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| Illustration by Ai |
Unequal Health Worker Distribution Weakens Primary Care in Baubau, Study Finds
A new policy analysis by Yully Soraya, Syahrir Ramadhan, and Rahmawati from Dayanu Ikhsanuddin University Baubau, Indonesia, reveals that unequal distribution of health workers across community health centers in Baubau City is reducing the effectiveness of primary healthcare services. Published in 2026 in the Jurnal Multidisiplin Madani (MUDIMA), the study concludes that the problem is not simply a shortage of personnel but a mismatch in workforce placement policies. The findings highlight the need for data-driven health workforce management to improve healthcare access and service quality, particularly in underserved areas.
Health Workforce Distribution Remains a National Challenge
Human resources are one of the most important components of any healthcare system. Doctors, nurses, midwives, nutritionists, environmental health officers, and other health professionals determine whether communities receive timely and effective care.
Indonesia has made significant investments in healthcare infrastructure and workforce development, yet unequal distribution of health workers remains a persistent issue. Urban health facilities often attract more personnel, while remote or peripheral areas struggle to recruit and retain qualified staff.
This imbalance affects the quality of healthcare services, increases workloads in some facilities, and leaves critical positions vacant in others.
In Baubau City, Southeast Sulawesi, the issue has become particularly visible at community health centers, known as Puskesmas, which serve as the frontline of Indonesia’s primary healthcare system.
According to the researchers, understanding workforce distribution requires more than administrative planning. It requires policy analysis capable of identifying the structural causes behind unequal staffing patterns.
How the Study Was Conducted
The research used a qualitative policy analysis approach based on the framework developed by public policy scholar William N. Dunn.
Rather than focusing only on workforce numbers, the researchers examined how policies are formulated and implemented.
Data were collected from:
- Government documents.
- Health workforce planning records.
- Community health center staffing data.
- Relevant policy literature.
- Official reports from Baubau City.
The analysis followed four stages:
- Identifying symptoms of the problem.
- Measuring workforce gaps.
- Determining root causes.
- Developing policy recommendations.
This method allowed the researchers to distinguish between immediate workforce issues and deeper systemic factors affecting staffing decisions.
Key Findings
The study found that health workforce inequality in Baubau City is quantitative, structural, and systemic.
The Main Problem Is Misdistribution, Not Absolute Shortage
One of the most important findings is that Baubau City's healthcare system does not primarily suffer from a lack of personnel.
Instead, many workers are concentrated in certain locations while other facilities remain understaffed.
Researchers identified a gap of 19 health workers compared with the ideal staffing standard. However, the shortage is unevenly distributed.
For example:
- Urban health centers such as Wolio and Betoambari have surplus personnel in some categories.
- Peripheral health centers such as Sorawolio and Lakologou continue to experience shortages of strategic staff.
The result is a mismatch between actual healthcare needs and workforce allocation.
Workloads Differ Dramatically Across Facilities
The study found significant differences in patient workloads between health centers.
In central urban facilities:
- Doctors may see 50–70 patients per day.
In more remote facilities:
- Doctors may see only 15–20 patients per day.
Researchers also found cases where certain staff members experienced substantial idle time while critical positions remained vacant.
This imbalance creates inefficiencies and affects service delivery.
Critical Health Positions Remain Unfilled
The workforce shortages are particularly severe in specific professional categories.
The study identified shortages in:
- Environmental health officers (sanitarians).
- Nutrition personnel.
- Dentists.
In some cases, a single environmental health officer was responsible for serving two different health centers simultaneously.
As a result, preventive healthcare programs such as environmental inspections and community health promotion activities were not fully implemented.
Administrative Policies Drive Inequality
The researchers found that staffing decisions are often based on administrative procedures rather than actual service needs.
Analysis of employee transfers over the past three years showed that approximately 65 percent of transfer requests were motivated by family and residential considerations rather than workforce redistribution objectives.
This trend contributes to an urban bias, where health workers seek assignments closer to city centers and government facilities.
According to the study, rigid civil service regulations and inconsistent coordination between national and local policies further complicate workforce planning.
Why the Problem Persists
The study argues that workforce planning in Baubau City still relies heavily on static population ratios rather than dynamic workload measurements.
Although Indonesia has workforce planning tools such as the Workload Indicators of Staffing Need (WISN) system, researchers found that these tools are not consistently used as the primary basis for staffing decisions.
As a result:
- Some health centers appear adequately staffed on paper.
- Actual workloads remain uneven.
- Healthcare workers are either overwhelmed or underutilized.
The researchers describe this as a policy failure caused by inaccurate problem definition.
Rather than addressing workforce placement, policymakers often focus on recruiting additional personnel, which may not solve the underlying issue.
Implications for Healthcare Policy
The findings carry important implications for healthcare planning at both local and national levels.
The researchers recommend:
- Greater synchronization between national and regional workforce regulations.
- Stronger use of workload-based staffing systems such as WISN.
- More adaptive transfer and placement policies.
- Incentive programs for health workers assigned to high-need areas.
- Development of real-time workforce monitoring systems.
Such reforms could improve the distribution of healthcare personnel without necessarily requiring large increases in recruitment.
For patients, more balanced staffing could mean shorter waiting times, better access to preventive services, and improved healthcare quality.
For policymakers, the research demonstrates the importance of evidence-based workforce planning in achieving equitable healthcare outcomes.
Academic Perspective
According to Yully Soraya, Syahrir Ramadhan, and Rahmawati of Dayanu Ikhsanuddin University Baubau, unequal health workforce distribution stems largely from policy and management challenges rather than an overall lack of personnel. Their analysis indicates that health worker placement must be guided by actual workload demands and service needs rather than administrative convenience or geographic preference.
The researchers conclude that effective healthcare reform in Baubau City requires adaptive, data-driven workforce policies capable of responding to changing healthcare demands across different communities.
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