Nursing in Indonesia: Surplus, Shortage, and Migration – A Look at a Paradoxical Situation
Indonesia, the world’s fourth most populous country with over 270 million inhabitants, faces a complex healthcare challenge: an apparent surplus of qualified nursing professionals coexists with a simultaneous shortage of employed nurses within its domestic healthcare system. This paradox raises questions about labor market policies, international recruitment, and ethical dilemmas.
I approach the recruitment of nurses from other countries critically. When industrialized countries—including Germany—recruit professionals, they often deplete the home countries of urgently needed resources. However, Indonesia presents a unique case, as its market cannot absorb all trained nurses, offering limited career prospects within the country.
Surplus of Trained Nurses
Indonesia produces far more nurses than its domestic labor market can employ. Statistics highlight this issue:
• In 2018, there were 695,248 qualified nurses available, of whom only 446,428 were actually employed.
• This led to an oversupply of more than 219,000 nurses in 2018.
• The annual training capacity grew rapidly: from 34,000 graduates in 2008 to 138,206 in 2019.
Simultaneous Shortage in the Healthcare System
Despite this surplus, the nurses employed in Indonesian clinics and healthcare facilities are insufficient to meet demand:
• With a ratio of 1.3 nurses per 1,000 inhabitants, Indonesia falls below the WHO ideal of 1.58 and the national target of 1.8 nurses per 1,000 inhabitants.
• Between 75,000 and 135,000 nurses are needed to meet these targets.
Background of the Paradoxical Situation
1. Limited Absorption Capacity of the Labor Market: The healthcare sector lacks sufficient positions to employ all trained nurses.
2. Unequal Regional Distribution: While some regions have a high concentration of nurses, others are severely underserved.
3. Budget Constraints: Financial limitations, especially in underdeveloped areas, prevent the hiring of more nurses.
4. Lack of Healthcare Facilities: A shortage of hospitals and care facilities prevents full employment of many nurses.
Solutions and International Cooperation
Indonesia employs several strategies to address this issue:
• Overseas Deployment: The government promotes the emigration of nurses to ease the domestic job market and generate economic benefits through remittances.
• International Recruitment Partnerships: Countries like Germany have established cooperation agreements to address nursing shortages with Indonesian nurses. However, such measures are not without challenges.
I view the recruitment of qualified nurses from poorer countries critically. In Indonesia’s case, a unique dynamic emerges: the labor market cannot employ all available professionals, making overseas opportunities often the only career advancement path for nurses.
• Improving Domestic Distribution: Efforts are also underway to distribute nurses more evenly across the country so that rural regions are better served.
A Balancing Act Between National and International Interests
Sending nurses abroad is a double-edged sword. On the one hand, it provides career opportunities and economic benefits for Indonesia; on the other hand, it contributes to the “brain drain” problem. This means that qualified professionals are lost to the domestic system—a loss that the country may struggle to compensate for in the long term.
The challenge remains to consider the interests of all parties involved: the needs of destination countries, the aspirations of nursing professionals, and Indonesia’s development prospects.
Indonesia vividly demonstrates that the international recruitment of nurses is not a simple solution to the global nursing shortage and must be considered in a nuanced manner. Long-term solutions are needed that take into account the needs of both source and destination countries without weakening healthcare systems in the countries of origin.
This article aims to show that discussions around international nurse recruitment should focus not only on the quantity of professionals but also on finding sustainable solutions that meet the needs of destination countries without compromising the healthcare systems of origin countries. Indonesia’s situation makes it clear that there is no one-size-fits-all solution, making it all the more important to approach the issue with foresight and responsibility.
In Germany, recruitment—or rather, poaching—of nurses should not be the only measure to improve the long-term care situation. Here, digitalization undoubtedly plays a significant role, and particularly in outpatient care, more financial support should be provided by policymakers. After all, the framework conditions in nursing play a decisive role in whether the profession will become more attractive again in the future.