By: Lisa McKenna and Robert Herdiyanto

This op-ed was published on The Jakarta Post on 7 March 2023.

They were the unsung heroes of the COVID-19 pandemic. More than ever, the role of nurses has grown in importance and significance, not only because nurses make up the largest group of healthcare providers. As caregivers, nurses provided early response and quality care for patients with suspected infection. As patient advocates, nurses helped protect patients by being their voice.

Against the setting of increasing chronic diseases and comorbidity, and ageing populations, demands for services from health professionals are increasing around the globe. This has pushed for competition among health services providers, either domestically within a country or cross-border between countries, to hire nursing staff.

Indonesia, traditionally known as a natural resource-rich country, is blessed even more with abundant human resources. The Indonesian Ministry of Health (MOH)’s health workers information system (i.e., SI SDMK) shows there are 557,000 nurses across Indonesia as of February 2023. This translates to a nurse/population ratio of just over two nurses to every 1000 Indonesians. Furthermore, in a 2020 report, the MOH predicted that Indonesia would continue to have an aggregate surplus of nurses in coming years, despite also noting that the distribution of nurses across Indonesia is uneven. There are also many reports today of nurse graduates unable to find employment. If the distribution can be well managed and Indonesia can maintain its current overall nurse/population ratio, the predicted pool of nurses that Indonesia will have in the coming years could represent a significant new source of exports.

Over the 2015-2020 period, almost 6,500 Indonesian nurses have found employment in hospitals and clinics in more than seven countries across the East Asia and Middle East regions, with demand from other regions continually on the rise, according to the Agency for the Protection of Indonesian Migrant Workers (BP2MI). The figure could be pushed further, especially looking at what Indonesia’s neighbour in the Southeast Asian region has done, where around 300,000 nurse professionals from the Philippines were working outside the country as of December 2021.

Different from natural resources where Indonesia holds an almost absolute advantage globally, the competitiveness in promoting its human resources in the global markets must be built up and planned thoroughly. This is where Australia, as its closest developed country neighbour, can be seen as a good training ground to tap into more sophisticated, advanced economy markets.

As part of the Indonesia-Australia Comprehensive Economic Partnership Agreement (IA-CEPA), Indonesia and Australia have mutually decided to further strengthen their economic partnership in the health sector by undertaking work to strengthen health professional standards and competitiveness in the health sector.

Despite the proximity between Indonesia and Australia, there has been little previous work to explore nursing context and alignment with little collaboration between professional nursing organisations and education providers. A recent study by the IA-CEPA Economic Cooperation Program Katalis entitled ‘Comparative Assessment of Nursing Standards in Indonesia and Australia’ is the first of such work to lay the foundation for increased bilateral collaboration on health standards between the two regional neighbours. The comparative assessment of nursing education systems and standards in Indonesia and Australia included an initial gap analysis and was enriched by interviews and workshops in Australia and Indonesia. The study uncovered a host of potential opportunities for greater collaboration and pointed to a need for greater equivalence in the educational preparation of nurses as a paramount factor in ensuring the delivery of high quality and responsive healthcare.

In the area of education, among others, the study found similarities in the process of obtaining accreditation from nursing programs; and differences in the undergraduate curricula of nursing programs in Australia and Indonesia. In Australia, teaching is geared towards producing comprehensive nurses with stronger focus on diversity and cultural practice than on specialist preparation, whereas Indonesian curricula demand more clinical practice hours and wider exposure to specialty practice, as well as a final semester project. The study found there is potential for improving access to specialty healthcare where higher-level postgraduate education exists.

In terms of registration, there are significant differences when it comes to licensing practice and renewals. However, both countries encounter similar issues related to registration processes for internationally qualified nurses, for which a joint approach would be beneficial.

A look into practice standards impacting education shows both countries experience challenges in education and practice of nurses in rural and remote areas. Indonesian nurses were also found to work in generalist roles, whereas Australian nurses tend to be more specialised. Unlike in Australia, there is a perceived lack in regulation and legal protection for nurses in Indonesia, which could lead to opportunities for strengthening, both in curricula and after graduation.

Given that improving access to health and related services is a priority for Indonesia, addressing issues related to nursing skills and competencies, by using Australian nurse education standards as a benchmark, would be a step in the right direction. That, as both countries continue on the common path towards closer cooperation in the health sector.

The road may be steep, but it is never too early to get started.

Professor Lisa McKenna, Dean of the School of Nursing and Midwifery at La Trobe University, Australia, and Robert Herdiyanto, senior economist with the IA-CEPA Economic Cooperation Program Katalis, are project leaders of the study.