"How is the availability of public health workers in Indonesia's primary health care? Secondary data analysis of health facility research in 2019".

The lack and maldistribution of public health workers are critical issues for primary health care. This study aimed to assess the availability of public health workers at primary health care and to identify its related factors. We use secondary data from health facility research in 2019. Overall, 68.79% of primary health care in rural areas and 71.33% of primary health care in remote areas have the number of public health workers fit standards, but urban areas only reach 46.82%. The public health worker from health promotion and behavior concentration is more dominantly fulfilled than others. Accreditation status is a determinant factor of the availability of public health workers in urban and rural primary health care. Especially remote primary health care, it is not only affected by accreditation status but also service capability. The government needs to review the policy of public health worker recruitment at primary health care to support the fulfillment of public health workers. Public health education should start considering career development programs to ensure that all graduates from various concentrations can be absorbed into the workforce.

Challenges of Shifting Diabetes Mellitus Care From Secondary- to Primary-Level Care in Urban and Rural Districts: A Qualitative Inquiry Among Health Providers.

Objectives: The study aims to understand the acceptability of Prolanis, a program that shifts the diabetes mellitus type 2 (T2DM) patient management from secondary to primary care, among Indonesian primary health care providers. Method: We completed face-to-face semistructured interviews with 14 health professionals from 3 urban and 4 rural government-owned primary health care clinics (Puskesmas) in 4 districts. We performed content analysis using the theoretical framework of acceptability (TFA) to understand which factors could facilitate or reduce acceptability. Results: Our study identifies that lack of health care providers' acceptability to Prolanis was attributable to the negative affective attitude, low perceived effectiveness, poor self-efficacy, and work burden. The use of Prolanis output as one of the pay-for-performance indicators was deemed unsuitable because it could demotivate health providers to capture more undetected T2DM cases. This, compounded by lacking perceived benefit for the health care providers, leading to negative attitudes. Participants believed that the program improved patients' adherence to visiting clinics routinely; however, the absence of a formal evaluation of reductions of key T2DM indicators-blood glucose level and HbA1c-causing the health providers to doubt the program effectiveness. Availability of or access to adequate blood glucose testing equipment is also of paramount importance to improve acceptability. Although the significant increase in patient load only occurred to Puskesmas with lacking doctors, an increased workload burden due to clerical works was experienced by the nonmedical workforce. The program appears to be more acceptable for health care providers in urban Puskesmas compared with their rural counterparts, attributable to better geographical accessibility and care-seeking behavior among people living in urban locations. Conclusions: This study highlights critical issues that should be addressed to improve the acceptability of Prolanis among health care professionals. Government or stakeholders play a critical role in improving program acceptability. More study is needed to capture wider variety of health care facilities' characteristics.