e-ISSN 2598-3849       print ISSN 2527-8878

Vol 3, No 2 (2018)

Health Workforce Assessment in Jakarta for Effective HIV Policy Implementation: Challenges and Opportunities toward Epidemic Control

Rachel Hoy Deussom, Elisabeth Rottach, Ciptasari Prabawanti, Edhie Rahmat, Tetty Rachmawati, Nanda Sirajulmunir


Abstract Strategic efforts are needed in Indonesia to implement the recently released human immunodeficiency virus (HIV) Test and Treat policy which promotes increased treatment uptake, known to have important economic benefits. Of Indonesia’s estimated 631,635 people living with HIV (PLHIV) in 2018, only 12% are on treatment. The USAID- and PEPFAR-funded Human Resources for Health in 2030 (HRH2030) Program undertook policy analysis and assessed the available health workforce and service delivery at select sites in Jakarta to identify and anticipate Test and Treat implementation gaps. A mixed methods concurrent triangulation design was used, including policy analysis, key informant interviews, and site-level tools to capture workforce availability, skills, quality, and performance. Results indicate priorities to: define and implement HIV standards of practice for the Test and Treat policy; improve relevance and coordination of pre-service and in-service training programs; and support managers to optimize task and workforce allocation, including allocating lower-skilled workers to routine testing. Additional site-level data are needed from rural and remote sites in Indonesia, where fewer health workers are distributed. Efficiencies can help sustain HIV programs and contribute to epidemic control.Abstrak Upaya strategis dibutuhkan Indonesia untuk implementasi kebijakan Pemeriksaan dan Pengobatan (Test and Treat) HIV, seperti yang diterbitkan oleh USAID dan PEPFAR. Kebijakan ini mendorong peningkatan cakupan pengobatan yangd diyakini penting secara ekonomi. Diperkirakan pada tahun 2018 terdapat 631,635 ODHA di Indonesia dan hanya 12% yang menjalani pengobatan. Program HRH2030 yang didanai oleh USAID dan PEPFAR melakukan analisis kebijakan dan penilaian ketersediaan tenaga kesehatan dan pelayanan HIV di beberapa unit layanan di Jakarta, untuk mengidentifikasi dan mengantisipasi kesenjangan implementasi kebijakan. Kajian menggunakan metode campuran dengan melakukan analisis kebijakan, wawancara informan kunci, dan serangkaian alat asesmen tingkat unit layanan untuk menangkap informasi terkait ketersediaan, keterampilan, kualitas, dan kinerja tenaga kesehatan. Hasil kajian ini memprioritaskan adanya penetapan dan penerapan standar praktik layanan HIV yang sesuai dengan kebijakan Pemeriksaan dan Pengobatan. Peningkatan koordinasi program pendidikan pra-layanan dan pelatihan dalam jabatan dan dukungan kepada manajer unit layanan untuk mengoptimalkan alokasi tugas dan tenaga kesehatan menjadi hal yang penting. Pendekatan ini diharapkan dapat meningkatkan efisiensi layanan dan keberlanjutan program HIV. Data dan informasi tingkat unit layanan dibutuhkan, khususnya dari wilayah pedesaan dan terpencil. 


human resources for health; health workforce; HIV/AIDS; policy implementation; workforce management


(1) Bhuyan, A., A. Jorgensen, and S. Sharma. 2010. Tak-ing the Pulse of Policy: The Policy Implementa-tion Assessment Tool. Washington, DC: Futures Group, Health Policy Initiative, Task Order 1. http://www.healthpolicyplus.com/archive/ns/pubs/hpi/1155_1_PIAT_Paper_Taking_the_Pulse_of_Policy_acc.pdf

(2) Government of Indonesia (GOI). 2004. Law of Medical Practices 29/2004.

(3) GOI. 2009. Law on Health 36/2009.

(4) GOI. 2014a. Law on Nursing 38/2014.

(5) GOI. 2014b. Law on Health Workers 36/2014.

(6) Grimsrud A., H. Bygrave, M. Doherty, P. Ehrenkranz, T. Ellman, R. Ferris, N. Ford, B. Killingo, L. Mabote, T. Mansell, A. Reinisch, I. Zulu and L.-G. Bekker. 2016. Reimagining HIV service delivery: the role of differentiated care from prevention to suppression. J Int AIDS Soc. 2016; 19(1)

(7) HRH2030 Program. 2018a. Toolkit: Optimizing Health Worker Performance and Productivity to Achieve the 95-95-95 Targets. Washington, DC: University Research Company, LLC (URC) and Chemonics International, HRH2030 Program. https://hrh2030program.org/prodperftoolkit/

(8) HRH2030 Program. 2018b. Indonesia HIV and Human Resources for Health Assessment: Rec-ommendations for Implementing and Scaling Up the Test and Treat Policy. Washington, DC: Che-monics International and The Palladium Group, HRH2030 Program. https://hrh2030program. org/indonesia-hiv-and-human-resources-for-health-hrh-assessment-recommendations-for-im-plementing-and-scaling-up-the-test-and-treat-policy/

(9) Hull M., and J.S.G. Montaner. 2013. HIV treatment as prevention: the key to an AIDS-free generation. J Food Drug Anal. 2013 Dec; 21(4): S95–S101.

(10) Indonesian Medical Council. 2012. Competence Standards for Medical Doctors.

(11) Indonesian Nurses Association. 2013. Competence Standards for Nurses

(12) International Association of Providers of AIDS Care (IAPAC). No date. http://www.fast-trackcities. org/cities/jakarta

(13) Januraga P.P., J. Reekie, T. Mulyani, B.W. Lestari, S. Iskandar, R. Wisaksana, N.A. Kusmayanti, et al. 2018. The cascade of HIV care among key pop-ulations in Indonesia: a prospective cohort study. Lancet HIV. 2018 Oct;5(10):e560-e568.

(14) Jaskiewicz W., V. Oketcho, D. Settle, D. Frymus, F. Ntalazi, I. Ezati, and K. Tulenko. 2016. Investing in the health workforce to increase access to and use of HIV and AIDS services in Uganda. AIDS. 2016 Aug 24; 30(13): N21–N25.

(15) Mahendradhata Y., L. Trisnantoro, S. Listyadewi, P. Soewondo, T. Marthias, P. Harimurti, and J. Prawira. 2017. The Republic of Indonesia Health System Review. Eds. K. Hort and W. Patcharana-rumoi. Asia Pacific Observatory on Health Sys-tems and Policies. Volume 7, No. 1 2017.

(16) Ministry of Health. 2007. Midwifery Professional Standard 369/MENKES/SK/III/2007.

(17) Ministry of Health. 2013. Regulation on Health Work-er Registration 46/2013.

(18) Ministry of Health. 2014. Guidelines for Anti-retrovi-ral Treatment 87/2014.

(19) Ministry of Health. 2016. Estimates and projection of HIV/AIDS in Indonesia 2015-2020. Director-ate General of Disease Prevention and Control. Ja-karta, Indonesia: Ministry of Health, Government of Indonesia. http://siha.depkes.go.id/portal/files_ upload/ESTIMATES_AND_PROJECTION_OF_ HIVAIDS_IN_INDONESIA_2015___2020.pdf

(20) Ministry of Health. 2018. Letter HK.02.02/1/1564/2018.

(21) Rutherford G.W., and A. Anglemayer. 2016. Initiat-ing antiretroviral therapy in HIV-infected patients with >500 CD4 cells/µL provides more benefit than delaying treatment. Evid Based Med. 2016 Feb;21(1):26.

(22) Sousa A., R.M. Scheffler, J. Nyoni, and T. Boerma. 2013. A comprehensive health labour market framework for universal health coverage. Gene-va, Switzerland: The World Health Organization. Bulletin of the World Health Organization 2013; 91:892-894.

(23) Thirumurthy H., O. Galárraga, B. Larson, and S. Ros-en. 2012. HIV treatment procuded economics re-turns through increased work and education, and warrants continued US support. Health Aff (Mill-wood). 2012 Jul; 31(7): 1470–1477.

(24) World Health Organization (WHO), United States President’s Emergency Program for AIDS Relief (PEPFAR), and the Joint United Nations Pro-gramme on HIV/AIDS (UNAIDS). 2008. Task shifting : rational redistribution of tasks among health workforce teams : global recommenda-tions and guidelines. Geneva, Switzerland: WHO. Available at: https://www.who.int/healthsystems/ TTR-TaskShifting.pdf

(25) WHO, International Labor Organization (ILO) and the Organization for Economic Co-operation and Development (OECD). 2015. Working for health and growth: investing in the health workforce. Report of the High-Level Commission on Health Employment and Economic Growth. Geneva, Switzerland: WHO. https://apps.who.int/iris/bit-stream/handle/10665/250047/9789241511308-eng.pdf?sequence=1

Full Text: PDF

DOI: 10.7454/eki.v3i2.2790


  • There are currently no refbacks.