How to Attract Doctors to Work in Remote Area of Indonesia

We have very much know that fact that most of the doctors and specialists prefer to work in the urban area, especially in Jakarta. There is higher salary (if working in private hospitals) and better lifestyle (more entertainment like shopping mall in the cities). Although money may be the big magnet that influence the distribution of doctors, I believe that there are still other values and motivation that the doctors uphold when they register their name for the medical schools.

If one day you are in the position to decide on national health policy, what would you do to bring more doctors to the remote area? Things could be easier if Indonesia is a communist state or ruled by a dictator. The unchallenged health authority just have to issue the command. 

“Doctor X, you go area no 1. Doctor Y, you go area no 2. Doctor Z, you go area no 3. You will be stationed there for 2 years, then we will rotate again”

“Yes, Sir !”

Swift and easy. No questions asked. No protest. Everybody has equal pay. No excuse.

Too bad this is not the situation. Indonesia is a democratic country with decentralization policy. Local government has autonomy in deciding health policy. There is a total mess in coordinating the distribution of doctors. Nobody can stop the flow – the flow of doctors to urban cities!

After listening to lecture by dr. Andreasta Meliala about motivation, I would like to attempt to solve this problem utilizing the motivation theory. I will first introduce about the theory, then state my application of that theory.

Instrumentality Theory

It assumes that people only work for money. People will be motivated to work if monetary rewards and penalties are tied directly to the performance.

My suggestion: Increase the salary of doctors working in the remote area to the comparable amount in the city. Currently the salary of 2 million rupiah (200 USD)per month is too little comparable to 20-100 million rupiah (2000-10000 USD) in the cities. Give other forms of incentive like vocation package and tax reduction.

Needs Theory

It assumes that all behaviours are motivated by unsatisfied needs that creates disequilibrium.

My suggestion: I think some religious people has more desire to do good deeds than others, having a stronger need to leave an impact in the society. A common approach I notice used by my lecturers is this “Kalao bekerja di remote area, kekayaan yang dikumpuli itu bukan duniawi, tetapi surgai !”. This means “if you are willing to work in remote area, the wealth that you accumulate is not on earth, but in heaven! ”. Sounds appealing to me. Not all doctors working in remote area will go heaven, but at least the direction is right.

Expectancy Theory

Motivation is likely only when a clearly perceived relationship exist between performance and outcome, and satisfies the need.

My suggestion: Prioritize the specialization opportunity to the doctors who are willing to work in the remote area. Let them sign the service contract with the local government. Give them a mind set that working in remote area is a faster pathway to become a specialist.

Equity Theory

Motivation will be enhanced if people think they are being treated fairly.

My suggestion: Create upgrading opportunities for the doctors working in remote area. Provide seminars and updated health information so that doctors will feel that they have the same opportunity to deepen their knowledge compared to city doctor. Install telecommunication infrastructure such as the internet.

Role Model Theory

Motivation is enhanced by high-performing role model.

My suggestion: Give award to doctors working in remote area who has contributed a lot to the local community. Offer these good doctors a chance to be in the leadership position in the Ministry of Health. Perform branding on the good doctors and publicize their good deeds. This may attract the young graduates to follow the role model’s footstep to work in remote area.

These are some of my suggestion to attract doctors to work in remote area. I personally think Instrumentality Theory will be more effective compared to the rest. But who is gonna pay for it?

Reference: dr. Andreasta Meliala’s lecture on Motivation

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