The Minister of Health Regulation No. 33 Year 2015: The Key of Inter Sector and Inter Level Harmonisation and Synchronisation for Human Resources for Health (HRH) Planning

The Minister of Health Regulation (Permenkes) No. 33 Year 2015 on the Guideline of Planning for Human Resources for Health for national, provincial and district / city level is the response of the Ministry of Health of the Republic of Indonesia to the complexity of human resources for health (HRH) planning and development, and to ensure that the plans for HRH are precise and according to the needs at each level of services in terms of quantity, type, quality, qualification and distribution. To fulfil this need, the purpose of the Minister of Health Regulation (Permenkes) No. 33/2015 is:

1). Strengthening the Synergy/Harmonisation of policies between inter-Ministries, inter related agencies, and inter-Government level

The Minister of Health Regulation (Permenkes) No. 33/2015 is a refinement of the Minister of Health Decree (Kepmenkes) No. 81 year 2004 that is no longer relevant due to changes in policy, especially with the enactment of Act No. 23 year 2014 on Regional Government and Act No. 36 year 2014 on Health Workers. Enforcement of these Acts requires an adjustment in the Minister of Health Decree No. 81 year 2004:

  • To overcome internal constraints in the Ministry of Health related to the capacity of planning at the local level, HRH information management systems and integration among stakeholders, and policy support at the local level related to the HRH planning;
  • To overcome external constraints related to policy differences among several ministries and related institutions (Ministry of Home Affairs, Ministry of State Apparatus Empowerment/Pendayagunaan Aparatur Negara (PAN) and State Civil Service Agency/Badan Kepegawaian Negara (BKN)) regarding the systems, methods and elements in calculating human resource needs.

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In order to create harmony between these policies, the Minister of Health Regulation (Permenkes) No. 33/2015 applies two methods in planning for HRH needs, namely:

  • Method by institution. For Annual Planning, it uses Workload Analysis (Analisis Beban Kerja/ABK) for Health, and Minimum Workforce Standards;
  • Method by territories. For medium-term planning, it uses the ratio of health workers compared to the population.

By incorporating both methods, the synergy / harmonisation of policies between relevant ministries and institutions, and among different levels of government, is attainable.

Currently, the trial for implementing the Minister of Health Regulation (Permenkes) No. 33/2015 has been completed in two provinces within the Australia Indonesia Partnership Program for Health Systems Strengthening (AIPHSS) framework, namely the East Java province and East Nusa Tenggara province. In 2016, the Ministry of Health will conduct debriefing sessions for facilitators at the central level using the state budget. Next, it will be disseminated at the provincial level and is expected to be disseminated further to District / City using the ‘deconcentration’ fund.

2). Provide the formulation of planning HRH needs at the central, provincial and district / city level

This guideline acts as a reference for those having the responsibility and authority in the management of HRH at central and regional levels in the preparation of planning HRH needs. As a guide, the Regulation sets out:

  • The team of the HRH planner.  A team for coordination and facilitation of health workers is established at all levels (district / city, province and central) led by the Health Office.
  • Method for planning HRH needs is divided into two, namely: i). Institution-based, using ABK methods and Minimal Workforce Standards Method as set by Permenkes No. 75/2014; Permenkes No. 56/2015, and Permenkes No. 340/2010; ii). Based on the region, using the method of population ratio, i.e. the ratio of health personnel to population in a particular area;
  • Approach. The process of planning the needs of human resources for health, using two approaches at the same time namely the Top-Up Planning and Bottom-Up Planning. The Top-Up Planning approach is used for matters related to policy, facilitation, advocacy and methods. While the Bottom-Up Planning approach is used for the HRH planning, tiered recapitulation, and to evaluate the results of recapitulation and HRH needs;
  • Stages and processes  in HRH needs planning. This explains the stages of processes and mechanisms to be followed in each of the approaches (Top-Up Planning and Bottom-Up Planning).

There is a fundamental lesson learned from the implementation of the Minister of Health Regulation (Permenkes) No. 33/2015 and the application of the HRH planning method in the East Java province and NTT province. There is an emerging need for greater coordination and synergy between the Centre – Regional, cross-sector and cross-program actors, to meet the needs of each level of government in terms of human resources for health.

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