Factors influencing the retention of specialist doctors in the placement area: realist evaluation approach in the specialist doctor utilization program.

Abstract

The utilization of specialist doctors is one of the government's efforts in distributing healthcare workers in Indonesia. This initiative has been led by the Indonesian Ministry of Health as a national regulator in ensuring health workforce, especially medical specialists, availability in communities. It is hoped that communities will have better health services with the presence of specialist doctors in regional hospitals. The main objective of this study was to explore the contextual factors that influence the retention of specialist doctors in placement areas. The design of this study used a realist evaluation approach through the configuration of context, mechanism, and outcome. Qualitative data were collected through in-depth interviews with specialist doctors, the Provincial Health Office, and professional organizations. The study locations are in eight provinces representing seven regions of Indonesia: South Sumatra, West Java, Bali, East Nusa Tenggara, Central Kalimantan, Southeast Sulawesi, North Maluku, and West Papua. The contextual narrative was obtained from the thematic analysis of the interviews. The research results show that the specialist doctor utilization program has succeeded in attracting specialist doctors to become participants when the context of individual considerations such as geographic, demographic, and socioeconomic factors are met. This program also increases the retention of specialist doctors in the context of regional commitments such as providing appropriate incentives, the fulfillment of infrastructure for program participants and hospitals, and opportunities for career development. This study recommends that local governments fulfill their commitments, so that specialist doctors can work comfortably until the assignment period is over and perhaps extend their assignment period. Furthermore, there is a need for strong coordination between local and central governments regarding the utilization of these specialist doctors to ensure the program's sustainability.