Improving Human Resources for Health through Online Distance Learning (ODL): Learning from East Flores Experience

The Act 36/2014 on Health Workers stipulates that the minimum level of qualification of health workers, including nurses and midwives is Ahli Madya (middle level expert) or Associate Diploma (DIII) or equivalent. In reality, however, there are more than 116,000 nurses and midwives who provide health services today with a level of education equivalent to High School diploma and Diploma I.

The major challenge of the Central and local governments is to upgrade the qualifications of nurses and midwives without them having to leave their posts at health centers, clinics, hospitals and other health services. This is so that the already limited services are not disrupted, especially for those who serve in remote areas, borders and islands (Daerah Terpencil, Perbatasan dan Kepulauan/DTPK) and areas classified as Regional with Health Problems (Daerah Bermasalah Kesehatan/DBK) as in the case of some parts of East Nusa Tenggara, Papua, West Papua and East Kalimantan.

The implementation of the Online Distance Education (ODL) program is an important breakthrough from the Ministry of Health to respond to the abovementioned issues. The ODL program is originally part of the scheme that the Ministry of Health and the District Government of East Flores developed through the Australia-Indonesia Partnership for Health Systems Strengthening (AIPHSS) in 2013.

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With the support AIPHSS, ODL has been implemented in East Flores since mid-2013 in which the Government of East Flores will see one (1) batch of nursing staff upgrade their nursing qualifications. Through the ODL program, the graduates of the Health Nursing School (Sekolah Perawat Kesehatan/SPK) are able to pursue the Diploma of Nursing without leaving their day-to-day tasks. In the first batch, there are 39 nurses who participated in the program.

The ODL program also has a learning model at the Open University. The process of teaching and learning in ODL was designed by the Health Polytechnic (Poltekes, MoH owned) in Kupang with technical assistance from the Agency for Development and Empowerment of Health Human Resource (Ministry of Health), the Directorate General of Higher Education (Ministry of Education) and AIPHSS using structured learning. This is conducted in eight sessions that are divided into 8 online tutorials/face-to-face sessions and 8 independent learning sessions for each course.

The process of developing the ODL Nursing program was simultaneously conducted with the development of ODL in Midwifery, which was implemented nation-wide, with the following stages:

  1. Development of modules;
  2. Development of Learning Systems (design) by Poltekes Kupang (technical assistance);
  3. Development of content, structure and the administering HR;
  4. Monitoring and Evaluation.

Through the ODL Program for DIII Nursing and DIII Midwifery, any local government could develop a HRH Upgrading Plan for their existing nurses and midwives to qualify as DIII Nurses and DIII Midwives – to meet the minimum requirements of HRH in Indonesia – in collaboration with the Health Polytechnic (owned by MoH) who has the license to organise this program. Upgrading is done progressively in a short time, while the Nurses and Midwives still provide services during their time of study. Meanwhile, the program also provides other positive outcomes, such as encouraging discussions among peers in the health center or hospital to discuss what is being studied in the real life context.


The East Flores government has taken some steps to ensure the sustainability of ODL following the end of AIPHSS support, namely:

  1. Accelerate the upgrading process for all Nurses and Midwives with the support of the local governments
  2. Provide funding through the local budget as a complement to the state budget funding that is provided by the Center for Training of HRH to finance DIII classes for the remaining time (following the 4 semesters that have been financed by AIPHSS).
  3. Provide funding in the 2016 budget (Rp 834.524.900), – to fully finance the ODL for Midwifery for 83 people, and also in the following years to complete the upgrading process to DIII for all Nurses and Midwives.
  4. Improve coordination with the Health Polytechnic in Kupang to maintain a seamless teaching and learning process, while maintaining the quality of graduates.

These strategies are well-defined and hopefully will be well-executed so that when AIPHSS ends, the program can be resumed by the Government of Indonesia, both at central and local level.