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Underpaid doctors, underserviced health
The maldistribution of health workers is a chronic problem in Indonesia
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span>The maldistribution of health workers is a chronic problem in Indonesia. Many public health centers lack doctors while the incentive system to attract health workers to remote areas is still lacking.
When presidential candidate Prabowo Subianto expressed concern for physicians who are paid less than parking officers, his audience went wild. Is the opinion valid? We were reminded of this disturbing question during the commemoration of World Health Day on April 7.
Parking officers in the capital are paid according to the regional minimum wage, which is Rp 3.6 million (US$254.33) but this will reportedly increase to Rp 3.9 million this year.
The Health Ministry claimed doctors who joined the Nusantara Sehat (Healthy Indonesia) program to strengthen primary health services are paid Rp 11.2 million monthly. However, the program involves only a small number of doctors.
The latest survey by Junior Doctor Network Indonesia shows 5.5 percent of general practitioners are paid the Indonesia Medical Association’s recommendation of Rp 12.5 million for a 40 hour working week.
However, this recommendation means virtually nothing in the absence of regulations.
Every doctor is entitled to work at three medical facilities; many indeed need to work in two or three places to earn a sufficient income.
A survey on doctors showed that almost a quarter of the 452 respondents were paid less than Rp 4 million while working a 40 hour week in one clinic or hospital. Even when working at two or three places, we still have one-tenth of doctors paid less than parking officers.
Underpaid doctors are found all around Indonesia, including Jakarta and West Java.
In cities there are more graduates of medicine than available job opportunities. This supply and demand imbalance is exploited by clinics and hospitals to hire doctors as cheaply as possible to maximize profits.
In rural or remote settings, income and incentives to attract physicians are grossly lacking, hence doctors are not willing to trade urban infrastructure and facilities to work in more rural environments for little pay.
Moreover, many doctors complain about a lack of incentive transparency, saying they are paid much less than what was promised.
Low salaries lead to doctors working in two or three places, accumulating a 66-hour average working week, according to the Junior Doctor Network Indonesia survey.
The expense of specialist tuition fees and social pressure has resulted in doctors working excessive hours — leading to stress, burnout, anxiety and depression among physicians — not to mention the increasing risk of malpractice or other errors.
Every professional should be paid proportionally, especially for work related to health. The absence of regulations on incentives and limits on working hours is detrimental to the profession and patients because it results in suboptimal services.
Physicians’ low wages are the result of systemic errors among relevant institutions. Government calculations regarding financial disbursements through the Health Care and Social Security Agency are lower than real costs. As a result, hospitals, health centers and clinics use the minimum wage to maintain profits.
There are several alternatives that the government can adopt. The first is to raise the status of doctors.
Local governments can appoint honorary and new doctors as civil servants and provide them with proper incentives in accordance with the remoteness of the workplace. Better incentives will attract doctors to rural areas, resulting in a more even distribution and balanced demand and supply in big cities.
Alternatively, the Health Ministry together with the Manpower Ministry can issue regulations to standardize wages and working hours. Health facilities that do not meet standards should be subject to penalties.
The problem of physicians’ distribution must be resolved by the government. Access to health services is a right for all people.
The 2019 general elections are a window of opportunity to reform health services. Both presidential candidates need to prepare health service designs that prioritize equity.
Whoever is elected, we need to remind him that health is the right of all that the government is obliged to fulfill.
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The writer, a medical doctor and graduate from the University of Indonesia, previously worked in West Papua and Jakarta. He is now working under the USAID-LINKAGES project and is a policy analyst with the Junior Doctor Network Indonesia.
