVID-19 spreads quickly, especially in densely populated countries like Indonesia.... more Introduction: COVID-19 spreads quickly, especially in densely populated countries like Indonesia. Understanding transmission factors can support in reducing transmission rates. The purpose of this study is to analyze the various factors that may contribute to the transmission of COVID-19 in Indonesia, especially in the first wave of pandemic. Methods: This was a cross sectional study design. The sample was selected from the new all record data or the database for recording COVID-19 cases at the health office at the research location by online system. The research was conducted in seven districts and cities across three provinces to obtain an overview of transmission in each regional characteristic. The number of samples was as high as 2,010, with confirmed cases and close contacts in
Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both i... more Anemia is a global threat among women of reproductive age (WRA), or 15-49 years old women, both in developed and developing countries. Prevalence of anemia in WRA is higher by fourfold in developing countries, based on extensive studies and surveys conducted by WHO and UNICEF. However, there is limited studies that conducted pooled analysis of anemia prevalence in low resource countries. This study aimed to assess the prevalence and factors associated with anemia among women of reproductive age in low-and middle-income countries (LMICs). This study used secondary data from the Demographic and Health Survey (DHS) in 46 low-and middle-income countries during 2010-2021. Descriptive statistics of proportions between pregnant and non-pregnant mothers were assessed. Multilevel binary logistic regression was used to test the factors associated with anemia among women of reproductive age. A total of 881,148 women of childbearing age in LMICs were included. This study found a high prevalence of 45.20% (95% CI 41.21, 49.16) of anemia was observed in among pregnant women and 39.52% (95% CI 33.88, 45.15) anemia was observed in non-pregnant women. Educational status, wealth status, family size, media exposure, and residence were common factors significantly associated with anemia in both pregnant and non-pregnant women. The high global burden of anemia in LMICs continues to underline the need for unusual approaches and target interventions on an individual basis. Global commitment and movement to reduce the prevalence of anemia need to be revisited and redesigned for current circumstances. Anemia is one of the global health problems faced by people around the world, especially in developing countries as a large contributor 1,2. The three regions most contributing to anemia worldwide are West Africa, South Asia, and Central Africa 3. Recent data shows that anemia among women of reproductive age in 82 low and middleincome countries remains a significant challenge 1. One study noted that the prevalence rate of anemia was 9% in developed countries 4 while in contrast, in developing countries, the prevalence rate reached 43%, with children and women of reproductive age (WRA) at a greater risk of contracting anemia 5. The rates of anemia among pregnant women in developed countries such as Australia and the United States of America have been reported at 20% and 18% respectively 6,7 , while in developing countries the number is much higher, for example in Ethiopia
Introduction Experiences and determinants connected with type 2 diabetes mellitus-associated erec... more Introduction Experiences and determinants connected with type 2 diabetes mellitus-associated erectile dysfunction (T2DMED) in health appointments are not well understood and infrequently reported. This systematic review was undertaken to synthesise evidence of the experiences, facilitators, and barriers around screening ED in men with T2DM during health service consultations. Methods The review report was based on the guidelines provided by the Joanna Briggs Institute for conducting mixed-method systematic reviews. Eight electronic databases were searched, including Web of Science, Embase via Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO, ProQuest, PubMed, PsychInfo via Ovid, MEDLINE via Ovid, Portal Garuda. Additionally, the review manually looked through the reference lists of the studies we included. Erectile dysfunction, type 2 diabetes mellitus, screening and barriers were initially used as keywords in the search strategy. All identified primary studies written in English and Bahasa Indonesia, and published between 2001 and 2022 were meticulously screened following an agreed set of inclusion criteria.
Background. Reducing maternal mortality remains a significant challenge in Indonesia, especially ... more Background. Reducing maternal mortality remains a significant challenge in Indonesia, especially for achieving the country's Sustainable Development Goals (SDGs) by 2030. One of the challenges is increasing delivery at healthcare facilities to ensure safe and healthy births. In Indonesia, research on factors affecting women's use of facility-based childbirth services is scarce. Objective. This study was conducted to identify the determinants of facility-based deliveries in Indonesia. Methods. This study used data from the Indonesia Demographic and Health Survey of 2012, with a cross-sectional design. An odds ratio with 95% confidence intervals (CI) was employed to outline the independent variables for the determinants, including maternal age and education, place of residence, involvement in decision-making, employment status, economic status, and number of antenatal care visits. The dependent variable in this study was the place of delivery: whether it took place in healthcare or nonhealthcare facilities. The statistical significance was set at p<0.05 using bivariate analysis and binary logistic regression. Results. This study showed that a high level of education (OR: 3.035, 95% CI: 2.310-3.987), high economic status (OR: 6.691, 95% CI: 5.768-7.761), urban residence (OR: 2.947, 95% CI: 2.730-3.181), working status (OR: 0.853, 95% CI: 0.793-0.918), involvement in decision-making (OR: 0.887, 95% CI: 0.804-0.910), and having more than four visits to antenatal care centers (OR: 1.917, 95% CI: 1.783-2.061) were significant determinants of delivery at healthcare facilities. Conclusion. Efforts to improve facility-based childbirth in Indonesia must strengthen initiatives that promote women's education, women's autonomy, opportunities for wealth creation, and increased uptake of antenatal care, among others. Any barriers related to maternal healthcare services and cultural factors on the use of health facilities for childbirth in Indonesia require further monitoring and evaluation.
Results: There were 145 articles found in the search. Articles were identified and screened resul... more Results: There were 145 articles found in the search. Articles were identified and screened resulting in five complete articles that met the inclusion criteria. The results of this study found that health education interventions via mobile phones could increase patient knowledge about hypertension; improve self-management; monitor blood pressure; increase adherence to pharmacological treatment, a hypertensive diet, i.e.,low salt intake, vegetable and fruit intake, and physical activity; decrease blood pressure; and improve quality of life. Health education via mobile phones can also provide the latest information quickly to patients about controlling hypertension, antihypertensive drugs, and health services that can be utilised. Conclusion: Health education interventions via mobile phones have a significant positive effect in controlling hypertension in the community, but it is necessary to consider the patient's age, socioeconomic status, literacy conditions, and ability to use mobile phones to receive the health education that will be provided.
Coronavirus Disease 2019 (COVID-19) pandemic has changed all aspects of life, including the way p... more Coronavirus Disease 2019 (COVID-19) pandemic has changed all aspects of life, including the way people work and interact with each other. During the pandemic, several essential industries, not to mention healthcare workers, have had to endure the chaotic or life-threatening situation to keep working at desks to ensure that the pandemic can be tackled. Their actions are initially a kind of contribution that is rarely noticed by the public, but they have begun to be recognized as the new everyday heroes. Nurses are the frontline workers among other health workers who face the COVID-19 virus or other deadly infectious disease. Nurses directly provide essential healthcare services where they are most needed, both in hospital and community settings. Not only physical energy will be exploited, but mental sacrifices can also be affected. This phenomenon has been proven by the increase in mortality rate among nurses worldwide. The International Council of Nurses’ latest data showed that more than 1500 nurses have died from COVID-19 in 2020 (International Council of Nurses, 2020) and up to 180,000 health and care workers could have died from COVID-19 in 2021 (World Health Organization, 2021). This crisis emerged the demand for nurses who intend and are able to substitute for those who have fallen. This challenging situation leads nurses to be capable of managing the crisis and, at the same time, they can be the new leaders on the frontline. The lesson learned that can be recorded from the COVID-19 pandemic, is that nurses as the frontline workers continue to manage a tough healthcare facilities environment in order to save many people from COVID-19. They are potential candidates being front leaders as they have had experienced treating clients and community in quite complex ways during the pandemic. Because of that, it is essential to perceive them as future leaders such as by providing greater policy support at a national level. Equal opportunity to contribute to policy making process would create a solid environment for nurses. Standardized regulation on decent job and salaries also needs to be developed in order to protect the welfare of nurses. It goes without saying that nurse’s salary in Indonesia varies across sectors, even though the nurses are often going beyond their duties, many of them have been expected to accomplish more with less appreciation. These unfair situations should be transformed into a good situation by equipping the nurses with decent salaries equal to other frontline health workers. Talent management of nurses also needs to be developed at national level to accommodate regeneration and succession as a leader. This strategy will impact on how nurses can have the same benchmark as other health professions both regionally and nationally. A recent call from the World Health Organization (2020) mandated three pillars of essential aspects, namely, investment, education, jobs and leadership. This pandemic has opened an opportunity for nurses to move up the leadership ladder and expand the leadership position in every setting. To sum up, we might call the frontline nurses’ personnel as heroes in the pandemic era; however, just labelling them without also considering what they have to say eliminates any chance of progress. Concrete policy implementation is crucial, investing in the education sector is inevitable, and bottom-up coordination is critical in ensuring that frontline views are heard. Regardless of whether or not things are optimal, frontline nurses show up and perform their duties as do any leader who serves and protects clients and community.
Introduction: Breast cancer occupies the first position in Asia’s women cancer cases in recent ye... more Introduction: Breast cancer occupies the first position in Asia’s women cancer cases in recent years. Signs and symptoms experienced by the patient affect the stress condition of the patient as well as the family as a caregiver. The condition changes to deal with problems during patient assistance as a major problem in an outpatient setting. The demands of adaptation to through the needs during the period of assistance by the family is more complex. The study aimed to determine the experience of stress and adaptation of breast cancer patient’s family. Methods: The qualitative method used with in-depth interviews on seven respondents who were the family caregiver of breast cancer patients. Setting carried out at the shelter house in Bandung. The analysis process used thematic analysis based on Braun & Clarke. Results: The results found five main themes are: 1) Stressor on breast cancer patients, 2) Crisis fulfillment of companion needs, 3) Crisis accompaniment, 4) Coping mechanisms o...
Introduction: High dropout rate, inadequate treatment, and resistance to medication, still become... more Introduction: High dropout rate, inadequate treatment, and resistance to medication, still become an obstacle in the treatment of pulmonary TB. Pulmonary TB patient care management at home can be done actively through telenursing. N-SMSI (Ners-Short Message Service Intervention) is one of community nursing intervention, in which community nurses send short messages to remind patients to take medication and nutrition. The aim of this study was to analyze the effect of nursing management model N-SMSI to increased medication adherence and nutritional status of patients with pulmonary TB. Method: This study was used prospective design. The populations were new pulmonary TB patient at intensive phase, at Puskesmas Pegirian Surabaya. Samples were taken by purposive sampling technique; consist of 30 people, divided into treatment and control groups. The independent variable was N-SMSI. The dependent variables were medication adherence collected by using questionnaire and nutritional status...
Indonesia merupakan salah satu dari 57 negara yang mengalami krisis Sumber Daya Manusia Kesehatan... more Indonesia merupakan salah satu dari 57 negara yang mengalami krisis Sumber Daya Manusia Kesehatan di dunia. Krisis tenaga kesehatan semakin dirasakan di daerah tertinggal yang mengakibatkan terhambatnya pembangunan Indonesia secara keseluruhan. Kondisi ini diperparah pula oleh rendahnya retensi tenaga kesehatan untuk mengabdi di daerah tersebut. Tujuan dari penelitian ini adalah menganalisis best practices dalam meningkatkan retensi tenaga kesehatan di daerah tertinggal. Sistematis review dilakukan dari database artikel di google scholar, pubmed, ebsco, proquest dan science direct dengan kata kunci “retensi tenaga kesehatan” dan “daerah tertinggal”. Pencarian dilakukan dengan rentang publikasi adalah 10 tahun lalu. Kriteria artikel adalah artikel yang direview oleh mitra bestari, dokumen pemerintah dan lokasi penelitian di negara berkembang. Didapatkan 33 referensi dari sekitar 2000 referensi yang memenuhi kriteria yang telah ditetapkan. Berdasarkan analisis yang dilakukan, kebijaka...
Introduction: Hypertension is a silent killer disease that, if
not handled properly, will lead to... more Introduction: Hypertension is a silent killer disease that, if not handled properly, will lead to dangerous complications for the patient. Health education through mobile phones can be an intervention used to improve health services and the management of hypertension in the community. This study aims to synthesise research findings on the effect of mobile phone health education interventions on hypertensive patients. Materials and Methods: A systematic review. Search strategy was conducted on international journal databases, namely Scopus, PubMed, ProQuest, Web of Science, and Science Direct with the keywords ‘health education’, ‘mobile phone’ and ‘hypertension’. Inclusion criteria using PICOS, namely Population: hypertensive patients, Intervention: health education using a mobile phone, Comparation: ordinary health education, Output: knowledge, attitudes, behaviour, Study design: trial method. The publication year 2017-2021. Results: There were 145 articles found in the search. Articles were identified and screened resulting in five complete articles that met the inclusion criteria. The results of this study found that health education interventions via mobile phones could increase patient knowledge about hypertension; improve self-management; monitor blood pressure; increase adherence to pharmacological treatment, a hypertensive diet, i.e.,low salt intake, vegetable and fruit intake, and physical activity; decrease blood pressure; and improve quality of life. Health education via mobile phones can also provide the latest information quickly to patients about controlling hypertension, antihypertensive drugs, and health services that can be utilised. Conclusion: Health education interventions via mobile phones have a significant positive effect in controlling hypertension in the community, but it is necessary to consider the patient's age, socioeconomic status, literacy conditions, and ability to use mobile phones to receive the health education that will be provided.
Adolescents’ risky behavior such as high-risk sexual behavior, delinquency, antisocial, drug use,... more Adolescents’ risky behavior such as high-risk sexual behavior, delinquency, antisocial, drug use, low selfesteem, and academic failure are related to poor family function, especially interaction with parents. The aim of this study is to see the relationship between interaction of parent and adolescent in adolescent’s behavior. Methods: The key words used were related to the family included “parent,” “monitoring,” “parental warmth,” “parent-child relationship,” “parental support,” “parenting styles” and “family”. Journal articles search were done electronically using multiple databases, namely: DOAJ, Sage, Proquest, Medline, Google Scholar, Science Direct and Elsierver. Limitation year used was 5 years (2012 -2017). From the results obtained ten literatures selected of journal articles from 2037 journal articles found. Result: Ten studies raised in this study were all cross-sectional design. Combined findings of this study provided support for the interaction of parents interaction t...
BACKGROUND Mental health issues following the occurrence of disaster remain neglected area especi... more BACKGROUND Mental health issues following the occurrence of disaster remain neglected area especially for older people group. The purpose of this study was to explore stakeholders' perspectives on post-disaster management related to the elderly's mental health needs. DESIGN AND METHODS This qualitative case study was conducted between June and October 2020. The investigators conducted in-depth interviews with policymakers who were in charge of disaster management at national, provincial, and regional levels. The policymakers were selected through purposive sampling. A policy analysis was conducted by the investigators to answer the research question. RESULTS The results were presented based on actor, content, context, and process. The actors engage in intersectoral collaboration between disaster agencies, health agencies, and social agencies. The content is largely comprehensive; however, the disaster management policy should not neglect to address mental health conditions a...
Background: Therapeutic non-operative management is an important part in healing the wounds of di... more Background: Therapeutic non-operative management is an important part in healing the wounds of diabetic foot ulcer but the most effective methode among this remain questionable. This study aims to identify effective intervention to treat diabetic foot ulcer with therapeutic non-operative management by systematic review and followed the PRISMA statetment guidelines. Methods: Scopus, PubMed, and Science Direct database from 2012 – 2018 were search for the relevant keyword. All included studies were access base on (1) random controled trial, (2) case-control studies and (3) cohort studies. Results: 19 out of 1651 papers were including. Two articles suggest that advanced biologic therapy, the bioengineered living cellular construct (BLCC) of human fibroblast-derived dermal subtitution (HFDS) and advanced skin substitution using grafix have a significant. Five articles reported electrophysical therapy has significant. Two articles reported hyperbaric oxygen therapy (HBOT) had a significa...
This study assessed the relationship between women’s empowerment and the use of antenatal care (A... more This study assessed the relationship between women’s empowerment and the use of antenatal care (ANC) services in five Southeast Asian (ASEAN) countries. The data used in the study are from the most recent Demographic and Health Surveys (DHS) conducted in Cambodia (2014) Indonesia (2012) Myanmar (2016) the Philippines (2013) and Timor-Leste (2009). The focus of the analysis was on currently married women who gave birth within the last 5 years before the survey. The two main outcomes were the number of ANC visits they made (four or more compared with none to three) and the timing of the first ANC visit (within the first trimester or later in the pregnancy). Four composite women’s empowerment variables were created from 17 indicators: (1) labor force participation; (2) disagreement with reasons for wife beating; (3) decision-making power over household issues; and (4) knowledge level (based on education and media exposure). Analysis used logistic regression with adjustment for complex ...
Women living with HIV / AIDS have low quality of life because of the strong stigma in society. Th... more Women living with HIV / AIDS have low quality of life because of the strong stigma in society. The quality of life of women with HIV/AIDS is influenced by various factors including low social capital. The purpose of this research was to develop a model of community healthcare as partners (CHCP) on stigma and quality of women living with HIV/AIDS. This research was conducted using a cross-sectional approach in 119 people with multi-stage cluster sampling. The instrument of this study used questionnaire and data analysis used Structural Equation Modeling (SEM) based on variance or component based SEM, well-known as Partial Least Squares (PLS). Development of an HIV/AIDS cadre empowerment model, after a path analysis study and formulating strategic issues through focus group discussions (FGD) and expert discussions was in accordance with the research conducted. The influence of demographic factors, cadres' personal resources, cadre social contextual resources, and nurse support sho...
Cancer-related fatigue (CRF) is one of the symptoms commonly experienced by cancer patients and h... more Cancer-related fatigue (CRF) is one of the symptoms commonly experienced by cancer patients and has an impact on decreasing quality of life. The study aimed to explore the characteristics of cancer patients who experience cancer-related fatigue. The study involved 15 cancer patients using purposive sampling. The research instrument used a questionnaire characteristic of the research subjects and the Brief Fatigue Inventory. Descriptive data analysis using percentages and numbers. The results showed that most cancer patients experienced moderate fatigue, in the age range of the early elderly, stage III and received combination therapy. Fatigue in cancer patients is a symptom caused by multi factors. Cancer stage and type of treatment is one aspect that appears in the severity of perceived fatigue. CRF can occur in all phases of the disease, age, and type of treatment. Patient education about CRF needs to be done especially related to the management of fatigue that can be done both be...
Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM... more Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM). Foot complications can be prevented by routine foot exercises. Group support is needed to increase the routine of foot exercise. The effects of foot exercise can be seen by measuring the Ankle Brachial Pressure Index and foot sensation. The objective of this systematic review was to identify the prevention of DM foot complications in an easy way so then he patient can do it independently. Methods: The method used in this study was a systematic review focused on 2015 – 2019 using the PRISMA method. The literature was obtained from Scopus, Science Direct and Proquest. The results found 25 items of literature on foot exercise which was reduced to 4 studies on preventing damage to the feet of DM patients through routine foot exercise. The literature of this study is supported by 3 other studies that state that foot health can also be used to examine the foot’s blood circulation status and...
Background: In Indonesia, maternal health care services are widely available, aiming to improve h... more Background: In Indonesia, maternal health care services are widely available, aiming to improve health and survival among mothers. However, these services remain underutilised, and its determining factor was unknown. This study sought to identify determinant factors of maternal healthcare services utilisation among Indonesian mothers. Methods: This population-based cross-sectional study leveraged the 2017 Indonesia Demographic and Health Survey data. A total of 12,033 mothers aged from 15 to 49 years who had a live birth in the five years preceding the survey were included in the analysis. Multivariable logistic regressions were used to identify the determinant factors. Results: Approximately 93.44% of the mothers had adequate antenatal care, 83.73% had a delivery at the healthcare facility, and 71.46% received postnatal care. The mother’s age and household wealth index were the typical determinants of all maternal healthcare services. Determinants of antenatal care visits were husb...
Introduction: A well-balanced diet is one of the four pillars of diabetes self-management. Patien... more Introduction: A well-balanced diet is one of the four pillars of diabetes self-management. Patient's culture strongly influences intake food. Diabetic dietary guidelines which fit with the patient's culture is expected to improve patient's self-efficacy and diet compliance. This study was aimed to analyze the effect of ethnic foods diet program in improving self-efficacy and diet compliance among Type-2 Diabetes Mellitus (T2DM) patients.
Proceedings of the 9th International Nursing Conference, 2018
Community nurses had important role in promotive and preventive care in community. Aim of the stu... more Community nurses had important role in promotive and preventive care in community. Aim of the study was to identify community nurses role in promotive and preventive care, identify factors affected to community nurses role, analysis of factors affected to community nurses's role in promotive and preventive care in community based on Health Promotion Model (HPM). Design of the study was explanatory with cross sectional approach. Sum of participant was 161. This study was conducted in 11 Public Health Center in Banyuwangi at 1 January to 30 January 2018. Methods of data collection was cluster sampling. The results showed behavior related cognition and effect of nurses had affected to commitment of nurses (t-stat=19,575); commitment (t-stat=4,490), interpersonal influences (t-stat=3,747), and situational influences (t-stat=5,796) directly had affected to community nurses role. That was important to enhance of community nurses role capacity through modifying commitment of nurses, interpersonal influence factors and situational influence factors.
Proceedings of the 9th International Nursing Conference, 2018
Studies looking at the relationship between bullying and social anxiety have been mainly conducte... more Studies looking at the relationship between bullying and social anxiety have been mainly conducted in developed countries, and little is known about relationships and social withdrawal. The purpose of this study was to analyze the relationship between bullying, social anxiety, and social withdrawal among adolescents. This study used a quantitative method with a cross-sectional study design. Data were obtained from simple random sampling of 157 adolescents. All participants completed measures of bullying, social anxiety and social withdrawal. Data were analyzed using the Spearman rho correlation test with a level of significance <0.05. Results from this research found a strong relationship between bullying and social anxiety in adolescents (r = 0.628). The same result was identified between bullying and social withdrawal among adolescents (r = 0.538). It can be concluded that bullying has a negative impact on the social lives of the participants. The government and public should be aware of this issue and create a campaign to minimize the negative impact of bullying in today's society.
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Books by Ferry Efendi
tenaga kesehatan Indonesia untuk mendapatkan pengalaman kerja, peningkatan pengetahuan dan keterampilan yang dapat menjadi sumbangsih kesehatan di Indonesia. Diharapkan dengan adanya buku saku ini dapat memberikan informasi yang lengkap dan komprehensif kepada para perawat maupun mahasiswa jurusan keperawatan dari berbagai Poltekkes maupun perguruan tinggi lainnya. Ucapan terima kasih kami sampaikan kepada seluruh pihak yang telah menyumbangkan pikiran, tenaga, dan waktunya dalam penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini. Kami mengharapkan adanya masukan dan saran dari semua pihak dalam menyempurnakan buku saku ini.
Direktur
Sustainable Development Goals. It is fundamental for every nation to ensure
that no one is left behind from receiving proper health care by building financial
risk protection and promoting access to quality health service and adequate
medical supplies including vaccine. UHC is definitely unachievable without having
sufficient well-trained and well-performed health workers at all health. Three years
after the implementation of the national health insurance in 2014, the Indonesia
UHC service coverage index has achieved 57/100 based on the WHO report. This
is a good start for a country with a newly established mandatory social health
insurance, but also poses a real challenge on how to accelerate the health services
being accessible for all people.
When Indonesia was listed by WHO among countries with critical shortage
of health workers in 2006, the Government of Indonesia has recognized that
this issue should be strategically addressed. Policies to improve the availability
of health workforce, qualification and competency of health workforce, and the
distribution of health workers in underserved areas were enforced to strengthen
the national health system. Indonesia also adopted the Global Code of Practice
on The International Recruitment of Health Personnels one of references for the
national health policy in managing the international migration. To understand how
well the health workforce policies implemented, we recognize the importance of
having a reliable and timely data on health workforce situation.
In response, MOH developed a health workforce country profile to provide a
comprehensive picture of the health workforce situation in Indonesia based on
education, availability, distribution and the projection supply of each type of health
workforce. This 2019 Human Resources for Health Country Profile provides an
updated information on the Indonesia health workforce situation from the similar
report published in 2012.
This 2019 Human Resources for Health country profile was developed
collaboratively between Center for Planning and Deployment of HRH and Faculty
of Nursing, Airlangga University. The purpose of this document is to inform the
global and national stakeholders about the health workforce situation in Indonesia.
The document provide a comprehensive and the most recent overview of the health workforce situation in Indonesia in relation to the national development of
the human resources for health. We appreciate the hard work done by the team
in collecting and compiling pieces of data in developing this document. We do
welcome any feedback from stakeholder who have interest in the Indonesia health
workforce. . Finally I also thank to all contributors from the Ministry of Health and
from other ministries and national agencies who spend their time and thoughts in
participating during the development process.
a. Pendidikan dan Pelatihan
Pada tahun 2019 di Indonesia tercatat jumlah institusi pendidikan
keperawatan sebanyak 534 institusi. Secara keseluruhan terdapat 1.058
program pendidikan keperawatan di Indonesia yang terdiri dari D3
sebanyak 413 program studi, D4/S1 sebanyak 342 program studi dan
profesi sebanyak 280 program studi, sisanya sebanyak 23 adalah program
studi S2 keatas. Kurikulum pendidikan dan pelatihan sudah diperbarui oleh
kementerian terkait dan berbagai asosiasi pendidikan baik vokasi ataupun
ners. Kurikulum tersebut mengacu dan selaras dengan regulasi yang ada,
diantaranya adalah kompetensi inti Association of Southeast Asian Nations
(ASEAN) serta kebutuhan stakeholder yang telah diimplementasikan ke
mahasiswa keperawatan di Indonesia.
b. Regulasi Pendidikan dan Pelatihan
Peraturan yang menjadi pedoman dalam proses akreditasi yaitu: UU
12/2012, Permendikbud Nomor 3/2020, PerBan-PT Nomor 5/2019,
PerBan-PT Nomor 4/2017, Permendikbud Nomor 5/2020, Peraturan
LAM PTKes Nomor 2/2020, Permendikbud Nomor 7/2020. Ketetapan
akreditasi berlaku dalam 5 tahun merujuk pada Permendikbud Nomor
5/2020 dan persetujuan standar akreditasi ditetapkan oleh rapat anggota,
yang merupakan struktur organisasi tertinggi dalam LAM PTKes (terdiri
dari ketua organisasi asosiasi profesi dan institusi pendidikan bidang
kesehatan). Sementara itu Standar Nasional Profesi Keperawatan telah
disusun oleh Persatuan Perawat Nasional Indonesia (PPNI), akan tetapi
masih dalam proses penetapan (termasuk lingkup standar pendidikan
interprofesionalisme). Jenjang karir perawat sendiri telah memiliki
regulasi yaitu PMK 40/2017, tetapi belum semua fasilitas pelayanan
kesehatan menerapkan hal ini. Terkait dengan pengembangan karir
perawat pola karir di Indonesia ada dua pola, yaitu jabatan fungsional
perawat dan jenjang karir. Untuk jenjang karir sudah dijalankan di Rumah
Sakit, meskipun belum semua.
c. Pembiayaan Pendidikan
Biaya pendidikan telah diatur didalam Permendikbud Nomor 25 Tahun
2020 yang menetapkan Standar Satuan Biaya Operasional Pendidikan
Tinggi pada Perguruan Tinggi Negeri di Lingkungan Kementerian
Pendidikan dan Kebudayaan. Akan tetapi besaran nominal biaya
bergantung pada kebijakan universitas masing-masing dengan mengacu
pada batas kewajaran pembiayaan.
2. Angkatan kerja
a. Ketersediaan perawat
Secara garis besar ketersediaan perawat di Indonesia sudah dapat
mencukupi kebutuhan sesuai dengan jumlah penduduk dengan rasio
diatas target nasional yaitu mencapai 2,46 per 1.000 penduduk. Jumlah
perawat yang terdaftar dan memiliki STR hingga akhir tahun 2020 adalah
985.889 dengan sejumlah 592.342 STR berstatus aktif. Sebanyak 384.464
perawat dilaporkan bekerja pada Rumah Sakit, Puskesmas dan fasilitas
kesehatan lainnya di seluruh Indonesia.
b. Pergerakan Pasar Kerja Tenaga Keperawatan
1) Dinamika tenaga perawat dalam pasar kerja dalam negeri
Pasar kerja perawat merupakan sistem yang dinamis dan kompleks
untuk melihat ketersediaan dan kebutuhan perawat di tingkat
nasional beserta faktor kontekstual lainnya. Tantangan terbesar adalah
pada data serapan tenaga keperawatan di lapangan yang bersifat
sektoral serta pelacakan lulusan keperawatan di pasar kerja beserta
jumlah pengangguran bidang keperawatan. Ketersediaan lowongan
keperawatan baik dalam negeri maupun luar negeri dilakukan baik
oleh pemerintah ataupun swasta. Berdasarkan proyeksi target
kebutuhan tenaga perawat, diperkirakan pada tahun 2021 Indonesia
mengalami surplus 176.470 perawat dan kemungkinan akan terus
meningkat jumlahnya hingga 695.217 perawat pada tahun 2025.
2) Migrasi Perawat Indonesia ke Luar Negeri
Selama periode tahun 20015-2020, sebanyak 6.393 perawat
ditempatkan diluar negeri baik menduduki jabatan sebagai perawat
maupun sebagai tenaga asisten perawat atau careworker di institusi
perawatan lansia. Beberapa isu yang sering muncul dalam penjajakan
Kerjasama luar negeri yaitu Bahasa, rekognisi, kompetensi dan
sertifikasi. Isu lain yang kemudian muncul adalah terkait kontrak kerja
yang meliputi hak dan kewajiban, perlindungan terhadap Perawat
Migran Indonesia (PMI). Penempatan dan perlindungan tenaga
perawat Indonesia ke luar negeri dilakukan oleh Badan Perlindungan
Pekerja Migran Indonesia (BP2MI). Telah terdapat Kebijakan yang
mengatur penempatan tenaga kerja luar negeri melalui berbagai
macam mekanisme baik pemerintah ataupun swasta.
3) Migrasi Balik: Pendayagunaan Perawat Pasca Migrasi
Selain perluasan peluang kerja, Kemenkes mendorong pendayagunaan
perawat keluar negeri untuk alih ilmu pengetahuan dan teknologi
melalui optimalisasi strategi brain circulation. Hal ini ditempuh dengan
mengupayakan pendayagunaan kembali para tenaga Kesehatan yang
telah selesai bekerja di luar negeri atau dikenal dengan istilah returnee.
Untuk mengoptimalkan terjadinya brain circulation Kemenkes sedang
mengupayakan solusi untuk mengatasi deskilling serta menyusun
kebijakan reintegrasi untuk mendorong pendayagunaan kembali
untuk penguatan pelayanan kesehatan.
4) Karakteristik dan Kondisi Kerja
Karakteristik dan kondisi kerja bidang keperawatan bervariasi
tergantung dari status kepemilikan fasilitas kesehatan (pemerintah/
swasta atau organisasi kesehatan non-profit). Distribusi tenaga
keperawatan menurut jam kerja dan karakteristik pasar tenaga kerja
sangat penting untuk memahami dinamika ketenagakerjaan, dan
sebagai dasar menjaga keseimbangan antara pekerjaan dan kehidupan.
Di Indonesia sudah terdapat aturan yang mengatur standar jam kerja,
tenaga kontrak, regulasi upah minimum beserta perlindungan sosial
terhadap Perawat.
5) Penghasilan dan Remunerasi
Penghasilan, remunerasi dan pengembangan karir perawat diatur oleh
pemerintah dengan mengikuti upah minimum yang ditetapkan oleh
pemerintah pusat atau daerah. Penentuan upah minimum ini juga
mempertimbangkan tingkat pendidikan, masa kerja serta berbagai
tunjangan yang melekat. Pengembangan karir keperawatan saat ini
sedang dikembangkan dan diuji coba di beberapa Rumah Sakit yang
akan menjadi dasar penentuan pengembangan karir kedepan.
6) Pengembangan Karier Perawat
Setiap tenaga perawat berhak untuk memperoleh pengembangan
karir yang jelas. Kementerian Kesehatan telah menerbitkan
Permenkes Nomor 40 tahun 2017 tentang jenjang karir perawat, dan
bagi tenaga perawat dengan status ASN telah terbit pula Permenpan
RB Nomor 35 tahun 2019 tentang Jabatan Fungsional Perawat.
Namun dalam pelaksanaannya belum optimal. Tidak ada kewajiban
dari RS untuk menerapkan PMK 40/2017 karena ada perbedaan
persyaratan tiap tipe RS.
3. Pelayanan Kesehatan pada masyarakat
a. Komposisi Tenaga Perawat di Rumah Sakit
Perawat merupakan salah satu jenis tenaga kesehatan dengan jumlah
mayoritas dibanding jenis tenaga kesehatan lainnya. Berdasarkan
spesialisasi, Perawat terbagi menjadi Ners spesialis keperawatan baik itu
maternitas, medikal bedah, jiwa dan anak. Pengembangan Ners spesialis
sangat dimungkinkan dengan melihat kebutuhan dari pengguna dan
industri kesehatan.
b. Kebijakan Terkait Praktik Keperawatan
Kebijakan pemerintah dalam dunia keperawatan telah diatur dalam
Undang-Undang (UU) Nomor 38 tahun 2014 tentang Keperawatan.
Dalam UU tersebut, jenis perawat terdiri atas perawat profesi dan vokasi.
Perawat profesi dibagi lagi menjadi Ners dan Ners spesialis. Perawat yang
menjalankan praktik keperawatan wajib memiliki izin atau Surat Tanda
Registrasi dan perawat yang menjalankan praktik mandiri harus memasang
papan nama Praktik Keperawatan. Dalam menyelenggarakan Praktik
Keperawatan, perawat bertugas sebagai pemberi asuhan keperawatan,
penyuluh dan konselor bagi klien, pengelola pelayanan keperawatan,
peneliti keperawatan, pelaksana tugas berdasarkan wewenang dan
atau pelaksana tugas sesuai dengan ketentuan yang berlaku. Terdapat
mekanisme penyusunan kebijakan perawat yang melibatkan semua
stakeholder terkait untuk mengembangkan jenjang karir perawat yang
berkelanjutan. c. Sistem Informasi SDM Kesehatan
Sistem Informasi SDM Kesehatan telah dibangun oleh pemerintah
dengan kerjasama Internasional yang salah satunya membangun National
Health Workforce Account (NHWA). Sistem Informasi SDM Kesehatan
digunakan untuk pelaporan Kesehatan Internasional, pelaporan produksi
perawat melalui pendidikan dan pelatihan dan pelaporan tenaga Perawat
di pasar kerja.
重觀點之相關研究已對此提出正反兩面之辨證。本章節將探討回流移工在
印尼的發展:基於《印尼日本經濟夥伴協定》,日本已招募許多印尼籍護
理與照護人員,至今也有超過690名印尼籍護理與照護人員返回母國。這
些專業人員的動向頗耐人尋味,但目前甚少有研究加以關注。本章首先回
顧回流遷移相關的實證文獻,接著探討雙邊協定下印尼勞力的跨國遷移,
復探究曾任專業護理與照護人員之回流後現況,最後提出總結與未來政策
建議。本研究發現對於母國而言,回流移工是彌足珍貴的人力資本,應全
力發展人才循環與人才回流相關計畫,以充分運用其具備的專業知識與技
能。目前雖有部分回流移工持續從事護理與照護工作,但其他多數則投身
非醫療照護產業。政府應協助他們重新適應母國社會,進而縮減人才回流
與經濟發展間的差距。
care; drugs and health equipment availability; health management in the remote, country borderline
areas and outer islands including human resources for health (HRH); and healthcare services. In the
Strategic Plan document of the Ministry of Health year 2010-2014, HRH development is one of top
eight 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 has been undergoing a process of decentralizing
many responsibilities from central ministry to the district level particularly to the Provincial and
District Health Offices. This has had implications on human resource planning and management which
include the need for accurate and timely data and information on HRH. Most of the data required for
this HRH country profile is still limited or incomplete. It has become clear that there is an urgent need
to strengthen national health information system. Some key issues in HRH information need to
address including weak coordination among stakeholder, inadequate use for decision making, various
capacity of human resources in data processing of each level and 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.
Health services are provided by both public and private institutions. In general, the ratio of health
workers per 1000 population has increased from 1,42 per 1000 population in year 2009 to 2,11 per
1000 population in year 2010. The highest number of cadre is nurses with 160,074 and the lowest
number is physiotherapist with 2,587. Imbalance distribution remains one of key issues not only
between urban and rural but also among regions in Indonesia. The highest number of health
workforces remains in Java/Bali . Migration or movement of the health workforce within and across
country has become a great attention. So far in 2009 there were approximately 2892 nurses work in
United Emirate Arab, United State of America, Saudi Arabia, Kuwait, the Netherlands, Singapore,
Japan, and Norway. Distribution of health workers based on gender is also another issue, although the
exact data is unavailable. There is a tendency of increasing female medical doctors and dentists, for
example in mid 2010 the percentage of contract female doctors was 56% while the contract female
dentists was 81%. This document failed to describe the age distribution by cadre and the public –
private distribution by cadre due to lack of data. It is estimated 60 to 70 percent of publicly employed
health worker engaged in dual practice, mainly in private practice and private facilities.
Production of health workforce has been continuously increasing from year 2004 to 2009 especially in
private health education institutions. Accreditation of health education institutions was 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
trainings.
Projection of the health workforce requirement was developed for the HRH plan, which involved
participation of stakeholders. The method used was the ratio of health workers to the certain value i.e.
the health status measured by the life expectancy target.
To improve deployment and distribution for HRH especially in remote and underserved areas, the
MoH encourage the local government to provide additional incentives, scholarship, and other facilities
such as vehicles, housing, telecommunication equipment and electricity as well as safety at workplace.
This document showed that Human Resource Information System need to be strengthened both in
local and national level.
Papers by Ferry Efendi
tenaga kesehatan Indonesia untuk mendapatkan pengalaman kerja, peningkatan pengetahuan dan keterampilan yang dapat menjadi sumbangsih kesehatan di Indonesia. Diharapkan dengan adanya buku saku ini dapat memberikan informasi yang lengkap dan komprehensif kepada para perawat maupun mahasiswa jurusan keperawatan dari berbagai Poltekkes maupun perguruan tinggi lainnya. Ucapan terima kasih kami sampaikan kepada seluruh pihak yang telah menyumbangkan pikiran, tenaga, dan waktunya dalam penyusunan Buku Saku Pendayagunaan Perawat ke Luar Negeri ini. Kami mengharapkan adanya masukan dan saran dari semua pihak dalam menyempurnakan buku saku ini.
Direktur
Sustainable Development Goals. It is fundamental for every nation to ensure
that no one is left behind from receiving proper health care by building financial
risk protection and promoting access to quality health service and adequate
medical supplies including vaccine. UHC is definitely unachievable without having
sufficient well-trained and well-performed health workers at all health. Three years
after the implementation of the national health insurance in 2014, the Indonesia
UHC service coverage index has achieved 57/100 based on the WHO report. This
is a good start for a country with a newly established mandatory social health
insurance, but also poses a real challenge on how to accelerate the health services
being accessible for all people.
When Indonesia was listed by WHO among countries with critical shortage
of health workers in 2006, the Government of Indonesia has recognized that
this issue should be strategically addressed. Policies to improve the availability
of health workforce, qualification and competency of health workforce, and the
distribution of health workers in underserved areas were enforced to strengthen
the national health system. Indonesia also adopted the Global Code of Practice
on The International Recruitment of Health Personnels one of references for the
national health policy in managing the international migration. To understand how
well the health workforce policies implemented, we recognize the importance of
having a reliable and timely data on health workforce situation.
In response, MOH developed a health workforce country profile to provide a
comprehensive picture of the health workforce situation in Indonesia based on
education, availability, distribution and the projection supply of each type of health
workforce. This 2019 Human Resources for Health Country Profile provides an
updated information on the Indonesia health workforce situation from the similar
report published in 2012.
This 2019 Human Resources for Health country profile was developed
collaboratively between Center for Planning and Deployment of HRH and Faculty
of Nursing, Airlangga University. The purpose of this document is to inform the
global and national stakeholders about the health workforce situation in Indonesia.
The document provide a comprehensive and the most recent overview of the health workforce situation in Indonesia in relation to the national development of
the human resources for health. We appreciate the hard work done by the team
in collecting and compiling pieces of data in developing this document. We do
welcome any feedback from stakeholder who have interest in the Indonesia health
workforce. . Finally I also thank to all contributors from the Ministry of Health and
from other ministries and national agencies who spend their time and thoughts in
participating during the development process.
a. Pendidikan dan Pelatihan
Pada tahun 2019 di Indonesia tercatat jumlah institusi pendidikan
keperawatan sebanyak 534 institusi. Secara keseluruhan terdapat 1.058
program pendidikan keperawatan di Indonesia yang terdiri dari D3
sebanyak 413 program studi, D4/S1 sebanyak 342 program studi dan
profesi sebanyak 280 program studi, sisanya sebanyak 23 adalah program
studi S2 keatas. Kurikulum pendidikan dan pelatihan sudah diperbarui oleh
kementerian terkait dan berbagai asosiasi pendidikan baik vokasi ataupun
ners. Kurikulum tersebut mengacu dan selaras dengan regulasi yang ada,
diantaranya adalah kompetensi inti Association of Southeast Asian Nations
(ASEAN) serta kebutuhan stakeholder yang telah diimplementasikan ke
mahasiswa keperawatan di Indonesia.
b. Regulasi Pendidikan dan Pelatihan
Peraturan yang menjadi pedoman dalam proses akreditasi yaitu: UU
12/2012, Permendikbud Nomor 3/2020, PerBan-PT Nomor 5/2019,
PerBan-PT Nomor 4/2017, Permendikbud Nomor 5/2020, Peraturan
LAM PTKes Nomor 2/2020, Permendikbud Nomor 7/2020. Ketetapan
akreditasi berlaku dalam 5 tahun merujuk pada Permendikbud Nomor
5/2020 dan persetujuan standar akreditasi ditetapkan oleh rapat anggota,
yang merupakan struktur organisasi tertinggi dalam LAM PTKes (terdiri
dari ketua organisasi asosiasi profesi dan institusi pendidikan bidang
kesehatan). Sementara itu Standar Nasional Profesi Keperawatan telah
disusun oleh Persatuan Perawat Nasional Indonesia (PPNI), akan tetapi
masih dalam proses penetapan (termasuk lingkup standar pendidikan
interprofesionalisme). Jenjang karir perawat sendiri telah memiliki
regulasi yaitu PMK 40/2017, tetapi belum semua fasilitas pelayanan
kesehatan menerapkan hal ini. Terkait dengan pengembangan karir
perawat pola karir di Indonesia ada dua pola, yaitu jabatan fungsional
perawat dan jenjang karir. Untuk jenjang karir sudah dijalankan di Rumah
Sakit, meskipun belum semua.
c. Pembiayaan Pendidikan
Biaya pendidikan telah diatur didalam Permendikbud Nomor 25 Tahun
2020 yang menetapkan Standar Satuan Biaya Operasional Pendidikan
Tinggi pada Perguruan Tinggi Negeri di Lingkungan Kementerian
Pendidikan dan Kebudayaan. Akan tetapi besaran nominal biaya
bergantung pada kebijakan universitas masing-masing dengan mengacu
pada batas kewajaran pembiayaan.
2. Angkatan kerja
a. Ketersediaan perawat
Secara garis besar ketersediaan perawat di Indonesia sudah dapat
mencukupi kebutuhan sesuai dengan jumlah penduduk dengan rasio
diatas target nasional yaitu mencapai 2,46 per 1.000 penduduk. Jumlah
perawat yang terdaftar dan memiliki STR hingga akhir tahun 2020 adalah
985.889 dengan sejumlah 592.342 STR berstatus aktif. Sebanyak 384.464
perawat dilaporkan bekerja pada Rumah Sakit, Puskesmas dan fasilitas
kesehatan lainnya di seluruh Indonesia.
b. Pergerakan Pasar Kerja Tenaga Keperawatan
1) Dinamika tenaga perawat dalam pasar kerja dalam negeri
Pasar kerja perawat merupakan sistem yang dinamis dan kompleks
untuk melihat ketersediaan dan kebutuhan perawat di tingkat
nasional beserta faktor kontekstual lainnya. Tantangan terbesar adalah
pada data serapan tenaga keperawatan di lapangan yang bersifat
sektoral serta pelacakan lulusan keperawatan di pasar kerja beserta
jumlah pengangguran bidang keperawatan. Ketersediaan lowongan
keperawatan baik dalam negeri maupun luar negeri dilakukan baik
oleh pemerintah ataupun swasta. Berdasarkan proyeksi target
kebutuhan tenaga perawat, diperkirakan pada tahun 2021 Indonesia
mengalami surplus 176.470 perawat dan kemungkinan akan terus
meningkat jumlahnya hingga 695.217 perawat pada tahun 2025.
2) Migrasi Perawat Indonesia ke Luar Negeri
Selama periode tahun 20015-2020, sebanyak 6.393 perawat
ditempatkan diluar negeri baik menduduki jabatan sebagai perawat
maupun sebagai tenaga asisten perawat atau careworker di institusi
perawatan lansia. Beberapa isu yang sering muncul dalam penjajakan
Kerjasama luar negeri yaitu Bahasa, rekognisi, kompetensi dan
sertifikasi. Isu lain yang kemudian muncul adalah terkait kontrak kerja
yang meliputi hak dan kewajiban, perlindungan terhadap Perawat
Migran Indonesia (PMI). Penempatan dan perlindungan tenaga
perawat Indonesia ke luar negeri dilakukan oleh Badan Perlindungan
Pekerja Migran Indonesia (BP2MI). Telah terdapat Kebijakan yang
mengatur penempatan tenaga kerja luar negeri melalui berbagai
macam mekanisme baik pemerintah ataupun swasta.
3) Migrasi Balik: Pendayagunaan Perawat Pasca Migrasi
Selain perluasan peluang kerja, Kemenkes mendorong pendayagunaan
perawat keluar negeri untuk alih ilmu pengetahuan dan teknologi
melalui optimalisasi strategi brain circulation. Hal ini ditempuh dengan
mengupayakan pendayagunaan kembali para tenaga Kesehatan yang
telah selesai bekerja di luar negeri atau dikenal dengan istilah returnee.
Untuk mengoptimalkan terjadinya brain circulation Kemenkes sedang
mengupayakan solusi untuk mengatasi deskilling serta menyusun
kebijakan reintegrasi untuk mendorong pendayagunaan kembali
untuk penguatan pelayanan kesehatan.
4) Karakteristik dan Kondisi Kerja
Karakteristik dan kondisi kerja bidang keperawatan bervariasi
tergantung dari status kepemilikan fasilitas kesehatan (pemerintah/
swasta atau organisasi kesehatan non-profit). Distribusi tenaga
keperawatan menurut jam kerja dan karakteristik pasar tenaga kerja
sangat penting untuk memahami dinamika ketenagakerjaan, dan
sebagai dasar menjaga keseimbangan antara pekerjaan dan kehidupan.
Di Indonesia sudah terdapat aturan yang mengatur standar jam kerja,
tenaga kontrak, regulasi upah minimum beserta perlindungan sosial
terhadap Perawat.
5) Penghasilan dan Remunerasi
Penghasilan, remunerasi dan pengembangan karir perawat diatur oleh
pemerintah dengan mengikuti upah minimum yang ditetapkan oleh
pemerintah pusat atau daerah. Penentuan upah minimum ini juga
mempertimbangkan tingkat pendidikan, masa kerja serta berbagai
tunjangan yang melekat. Pengembangan karir keperawatan saat ini
sedang dikembangkan dan diuji coba di beberapa Rumah Sakit yang
akan menjadi dasar penentuan pengembangan karir kedepan.
6) Pengembangan Karier Perawat
Setiap tenaga perawat berhak untuk memperoleh pengembangan
karir yang jelas. Kementerian Kesehatan telah menerbitkan
Permenkes Nomor 40 tahun 2017 tentang jenjang karir perawat, dan
bagi tenaga perawat dengan status ASN telah terbit pula Permenpan
RB Nomor 35 tahun 2019 tentang Jabatan Fungsional Perawat.
Namun dalam pelaksanaannya belum optimal. Tidak ada kewajiban
dari RS untuk menerapkan PMK 40/2017 karena ada perbedaan
persyaratan tiap tipe RS.
3. Pelayanan Kesehatan pada masyarakat
a. Komposisi Tenaga Perawat di Rumah Sakit
Perawat merupakan salah satu jenis tenaga kesehatan dengan jumlah
mayoritas dibanding jenis tenaga kesehatan lainnya. Berdasarkan
spesialisasi, Perawat terbagi menjadi Ners spesialis keperawatan baik itu
maternitas, medikal bedah, jiwa dan anak. Pengembangan Ners spesialis
sangat dimungkinkan dengan melihat kebutuhan dari pengguna dan
industri kesehatan.
b. Kebijakan Terkait Praktik Keperawatan
Kebijakan pemerintah dalam dunia keperawatan telah diatur dalam
Undang-Undang (UU) Nomor 38 tahun 2014 tentang Keperawatan.
Dalam UU tersebut, jenis perawat terdiri atas perawat profesi dan vokasi.
Perawat profesi dibagi lagi menjadi Ners dan Ners spesialis. Perawat yang
menjalankan praktik keperawatan wajib memiliki izin atau Surat Tanda
Registrasi dan perawat yang menjalankan praktik mandiri harus memasang
papan nama Praktik Keperawatan. Dalam menyelenggarakan Praktik
Keperawatan, perawat bertugas sebagai pemberi asuhan keperawatan,
penyuluh dan konselor bagi klien, pengelola pelayanan keperawatan,
peneliti keperawatan, pelaksana tugas berdasarkan wewenang dan
atau pelaksana tugas sesuai dengan ketentuan yang berlaku. Terdapat
mekanisme penyusunan kebijakan perawat yang melibatkan semua
stakeholder terkait untuk mengembangkan jenjang karir perawat yang
berkelanjutan. c. Sistem Informasi SDM Kesehatan
Sistem Informasi SDM Kesehatan telah dibangun oleh pemerintah
dengan kerjasama Internasional yang salah satunya membangun National
Health Workforce Account (NHWA). Sistem Informasi SDM Kesehatan
digunakan untuk pelaporan Kesehatan Internasional, pelaporan produksi
perawat melalui pendidikan dan pelatihan dan pelaporan tenaga Perawat
di pasar kerja.
重觀點之相關研究已對此提出正反兩面之辨證。本章節將探討回流移工在
印尼的發展:基於《印尼日本經濟夥伴協定》,日本已招募許多印尼籍護
理與照護人員,至今也有超過690名印尼籍護理與照護人員返回母國。這
些專業人員的動向頗耐人尋味,但目前甚少有研究加以關注。本章首先回
顧回流遷移相關的實證文獻,接著探討雙邊協定下印尼勞力的跨國遷移,
復探究曾任專業護理與照護人員之回流後現況,最後提出總結與未來政策
建議。本研究發現對於母國而言,回流移工是彌足珍貴的人力資本,應全
力發展人才循環與人才回流相關計畫,以充分運用其具備的專業知識與技
能。目前雖有部分回流移工持續從事護理與照護工作,但其他多數則投身
非醫療照護產業。政府應協助他們重新適應母國社會,進而縮減人才回流
與經濟發展間的差距。
care; drugs and health equipment availability; health management in the remote, country borderline
areas and outer islands including human resources for health (HRH); and healthcare services. In the
Strategic Plan document of the Ministry of Health year 2010-2014, HRH development is one of top
eight 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 has been undergoing a process of decentralizing
many responsibilities from central ministry to the district level particularly to the Provincial and
District Health Offices. This has had implications on human resource planning and management which
include the need for accurate and timely data and information on HRH. Most of the data required for
this HRH country profile is still limited or incomplete. It has become clear that there is an urgent need
to strengthen national health information system. Some key issues in HRH information need to
address including weak coordination among stakeholder, inadequate use for decision making, various
capacity of human resources in data processing of each level and 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.
Health services are provided by both public and private institutions. In general, the ratio of health
workers per 1000 population has increased from 1,42 per 1000 population in year 2009 to 2,11 per
1000 population in year 2010. The highest number of cadre is nurses with 160,074 and the lowest
number is physiotherapist with 2,587. Imbalance distribution remains one of key issues not only
between urban and rural but also among regions in Indonesia. The highest number of health
workforces remains in Java/Bali . Migration or movement of the health workforce within and across
country has become a great attention. So far in 2009 there were approximately 2892 nurses work in
United Emirate Arab, United State of America, Saudi Arabia, Kuwait, the Netherlands, Singapore,
Japan, and Norway. Distribution of health workers based on gender is also another issue, although the
exact data is unavailable. There is a tendency of increasing female medical doctors and dentists, for
example in mid 2010 the percentage of contract female doctors was 56% while the contract female
dentists was 81%. This document failed to describe the age distribution by cadre and the public –
private distribution by cadre due to lack of data. It is estimated 60 to 70 percent of publicly employed
health worker engaged in dual practice, mainly in private practice and private facilities.
Production of health workforce has been continuously increasing from year 2004 to 2009 especially in
private health education institutions. Accreditation of health education institutions was 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
trainings.
Projection of the health workforce requirement was developed for the HRH plan, which involved
participation of stakeholders. The method used was the ratio of health workers to the certain value i.e.
the health status measured by the life expectancy target.
To improve deployment and distribution for HRH especially in remote and underserved areas, the
MoH encourage the local government to provide additional incentives, scholarship, and other facilities
such as vehicles, housing, telecommunication equipment and electricity as well as safety at workplace.
This document showed that Human Resource Information System need to be strengthened both in
local and national level.
Nurses are the frontline workers among other health workers who face the COVID-19 virus or other deadly infectious disease. Nurses directly provide essential healthcare services where they are most needed, both in hospital and community settings. Not only physical energy will be exploited, but mental sacrifices can also be affected. This phenomenon has been proven by the increase in mortality rate among nurses worldwide. The International Council of Nurses’ latest data showed that more than 1500 nurses have died from COVID-19 in 2020 (International Council of Nurses, 2020) and up to 180,000 health and care workers could have died from COVID-19 in 2021 (World Health Organization, 2021). This crisis emerged the demand for nurses who intend and are able to substitute for those who have fallen. This challenging situation leads nurses to be capable of managing the crisis and, at the same time, they can be the new leaders on the frontline.
The lesson learned that can be recorded from the COVID-19 pandemic, is that nurses as the frontline workers continue to manage a tough healthcare facilities environment in order to save many people from COVID-19. They are potential candidates being front leaders as they have had experienced treating clients and community in quite complex ways during the pandemic. Because of that, it is essential to perceive them as future leaders such as by providing greater policy support at a national level. Equal opportunity to contribute to policy making process would create a solid environment for nurses. Standardized regulation on decent job and salaries also needs to be developed in order to protect the welfare of nurses. It goes without saying that nurse’s salary in Indonesia varies across sectors, even though the nurses are often going beyond their duties, many of them have been expected to accomplish more with less appreciation. These unfair situations should be transformed into a good situation by equipping the nurses with decent salaries equal to other frontline health workers.
Talent management of nurses also needs to be developed at national level to accommodate regeneration and succession as a leader. This strategy will impact on how nurses can have the same benchmark as other health professions both regionally and nationally. A recent call from the World Health Organization (2020) mandated three pillars of essential aspects, namely, investment, education, jobs and leadership. This pandemic has opened an opportunity for nurses to move up the leadership ladder and expand the leadership position in every setting.
To sum up, we might call the frontline nurses’ personnel as heroes in the pandemic era; however, just labelling them without also considering what they have to say eliminates any chance of progress. Concrete policy implementation is crucial, investing in the education sector is inevitable, and bottom-up coordination is critical in ensuring that frontline views are heard. Regardless of whether or not things are optimal, frontline nurses show up and perform their duties as do any leader who serves and protects clients and community.
not handled properly, will lead to dangerous complications
for the patient. Health education through mobile phones can
be an intervention used to improve health services and the
management of hypertension in the community. This study
aims to synthesise research findings on the effect of mobile
phone health education interventions on hypertensive
patients.
Materials and Methods: A systematic review. Search strategy
was conducted on international journal databases, namely
Scopus, PubMed, ProQuest, Web of Science, and Science
Direct with the keywords ‘health education’, ‘mobile phone’
and ‘hypertension’. Inclusion criteria using PICOS, namely
Population: hypertensive patients, Intervention: health
education using a mobile phone, Comparation: ordinary
health education, Output: knowledge, attitudes, behaviour,
Study design: trial method. The publication year 2017-2021.
Results: There were 145 articles found in the search. Articles
were identified and screened resulting in five complete
articles that met the inclusion criteria. The results of this
study found that health education interventions via mobile
phones could increase patient knowledge about
hypertension; improve self-management; monitor blood
pressure; increase adherence to pharmacological treatment,
a hypertensive diet, i.e.,low salt intake, vegetable and fruit
intake, and physical activity; decrease blood pressure; and
improve quality of life. Health education via mobile phones
can also provide the latest information quickly to patients
about controlling hypertension, antihypertensive drugs, and
health services that can be utilised.
Conclusion: Health education interventions via mobile
phones have a significant positive effect in controlling
hypertension in the community, but it is necessary to
consider the patient's age, socioeconomic status, literacy
conditions, and ability to use mobile phones to receive the
health education that will be provided.