A national analysis of the pharmacy workforce in Indonesia | Human Resources for Health

Evidence from this study indicated an increasing trend in the number of pharmacists in Indonesia. Although there was an increasing trend, the density of pharmacists is substantially low (2.85 pharmacists per 10 000 population) compared to the global arithmetic mean in 2016 (7.36 pharmacists per 10 000 population) [12]. This may indicate sub-optimal access of the population to pharmaceutical care services in Indonesia (principally in primary healthcare environments). In addition, the pharmacists’ capacity size obtained from this study might not represent the active workforce who provide pharmaceutical care to the population—working in the patient-care setting. This study utilised data on the registration number of pharmacists, in which the data cover various sectors of practice that pharmacists can work, such as in industry, Wholesaling, government and regulatory sectors, in addition to working in patient-care settings. Further study in identifying the active pharmacy workforce and analysing the attrition pattern is needed to understand a national picture of pharmaceutical access to the population.

There was an increasing trend in the availability of higher education pharmacy initial education and training programmes number and student capacity number per programme. This indicated not only the growing market and opportunities for the pharmacy education sector, but also an effort to increase the pharmacists’ number in Indonesia. This could have resulted from the strategies by the Ministry of Health of Indonesia to strengthen HRH by improving HRH production, including the pharmacy workforce [23, 24, 34]. With an increasing supply trend resulting in an increased number of registered pharmacists, this might suggest the gap between supply and demand is decreasing. However, not all registered pharmacists will be an active workforce who provide pharmaceutical care to the population. It is also important to investigate key inflows and outflows from the workforce to gain a comprehensive analysis of the pharmacy workforce. The key inflows are: registration of new graduates, immigration and return to work following inactivity; the key outflows are retirement, emigration, career break and death in service [35]. In this study, the researcher only analysed the registration of new graduates. There was no information on immigration, return to work, emigration, career break, retirement or death specific to the pharmacy workforce. It is important to have these data to understand supply and productivity. Further research is also needed to understand how the supply has met the demand.

This study found that there was a variety of access to pharmacy programmes across islands. The inequality in access could contribute to the inequality of distribution of pharmacists. This study found a strong positive correlation between access to pharmacy programmes and access to the pharmacy workforce, indicating a possibility that the location of pharmacy schools might influence where students/graduates were based and looking for jobs. In Indonesia, the University in Indonesia in Depok and Padjajaran University in Jatinangor, West Java, are examples of successful higher-education facilities that draw migrants away from urban regions [36]. This study supports evidence from previous research in other countries, which found that rurally based faculties and healthcare schools provided a majority of graduates to the local rural healthcare workforce [37, 38]. Similarly, graduates from urban settings were more likely to remain and work in these urban environments [37, 38]. The WHO recommended further studies to explore the effects of locating schools and programmes outside urban areas on subsequent employment [39].

This study showed that there is an imbalance in the distribution of the pharmacy workforce across islands in Indonesia. This finding seems consistent with other research that found an uneven distribution of the mixed healthcare workforce between rural and urban areas in Indonesia [40,41,42]. A survey conducted in 2011 found variation across islands ranging from 23.2 to 51.5% of community health centres did not have pharmacists and pharmacy support staff to provide pharmaceutical care and medicines expertise, particularly in the Eastern Indonesia region [43]. The uneven distribution and unavailability of the pharmacy workforce illustrate that accessibility to medicines expertise, in the face of increasing use of medicines in an ageing co-morbid population, may have repercussions for universal health coverage and sub-optimal primary healthcare support. The pattern of having a higher workforce density in the capital city is also typical of other low- and lower-middle-income countries [44,45,46]. Reasons for this urban imbalance might be family and social relationships, working and living conditions, career opportunities and financial incentives [47]. In Indonesia, this pattern is also seen among other health professionals. An analysis in 2019 of general mixed health workforce distribution (physicians, nurses and midwives) using the Gini Index in Indonesia found that the number of physicians and nurses was concentrated in the capital of provinces or other big cities in the province [48]. Since 2015, the Ministry of Health of Indonesia has formulated the Nusantara Sehat programme for special recruitment to recruit health workers, including pharmacists, to work in community health centres in remote areas [49]. The evidence from this study suggests the need for more policies and strategies that would facilitate the recruitment and retention of the pharmacy workforce in rural and remote areas.

An increase in pharmacists’ graduation rate (supply pipeline) resulted in a youth bulge of pharmacists aged between 23 and 37. This situation suggests a need to develop structured post-license foundation training to better support early career pharmacists. Having structured foundation training in place will support early career pharmacists to progress toward advanced practice, and opportunities to engage with peers and preceptors are essential to ensure their readiness for practice. Opportunities for pharmacists have grown, considering the expanding role of pharmacists as medicines experts and the population health challenges, e.g., the ageing population; therefore, the existing workforce needs to scale up advanced training competencies to be more flexible and adaptable to face rising demand and healthcare challenges. Developing a programme to support pharmacists in developing their advanced practice competencies is urged. Moreover, opportunities for education and training and support to the workforce were found to be associated with job satisfaction for early career pharmacists, and job dissatisfaction was found to be linked with a higher attrition rate [50]. Therefore providing structured training and opportunities for advanced training to support early career pharmacists could have an impact on increasing workforce retention.

Like the global pharmacy workforce trends, this study found more females (77.8%) than male pharmacists in Indonesia and an increasing trend was predicted. Females in the pharmacy workforce generally have more career breaks than males and the high proportion of female pharmacists with family responsibilities, and increasingly early retirement ages, are factors that need to be considered more urgently for workforce planning [10]. In 2019, the general labour force participation rate of females aged 15–64 in Indonesia was 56%, significantly lower than 84% for males [51]. The Ministry of Manpower of Indonesia called for flexible working conditions for women to increase this participation rate [52, 53]. It is essential to develop a professional development system for female practitioners, allowing flexibility in professional development to facilitate them returning from a career break. This study also observed a lower license renewal rate for female pharmacists. This is an indication that ‘return to work’ policies need greater emphasis in Indonesia.

Another important finding from this study was that younger pharmacists tended to work in the Wholesaling sector after graduating more than in the other sectors of practice. They may be more attracted to work in the Wholesaling sector, which is possibly related to higher remuneration for early career pharmacists [54,55,56]. This may also be because of a recent expansion of industry markets in Indonesia, which might attract more recent graduates to take up more opportunities. More older pharmacists worked in government institutions and industry settings, which may reflect a more static job market and more opportunities in these sectors, tending to retain existing employees (and hence the strata getting older because they stay in the job for longer).

https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00767-4