Not Even West Java Has a Balanced Doctor-to-Population Ratio

Once in a lifetime, there has to be an event where someone needs to be admitted to the doctor, be it for preventive consultation, vitamin injection, or for curative treatment.

While having to be able to get admitted to the doctor whenever you need it is basic human rights (free access to healthcare), such a notion seems to be a utopia, regardless of the circumstances, especially in remote areas.

Thinking about remote areas, Indonesians often think about Papua and Maluku as those provinces are officially acknowledged as remote regions, although more remote regions can also be found in Sumatra. In such areas, locals often meet the doctors with certain and notable hindrances. However, we often forget that not every small region in Java Island is as privileged as Jakartans, despite living on the same Island where most economic activities take place. In Java Island itself, doctors are seldom to be found, especially in rural areas, although we can’t really generalize on that. However, using data from satudata Indonesia, we found that, indeed, even in Java Island, doctors are not ideally distributed.

Ideal condition

The World Health Organization has conceptualized that one of the ideal conditions of a medical setting is to have one doctor serving 1.000 populations, meaning that the ratio should be 1:1000. Although this ratio is not the only indicator to measure how good Indonesia healthcare is, doctor-to-population ratio shows how accessible healthcare is in one country and acts as one of the social determinants of health in the population. Despite that, the golden ratio set by WHO is 1:1000 far beyond the actual target in many WHO countries, Indonesia included. It’s funny that Jakarta may meet the golden ratio, however, a province that can be reached less than 30 minutes from Jakarta that is West Java, may not. This raises a question, how bad the situation can be in West Java? Therefore, this article aims to look up the possible answer.

How do we get there

To get the ratio, it’s actually pretty easy. All you have to do is to follow the formula below:

doctor to population ratio=

(number of physicians/number of total population) x 1.000

However, the real tasks are to get the data. Luckily enough, satudata and BPS website provides us what we need. Now, it’s time to work on the data real quick.

Nasty number of certain underdeveloped region

The data give us certain numbers for multiple years starting from 2016, however, we will just use the numbers from 2019 onwards to give us more recency. After processing the data, our number looks just as fine below. In the first picture, we can see that the population seems to be static in a way that does not really fluctuate over a year, although slight changes are caught for several provinces, but it is not really significant that really indicates that the population is indeed shifting or growing or shrinking.

While the population seems to be large with around 6 millions of people living in Bogor for 2019–2020, the number of doctors in all regions is miserable. All regions in West Java in 2019 failed to comply with the golden standard set by the WHO, therefore showing a significant, insufficient number of doctors to serve 1000 populations in each region. Should we be surprised or not? We expect that West Java should at least have enough doctors to serve, but in fact it does not. This is kinda odd, considering the logistics and the medical education also exist in certain regions in West Java, none or less imported from Jakarta for less than an hour.

However, this chart does not seem to be the best at visualizing the data. In those charts, the axis is not synchronized to each other due to the small number of doctors and therefore, the synchronized axis will just easily diminish the bar chart, so don’t be tricked by the bar!

Now, let’s move forward to the exciting part, that is doctor to patients ratio. We argue that there are similar sad stories about our ratio, which is proven to be true after processing the data. It looks just as sad below.

In 2019, the ratio screams misery. Indeed, no regions in East Java were able to comply with the golden standard with Kota Cirebon having the highest ratio among all regions. This trend continues to 2020 with Kota Cirebon finally able to meet the golden standard. Sadly, no other regions are showing similar and noticeable improvements as Kota Cirebon, although Kota Sukabumi and Kota Bekasi were catching up. This finding is quite surprising to us, as we thought that Kota Cirebon is not as populous as Kabupaten Bandung but the doctor-to-population ratio is the best among all.

Our finding shows two possible conclusions: 1) there is indeed a disparity among Kota (urban areas) vs Kabupaten (rural areas) as shown in the comparison of kota Cirebon vs kabupaten Cirebon; 2) this also shows uneven distribution where most populous regions don’t have enough doctors to serve, such as shown in Kabupaten Bogor. We also notice some regions are falling off, such as Kabupaten Garut, where the ratio increase does not necessarily happen (pseudo-increase). However, it is worthy to note that there seems to be an increasing number of doctors in 2020 from 2019, causing the ratio to grow towards a brighter side.

Implication

Our study implies that despite traveling to West Java from Indonesia’s capital city that is Jakarta takes less than an hour, there seems to be a huge disparity of healthcare access in West Java. We propose several factors that need to be identified by further studies. The first one is that we argue that Indonesia does not have a good and adequate logistics lane that may help to distribute human resources, despite having a lengthy railtrack span across Java Island. We also argue that this may also be attributed to low income doctors in Kabupaten or rural areas, thus raising a question of uneven wages distribution among health workers in the very same region. We argue that the combination of those causes fresh-graduate doctors to be reluctant to work and establish their medical career in Kabupaten (rural areas) in West Java. Even if they want to or are forced to, they are simply unable to do so as medical supplies such as supplements, medicines, and such are in shortage in rural areas. This also raises an issue of over workload among doctors serving in unideal condition, that is less than 1:1000 ratio, causing the quality to be collapsed and unable to deliver the best out of medical assistance.

This implies another structural problem of inequality that needs to be addressed in no time as doctor-to-population ratio represents several health indicators such as health quality index, sustainability, and essential health aspects. Thus, if our proposed factors are indeed true, we suggest that the best recommendation is to increase the minimum wage for doctors in unideal setting and improve the logistics of medical supplies to certain areas before 2030.

Because access to health care is basic human rights, this problem should be prioritized