A National Analysis of the Pharmaceutical Workforce in Indonesia | Human resources for health

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Evidence from this study indicated an upward trend in the number of pharmacists in Indonesia. Although there has been an upward trend, the density of pharmacists is significantly low (2.85 pharmacists per 10,000 inhabitants) compared to the world arithmetic average in 2016 (7.36 pharmacists per 10,000 inhabitants) [12]. This may indicate suboptimal population access to pharmaceutical care services in Indonesia (mainly in primary health care settings). Additionally, the size of pharmacist capacity obtained from this study might not represent the active workforce that provides pharmaceutical care to the population – working within the framework of patient care. This study used pharmacist registration number data, in which the data covers various practice sectors that pharmacists may work in, such as industry, wholesale, government and regulatory sectors, in addition to work in patient care facilities. Further study of active pharmacy workforce identification and attrition pattern analysis is needed to understand a national picture of pharmaceutical access to the population.

The availability of the number of initial pharmacy education and training programs in higher education and the number of students per program has increased. This not only indicated market growth and opportunities for the pharmacy education sector, but also an effort to increase the number of pharmacists in Indonesia. This could have resulted from the strategies of the Ministry of Health of Indonesia to strengthen the HRH by improving the production of the HRH, including the pharmacy workforce [23, 24, 34]. With an upward trend in supply leading to an increase in the number of registered pharmacists, this could suggest that the gap between supply and demand is narrowing. However, not all registered pharmacists will be an active workforce providing pharmaceutical care to the population. It is also important to investigate the main inflows and outflows of the workforce to get a complete analysis of the pharmacy workforce. The main inputs are: registration of new graduates, immigration and return to work after inactivity; the main exits are retirement, emigration, career break and death in service [35]. In this study, the researcher only analyzed the enrollment of new graduates. There was no information on immigration, return to work, emigration, career break, retirement, or death specific to pharmacy staff. It is important to have this data to understand supply and productivity. Further research is also needed to understand how supply has met demand.

This study found that there was a variety of access to pharmacy programs across the islands. Unequal access could contribute to the unequal distribution of pharmacists. This study found a strong positive correlation between access to pharmacy programs and access to the pharmacy workforce, indicating a possibility that the location of pharmacy schools may influence where students/ graduates were based and seeking employment. In Indonesia, the Indonesian University of Depok and Padjajaran University in Jatinagor, West Java, are examples of successful higher education institutions that draw migrants away from urban areas. [36]. This study supports evidence from previous research conducted in other countries, which found that rural health faculties and schools provide a majority of graduates to the local rural health workforce. [37, 38]. Similarly, graduates from urban settings were more likely to stay and work in those urban settings. [37, 38]. WHO has recommended further studies to explore the effects of locating schools and programs outside of urban areas on subsequent employment [39].

This study showed that there is an imbalance in the distribution of pharmaceutical manpower among the islands of Indonesia. This finding seems consistent with other research that has found an unequal distribution of mixed health personnel between rural and urban areas in Indonesia. [40,41,42]. A survey conducted in 2011 revealed variations between the islands ranging from 23.2 to 51.5% of community health centers did not have pharmacists and pharmaceutical support staff to provide pharmaceutical care and expertise in medicines, especially in the region of eastern Indonesia. [43]. The uneven distribution and unavailability of pharmaceutical personnel illustrates that accessibility to medicine expertise, in the face of increasing medicine use in an aging comorbid population, can have implications for universal health coverage and support. to suboptimal primary health care. The pattern of having a higher labor density in the capital is also typical of other low and lower middle income countries [44,45,46]. The reasons for this urban imbalance could be family and social relationships, working and living conditions, career opportunities and financial incentives [47]. In Indonesia, this trend is also seen among other health professionals. A 2019 analysis of the general mixed distribution of health workers (doctors, nurses and midwives) using the Gini index in Indonesia found that the number of doctors and nurses was concentrated in the capital. provinces or other major cities in the province [48]. Since 2015, the Ministry of Health of Indonesia has formulated Nusantara Sehat special recruitment program to recruit health workers, including pharmacists, to work in community health centers in remote areas [49]. Evidence from this study suggests the need for more policies and strategies that would facilitate recruitment and retention of the pharmacy workforce in rural and remote areas.

An increase in the graduation rate of pharmacists (channeling supply) has resulted in a surge of young pharmacists aged 23-37. This situation suggests the need to develop a structured post-graduate basic training to better support pharmacists at the start of their career. The establishment of a structured basic education will help pharmacists at the start of their career progress to advanced practice, and opportunities for dialogue with peers and preceptors are essential to ensure their preparation for practice. Opportunities for pharmacists have increased, given the growing role of pharmacists as drug experts and population health challenges, for example, the aging population; therefore, the existing workforce needs to develop their advanced training skills to be more flexible and adaptable to meet the growing demands and challenges of healthcare. It is highly recommended that a program be developed to help pharmacists develop their advanced practice skills. Additionally, education and training opportunities and workforce support were found to be associated with job satisfaction for early career pharmacists, and job dissatisfaction was found to be linked to a higher attrition rate. [50]. Therefore, providing formal training and advanced training opportunities to support early career pharmacists could have an impact on increasing workforce retention.

Similar to global pharmaceutical workforce trends, this study revealed more female (77.8%) than male pharmacists in Indonesia and an upward trend was predicted. Women in the pharmaceutical workforce generally have more career breaks than men and the high proportion of female pharmacists with family responsibilities, and increasingly earlier retirement ages, are factors that need to be addressed. considered more urgently for workforce planning. [10]. In 2019, the overall labor force participation rate for women aged 15-64 in Indonesia was 56%, significantly lower than 84% for men [51]. Indonesia’s Ministry of Manpower has called for flexible working conditions for women to increase this participation rate [52, 53]. It is essential to develop a professional development system for practitioners, allowing flexibility in professional development to facilitate their return after a career break. This study also observed a lower license renewal rate for female pharmacists. This indicates that “back to work” policies need to be further promoted in Indonesia.

Another important finding from this study is that young pharmacists tend to work in the wholesale industry after graduation more than in other areas of practice. They may be more attracted to work in the wholesale sector, which may be linked to higher compensation for pharmacists at the start of their careers [54,55,56]. It may also be due to a recent expansion of industrial markets in Indonesia, which may attract newer graduates to pursue more opportunities. A greater number of older pharmacists worked in government institutions and industrial settings, which may reflect a more static labor market and more opportunities in these sectors, tending to retain existing employees (and therefore aging strata because they stay in their jobs longer).

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