Indonesia has implemented decentralization policy since year 2002 and this has introduced tremendous changes to the health sector. Although the decentralization comes with good intention to increase the efficiency of the health system, it faces challenges in this country which wealth is not distributed equitably.
The Ministry of Health has anticipated such a danger of neglected public health services, undertaking regulation measures such as issuing minimum health care/service functions to be delivered by local governments. In practice, most local governments have difficulties in fulfilling the minimum functions due to lack of financial and human resources. High disparity in fiscal capacity across regions and a severe shortage of good health personnel, who have moved to the central government offices, have made the risks of worsening health status inevitable.
In the meantime, the severe shortage and huge gaps between the present and estimated supply of human resources (as measured by conservative population ratios) have been coupled with the sprouting of multiple education institutions throughout the country. The sudden increase in the number of education institutions trying to meet the expected demand poses other threats related to quality and equity of health care across the regions. It is argued that increasing supply of health personnel produced by the rapid increase of educational institutions, coupled with the restricted market option that is dominant in Indonesia, will deepen inequity across regions. In addition, non-existence of comprehensive national public health law may add uncertainties in improving the health status of the people of Indonesia. To address the urgent public health problems, the Ministry of Health has introduced “Vigilant Village“, aimed at expanding health promotion, ensuring disease prevention and providing simple medical care for villagers. Serious policy debates with evidence-based information on the future scenario of human resources for health in decentralized health systems in Indonesia are the needs of the hour.