After earning a medical degree from a prominent private university in Jakarta, Marietha Laetitia Du’a Weni decided to return to her remote, malnutrition-plagued hometown of Waipare, on Flores Island in East Nusa Tenggara, instead of pursuing a career in the big city.
“I just felt the need to go back and serve my community,” Weni, as she is known, told the Jakarta Globe on Tuesday.
Weni admitted that most of her doctor friends preferred the better incomes and the higher quality of life big cities offered to the burdens of working in far-flung districts like Sikka, where even basics like transportation were elusive.
The Waipare clinic serves patients from 24 villages across the subdistricts of Kangae, Kewapante and Hewokloang, all far from Waipare.
“It’s not just about being from this area. I would work in any rural area in Indonesia,” she said. “That’s our duty as doctors.”
Weni is the exception that confirms the rule — most health workers, including doctors, nurses and midwives, are reluctant to serve in rural areas.
In the 2010 World Health Report, Indonesia was named as one of 56 countries with the most severe shortages of health workers.
According to the report, Indonesia only has one doctor and eight nurses (or midwives) for every 10,000 people, a figure worse than countries like Uganda and East Timor, which both have one doctor and 13 nurses for every 10,000 people.
Mubashar Sheikh, executive director of Global Health Workforce Alliance, said that globally the world was short more than four million health workers, causing nearly a billion people worldwide to be without access to proper health care services.
In a country like Indonesia, the problem is not only about the limited number of health workers, but also their uneven distribution, Mubashar said.
“We produce enough health workers here but we don’t have the capacity to absorb them, and in the end many prefer to try their luck overseas,” he said, adding that those who stayed preferred the big cities because there was not enough money in rural areas.
Adang Bachtiar, the director of the Center for Health Administration and Studies of Faculty of Public Health at the University of Indonesia, said that many health workers refused to be placed in rural areas fearing that they would not get any professional development.
Many specialists, he added, are also concerned about work facilities in rural areas.
He said eastern Indonesia, border areas and small islands were the areas most lacking in health workers.
Mubashar said that to retain health workers in the country, especially in rural areas, the government needed to create good working environments.
“How can we expect female health workers, nurses or midwives to work in rural areas if we don’t provide them with the right environment, good housing, good education for their children and good money,” he said.
Adang said education and training standards were an issue.
“While the number of new medical schools is growing rapidly, we have no national standards governing the quality of their graduates,” he said.
The resulting uneven standards, he said, pose a whole new problem. “The quality of health workers produced in major cities is higher than those graduating in regional cities.”
He said that while the number of health education institutions was more than adequate — 70 medical schools, 156 public health school, more than 400 nursing schools and about 700 academies for midwives — “no one can guarantee that the quality of education in each school is at least similar.”
Additional reporting by Camelia Pasandaran