Ferry Efendi

IJEPA Gray Area for Health Policy and International Nurse Migration

Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country’s adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country’s own participation in a bilateral trade and investment agreement, known as the Indonesia–Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia–Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia–Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia–Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.

Monitoring the implementation of the WHO Global Code of Practice on the international recruitment of health personnel: the case of Indonesia

Background Indonesia has become one of the international nurse migration players that has supported the Code that was endorsed by the World Health Assembly, year 2010. In reference to the Code, the Minister of Health (MoH) as designated by the national authority, issued the regulation on the management of Indonesian nurses’ migration. This study aimed to monitor the implementation of the Code on state policy changing in facilitating nurse migration. Go to: Materials and methods Qualitative and quantitative data were collected in order to understand the impact of the Code on Indonesian nurse migration. A triangulation approach was achieved through semi-structured interviews with key stakeholders, and records review of nurses’ migration in the last two years. Go to: Results The Global Code of Practice contributed to shape the migration policy at the national level. This regulation provided a shift change of migration policy, which can be conducted by a country that had an agreement with Indonesia or a country that had a law on migrant protection. Acknowledging the importance of the Code, the MoH translated the Code into Indonesian, and disseminated the material to multiple stakeholders. By the spirit of this Code, Indonesia received financial and technical cooperation and agreement with Japan on the improvement of nursing capacity. The challenge faced by the MoH was a need for strong regulation which could accommodate the relevant players to coordinate on the national level, notably for the MoH, National Board for The Placement and Protection of Indonesia Manpower, Ministry of Foreign Affairs and private recruiters. Quantitative data showed that there was a significant flow of nurse migration, especially on nurses’ movement before and after the code was adopted. Nurse migration was increased four-fold between 2010 (567 nurses) to 2012 (2512 nurses) compared to three years before the Code was adopted. Indonesia’s government should carefully assess the flow of migration as the country has suffered a shortage of nurses. Lack of HRH information system and no integrated national HRH observatory hinder the policy maker to promote a strategic approach in nurse migration. Go to: Conclusions The Code has been utilized by the Ministry of Health to manage migration. This guideline at the least provides direction that may be used where appropriate in the formulation and implementation of nurse migration. A stronger regulation which not only ties the MoH, but also other stakeholders in health migrant placement needs to be established. Further, strengthening HRH information system and research on the impact of migration on Indonesia’s health system must be conducted soon.

Lived experience of Indonesian nurses in Japan: A phenomenological study.

AIM The movement of Indonesian nurses via a bilateral agreement with Japan has led to a substantial number of migrants to work as nurses in that nations healthcare system. The purpose of this research was to develop a deeper understanding of the meaningful experiences of Indonesian nurses while working in Japanese hospitals. METHODS In this phenomenological study, sampling was purposive and was based on information shared by five Indonesian nurses. The data were collected in interviews; the analysis was thematic. RESULTS Six key themes were identified: (i) seeking better than before; (ii) communication challenges; (iii) the nursing examination as a culmination; (iv) differences in nursing practice; (v) cultural differences; and (vi) the benefits of living in developed country. Among these challenges, communication as the basis of shared meaning and understanding was viewed as a complex issue, by both patients and coworkers. CONCLUSION The results of this study call for further intervention in supporting Indonesian nurses living in Japan in their struggle with the issue of communication. The emphasis on language acquisition for personal and professional objectives, and the bridging of cultural differences as well, should be considered in an international context.

Retaining and motivating health workers in very remote areas of Indonesia, do they respond to incentives?

Adequate Human Resources for Health (HRH) are crucial to the delivery of health care services in very remote areas of Indonesia. However, very remote areas suffer shortages in terms the number, type and quality of staff. This situation must be addressed through innovative policy, planning and implementation, such as incentives for retaining and motivating health workers. This paper aims to assess the application of an incentive scheme based on working location. The role of decentralized local government on incentives given to health workers also will be discussed. A desk study was performed from a relevant published materials, MoH database and online literature. The document highlights the importance of financial and non financial incentives. However, financial incentives alone are insufficient to retain and motivate the health workforce. Incentive systems must be integrated within the health system, in line with the goal and objective of Indonesia’s health development. The role of local leadership under decentralization is also crucial to motivate and maintain staff in the workplace. Different incentives between contracted and permanent staff in very remote areas must be established to ensure sustainability of the program.

Factors influencing Indonesian women's use of maternal health care services

ABSTRACT Employing the 2012 Indonesia Demographic and Health Survey data, we aimed to examine factors influencing married women to use maternity services. Data of married women who had given birth in the last five years before the survey were included in the analysis (n = 14,672). Factors of education, employment, womens age at first marriage, age at first birth, spousal education difference, contraceptive use, place of residence, and womans attitude toward wife beating were associated with the use of antenatal care, institutional delivery, and postnatal care services. The likelihood of women using those recommended maternal health care services increased along with the increased educational attainment among women and their spouses, and the older age at first birth. Higher schooling years may contribute to improving adequate maternal health care. Community awareness on maternal health issues should be promoted and include the prevention of early marriage, teenage pregnancies, and domestic violence.

Nursing qualification and workforce for the Association of Southeast Asian Nations Economic Community

International nurse migration among Association of Southeast Asian Nations (ASEAN) countries has the potential to increase the effectiveness of health services and access for the ASEAN Economic Community. Providing equivalent nursing qualifications and licensure standards and increasing the availability of the nursing workforce has become a challenge for ASEAN members. The purpose of this study is: 1) to comparatively analyze information on nursing licensing examinations (NLE) across ASEAN countries; and 2) to present information on the human resources required for a successful nursing workforce. This study reviews all documents published on the subject within the ASEAN Economic Community. NLE systems exist in all ASEAN Member States (AMSs)s except Brunei, Vietnam, and Lao PDR. Nursing education systems also vary across ASEAN countries. Language as a means of general communication and nursing examinations also differs. The availability of a qualified health workforce at the regional level is above the threshold in some areas. However, at the national level, Indonesia, Myanmar, Cambodia, and Lao PDR fall below the threshold. Professional licensure requirements differ among ASEAN nurses as a part of the process to become a qualified nurse in host and source countries. Mutual Recognition Agreements on nursing services should address the differences in NLE requirements as well as the availability of nurses.

Self-care model application to improve self-care agency, self-care activities, and quality of life in patients with systemic lupus erythematosus

Objectives This study aimed to examine the effect of the application of a self-care model to improve self-care agency (SCA), self-care operation, and quality of life (QoL) in patients with systemic lupus erythematosus (SLE). Methods This study employed a pre-experimental design with one pretest-posttest group. Thirty-six respondents were selected through total sampling. The experimental group was provided self-care management training, followed by four weekly home visits. Self-care agency was measured with the self-care agency scale, the other variables through self-rated abilities on the health practices scale and Lupus quality inventory. Data were analysed using paired t-tests with α < 0.05. Results SLE was common in actively working married women of childbearing age, most of whom had had SLE for 1–2 years (33.3%), with arthritis being the most common symptom (reported by 61.1%). The major flare trigger factor was physical stress (66.7%), resulting in fatigue. On average, the self-care model was able to improve SCA by 19.93%, self-care operation by 17.53%, and QoL by 12.19%. It was significantly effective in enhancing SCA, self-care operation, and QoL in patients with SLE (p < 0.001). Conclusions The application of Orems self-care model is effective in improving SCA, self-care, and QoL, and this study provides evidence of the benefits of its use in the nursing care of patients with SLE in a community setting. Health care providers should incorporate Orems self-care model in nursing care to enhance SCA, self-care, and QoL in patients with SLE.

Development of an empowerment model for burnout syndrome and quality of nursing work life in Indonesia

Objectives This study aimed to develop an empowerment model for burnout syndrome and quality of nursing work life (QNWL). Methods This study adopted a mixed-method cross-sectional approach. The variables included structural empowerment, psychological empowerment, burnout syndrome and QNWL. The population consisted of nurses who have civil servant status in one of the regional hospitals in Indonesia. The participants were recruited using multi-stage sampling measures with 134 respondents. Data were collected using questionnaires, which were then analysed using partial least squares. A focus group discussion was conducted with nurses, chief nurses and the hospital management to identify strategic issues and compile recommendations. Results Structural empowerment influenced psychological empowerment (path coefficient = 0.440; t = 6.222) and QNWL (path coefficient = 0.345; t = 4.789). Psychological empowerment influenced burnout syndrome (path coefficient = −0.371; t = 4.303), and burnout syndrome influenced QNWL (path coefficient = −0.320; t = 5.102). Structural empowerment increased QNWL by 39.7%. Conclusion The development of a structural empowerment model by using the indicators of resources, support and information directly influenced the psychological empowerment of the sample of nurses. As an indicator of meaning, psychological empowerment decreased burnout syndrome. In turn, burnout syndrome, as the indicator of personal achievement, could affect the QNWL. Structural empowerment directly influenced the QNWL, particularly within the workplace context. Further studies must be conducted to analyse the effects of empowerment, leadership styles and customer satisfaction.

Factors Affecting Husband Participation in Antenatal Care Attendance and Delivery

The government has implemented several programs to prevent and reduce a mothers mortality rate by enhancing active role of the family. The most responsible family member on maintaining the pregnancy and delivery process is the husband. The husband must be active to take care of his wife. Active participation of the husband in accompanying his wife during pregnancy and the delivery process is one of the substantial factors, which helps the husband to take decisions related to the health of his wife. This study aimed to identify variables and its trends, which significantly affect a husbands participation in accompanying his wife during pregnancy and the delivery process. The data used in this study was from an Indonesian Demographic Health Survey 2012. The study used binary logistic regression as the analysis method. The result showed as many as 8,237 husbands accompanied their wife in antenatal care and the delivery process. The significant variables affecting the husband participation are the age of the wife, the education of wife, the education of the husband, the occupational status of the wife and the husband, the number of children, pregnancy status, and residency region. The possibility for a husband to accompany his wife is larger in several factors, such as the wife being between the ages of 21 – 35 years old, a husband who minimally graduated from junior high school, a working husband, as well as a wife, and the number of children less than and equal to two and the expected pregnancy. The government should consider those factors to create policy related womens health and integrate the factors into various sectors.

Early weaning food for infants (0-6 months old) in madurese people based on transcultural nursing theory

The World Health Organization recommend weaning food is given to infants aged 624 months. In Madura culture still exist the practice of giving weaning food before infants reach six months old. The purpose of this study was to analyze the factors of giving weaning food for infants (0-6 months old) based on transcultural nursing theory. Design used was descriptive with cross-sectional approach. Population was Madurese mothers who have infants (0-6 months old) who has been given early weaning food. A total of 61 respondents were chosen by cluster sampling method. Variables in this study were education, economic, political and legal, cultural values and lifestyles, kinship and social, religious and philosophical, and technology. Data were collected by using structured interview and described by using frequency and percentage distribution. The results had showed educational mostly were primary and middle education (92%). Economic mostly come from low economic status (70%). Political and legal mostly positive (54%). Cultural values and lifestyles mostly negative (62%). Kinship and social mostly negative (64%). Religious and philosophical mostly positive (64%). Technology factor dominantly low (56%). Based on transcultural nursing theory it is shown a diversity in positive and negative values. Further research was suggested to reduce the practice of giving weaning food behavior of Madurese mothers which suits with local culture.