Interprofessional Collaborative Practice and Health Workers Retention at Remote Primary Health Care: Case Study from Nusantara Sehat Team-based Program

Prastuti Soewondo, Retno Pujisubekti, Ade Widyati Prastyani, Nurul Maretia Rahmayanti


The Nusantara Sehat Team (NST), established in 2015 and consist of multi-professional health workers, implemented to provide comprehensive services at remote primary health cares (PHCs) for two years. This study aimed to explore how the NST leverages the Interprofessional Collaboration (IPC) and its impact on the future career prospects of health workers. Using a qualitative approach, the information was gathered from 48 informants drawn from the current 30 NST recruits and 18 alumni through semi-structured interviews. Of these 48, 20 were clinical practitioners, while the rest were non-clinical health workers. The findings revealed several challenges in promoting collaborative practice, including the community's high demand for curative services, the unclear division of tasks among the NST and local PHC staff, and inadequate health facility support. The curriculum of IPC was yet to be included in the pre-service education and in-service training before NST, allowing the staff to enter the workplace and collaborate, especially in the backward areas. The institutional support through macro and meso policies has yet to enable collaborative-practice ready workers adequately. Other factors such as personal values, family expectations, gender roles, and career sustainability also affected the retention of personnel in the NST.


interprofessional collaboration, primary health care, remote area

Full Text:



 1. Bitton A, Ratcliffe HL, Veillard JH, Kress DH, Barkley S, Kimball M, et al. Primary health care as a foundation for strengthening health systems in low- and middle-income countries. Journal of General Internal Medicine. 2017; 32 (5): 566-71.

 2. Atun R, De Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. The Lancet. 2015; 385 (9974): 1230-47.

 3. Plochg T, van den Broeke JR, Kringos DS, Stronks K. Integrating primary care and public health. American Journal of Public Health. 2012; 102 (10).

 4. Veillard J, Cowling K, Bitton A, Ratcliffe H, Kimball M, Barkley S, et al. Better measurement for performance improvement in low- and middle-income countries. The Primary Health Care Performance Initiative (PHCPI) experience of conceptual framework development and indicator selection. The Milbank Quarterly. 2017; 95 (4): 836-83

 5. World Health Organization. The declaration of Alma Ata; 1978.

 6. Muldoon LK, Hogg WE, Levitt M. Primary care (PC) and primary health care (PHC): what is the difference? Canadian Journal of Public Health. 2006; 97 (5): 409-11.

 7. Labonté R, Sanders D, Packer C, Schaay N. Is the Alma Ata vision of comprehensive primary health care viable? findings from an international project. Global Health Action. 2014; 7 (1): 1-16.

 8. Ministry of Health, Republic of Indonesia. Peraturan Menteri Kesehatan nomor 43 tahun 2019 tentang pusat kesehatan masyarakat (MoH regulation about primary health care). Jakarta; 2019.

 9. Ministry of Health, Republic of Indonesia. Riset ketenagaan kesehatan nasional (National health workers survey). Jakarta; 2017.

 10. Nurcahyo H, Bachtiar A. Analysis of the problems of general practitioners distribution in community health centers (Puskesmas) in Indonesia. Advances in Health Sciences Research; 2020.

 11. Badan Penelitian dan Pengembangan Kesehatan. Laporan riset ketenagaan di bidang kesehatan (Risnakes) 2017: puskesmas; 2018.

 12. Mulvale G, Embrett M, Razavi SD. Gearing up to improve interprofessional collaboration in primary care: a systematic review and conceptual framework. BMC Family Practice. 2016; 17 (1): 1-13.

 13. Agreli HF, Peduzzi M, Bailey C. Contributions of team climate in the study of interprofessional collaboration: a conceptual analysis. Journal of Interprofessional Care. 2017; 31 (6): 679-84.

 14. World Bank. Implementation completion and result report on a loan in the amount of us$ 77.82 million to the Republic of Indonesia for a health professional education quality project (HPEQ). Jakarta: Health, Nutrition and Population Global Practice Indonesia Country Management Unit East Asia and Pacific Region; 2015.

 15. Ministry of Health, Republic of Indonesia. Keputusan Menteri Kesehatan Republik Indonesia nomor 484 tahun 2017 tentang besaran penghasilan penugasan khusus tenaga kesehatan dalam mendukung program nusantara sehat (MoH decree about NST wage standard). Jakarta; 2017.

 16. Belaid L, Dagenais C, Moha M, Ridde V. Understanding the factors affecting the attraction and retention of health professionals in rural and remote areas: a mixed-method study in Niger. Human Resources for Health. 2017; 15 (1): 1-11.

 17. Abdulraheem BI, Olapipo AR, Amodu MO. Primary health care services in Nigeria: critical issues and strategies for enhancing the use by the rural communities. Journal of Public Health and Epidemiology. 2012; 4 (1): 5-13.

 18. Barrett A, Terry DR, Le Q, Hoang H. Rural community nurses: insights into health workforce and health service needs. International Journal of Health, Wellness and Society. 2015; 5 (3): 109-20.

 19. Ojakaa D, Olango S, Jarvis J. 2014. Factors affecting motivation and retention of primary health care workers in three disparate regions in Kenya. Human resources for Health. 2014; 12 (1): 1-13.



  • There are currently no refbacks.