Retention of Doctors and Dentists to Serve in Remote Areas in Indonesia: A Discrete Choice Experiment.

Introduction: Retaining doctors and dentists in remote areas of Indonesia remains a national priority of the Indonesian government. The purpose of this study was to analyze the interventions for retention of doctors and dentists in remote areas using the discrete choice experiment (DCE) approach. Materials and Methods: A DCE was conducted to investigate preferences of doctors and dentists for retention in remote areas. This research was conducted in 78 primary healthcare settings across 15 provinces in Indonesia. The conditional logit model was used to explore stated preferences for each attribute. Results: The total number of respondents was 158, including 113 doctors and 45 dentists. In general, doctors placed the highest preference on getting priority for government scholarships to facilitate retention in remote areas (OR=5.65, p<0.001). Specifically, dentists preferred security guarantees from local government (OR = 4.87, p<0.001). Both groups valued having an official residence (OR=3.6, p<0.001) as a factor for retention in remote areas. Conclusion: Scholarship, security guarantees, housing facilities, and medical facilities were the most considered factors for retaining doctors and dentists in a remote area. This study confirms the importance of a combination of interventions in maintaining doctors and dentists in remote areas. Policy options in the form of non-financial and financial intervention packages can be combined to improve their retention.

Association Between Tobacco Smoking and Dental Caries in the Indonesian Population: Results of a National Study in 2018.

OBJECTIVES: The 2018 Basic Health Research (RISKESDAS), conducted by the Ministry of Health of the Republic of Indonesia showed a high prevalence of dental caries (88.8%) in Indonesia and suggested that smoking tobacco was associated with an increased risk of dental caries. This study analyzed the association between tobacco smoking and dental caries in the Indonesian population. METHODS: This was a cross-sectional analysis of secondary data collected from RISKESDAS 2018. The study population included 35 391 Indonesians aged ≥10 years from all 34 provinces. The decayed, missing, and filled teeth (DMFT) index was used to measure dental caries. Smoking status was assessed qualitatively based on smoking activity, and the level of smoking exposure was assessed based on the Brinkman index. A multivariable logistic regression analysis was employed to examine the relationships of smoking status and smoking exposure levels with the DMFT index. RESULTS: Of the population aged ≥10 years, 36% had a DMFT≥8 (females: 37.5%, males: 33.9%). Almost one-fourth (23.4%) were current smokers, and 4.1% were ex-smokers. Furthermore, 26.4% had a Brinkman index ≥400, indicating heavy smoking. According to the multivariate analysis, current smoking status was associated with the risk of DMFT≥8 in males (adjusted odds ratio [aOR], 1.40; 95% CI, 1.27 to 1.55; p<0.001) and overall (aOR, 1.07; 95% CI, 1.00 to 1.14; p=0.037). In females, ex-smoking was associated with a 41% higher risk of DMFT≥8 (aOR, 1.41; 95% CI, 1.07 to 1.84; p=0.014). Heavy smoking was associated with a higher risk of DMFT≥8 in males (aOR, 1.38; 95% CI, 1.25 to 1.52; p<0.001) and females (aOR, 1.24; 95% CI, 1.03 to 1.50; p=0.022). CONCLUSIONS: Tobacco smoking was associated with dental caries in the Indonesian population.

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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.