Abstract
BackgroundMany factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. This study describes factors associated with actual RR practice, preferred RR practice, and intention to remain practice in Maluku Province.MethodsAn online survey of work-related experience and intentions for future rural work was administered to 410 doctors working in the Maluku province of Indonesia. Participant characteristics were described using descriptive statistics, associations between the independent variables with the location of the workforce, intention to remain practice in Maluku, preference for future RR practice in Maluku were analysed using Chi-square tests and logistic regression.ResultsA total of 324 responses (79% response rate) were recorded, comprising 70% females and 30% Pattimura University graduates of doctors employed in Maluku. Doctors working in RR areas were more likely to be a GP (OR 3.49, CI 1.03–11.8), have a monthly salary of more than IDR 6 million (OR 11.5, CI 4.24–31.1), and have no additional practice (OR 2.78, CI 1.34–5.78). Doctors intended to stay practice in Maluku were more likely to be born in Maluku (OR 7.77, CI 3.42–17.7) and have graduated from Pattimura University (OR 3.06, CI 1.09–8.54), and less likely to be a temporary employee (OR 0.24, CI 0.10–0.57). Doctors who prefer future RR practice in Maluku were more likely to experience rural living (OR 2.05 CI 1.05–3.99), have a positive indication of the impact of community exposure during medical schools on their current practice (OR 2.08, CI 1.06–4.09), currently practising in RR Maluku (OR 8.23, CI 3.27–20.8); and less likely to have bigger take-home pay (OR 0.30, CI 0.13–0.70).ConclusionThis study indicates that special attention should be given to recruiting doctors with a rural background and ongoing support through attractive opportunities to build a sustainable RR workforce. Since a regional medical school helps supply doctors to the RR areas in its region, a sustained collaboration between medical schools and local government implementing relevant strategies are needed to widen participation and improve the recruitment and retention of RR doctors.
Highlights
Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia
This study identified that doctors currently working in Maluku were predominantly female, of young age, married, did not have a rural background, graduated from a university outside Maluku, and experienced rural exposure
While not significantly associated with rural practice location and rural preference in this study, we found that most doctors experienced rural exposure during their medical training, more than what was found in the national study [53]
Summary
Many factors contribute to engagement in rural and remote (RR) medical practice, but little is known about the factors associated with rural and remote medical practice in such remote locations as the Maluku Province of Indonesia. A shortage of health personnel and workforce maldistribution means unequal access to healthcare for people living in rural and remote (RR) communities, a persistent. A middle-income country in the Asian region, struggles with community access to healthcare and insufficient health workforce, especially in its RR areas [4,5,6]. Having ratio of doctors per population 1:2294 nationally, its health data shows maternal mortality rate 177/100,000 live births [8], higher than the World Health Organisation (WHO) target in the context of the Sustainable Development Goals (SDGs) [9], and neonatal mortality rate 15 deaths/1000 live births [8], higher than the SDGs target 12/1000 live births [10]. Service coverage index of Universal Health Coverage (UHC) through Indonesian National Health Insurance was 60% in 2020, with higher UHC achieved mostly in Java Island and some western parts of Indonesia [12]
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