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Abstract

Policy has focused on the unequal distribution of health workers, while the potential for improvements in efficiency to address this problem has been neglected. This study aims to measure and compare the level of efficiency in the use of the available health workforce for the delivery of selected primary healthcare services among districts/cities in Indonesia, and to identify factors influencing that efficiency. The Data Envelopment Analysis method with output orientation to measure efficiency and Tobit regression analysis was performed to determine the effect of contextual factors. The average score for the technical efficiency of primary health care service delivery throughout Indonesia was 1.29, indicating the potential to achieve on average 29% higher coverage of the selected primary health services if all were as efficient as the most efficient. The average efficiency score in the Eastern Indonesia region was 1.62 and the average in the Java-Bali region was 1.05, indicating higher potential efficiency gains in the Eastern Indonesia region. Access to health care facilities was a consistently significant factor influencing the efficiency of primary health care in almost all regions. This study has demonstrated the potential for significant gains in coverage of key primary care services through improvements in the efficiency of use of the existing health workforce.

Bahasa Abstract

Kebijakan terfokus pada ketimpangan distribusi tenaga kesehatan, di sisi lain potensi peningkatan efisiensi untuk mengatasi permasalahan ini masih diabaikan. Penelitian ini bertujuan untuk mengukur tingkat efisiensi atas penggunaan tenaga kesehatan yang tersedia untuk pelayanan kesehatan terpilih di layanan kesehatan primer di antara kabupaten/ kota di Indonesia, dan mengidentifikasi faktor yang mempengaruhi efisiensi. Metode Data Envelopment Analysis dengan orientasi output untuk mengukur efisiensi dan analisis regresi Tobit digunakan untuk menentukan efek dari faktor kontekstual. Rerata skor efisiensi teknis pelayanan kesehatan primer di seluruh Indonesia sebesar 1,29, mengindikasikan potensi untuk mencapai 29% cakupan layanan lebih luas atas layanan terpilih di fasilitas kesehatan primer jika seluruhnya bekerja secara efisien sebagaimana fasilitas yang paling efisien. Rerata efisiensi di regional Indonesia Timur adalah 1,62 dan rerata di Jawa Bali sebesar 1,05, mengindikasikan peningkatan potensi efisiensi di regional Indonesia Timur. Diantara ketiga faktor kontekstual yang diuji, faktor akses terhadap fasilitas pelayanan kesehatan yang konsisten bermakna signifikan terhadap efisiensi pelayanan kesehatan primer di hampir semua regional. Studi menunjukkan potensi peningkatan secara signifikan atas cakupan layanan kesehatan primer melalui peningkatan efisiensi penggunaan tenaga kesehatan yang tersedia.

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