34
Standardization of the Quality of Health Higher Graduates Trihono Indonesia Health Professions Board Majelis Tenaga Kesehatan Indonesia Bali, November 2019 1
Standardization of the Quality of Health Higher Graduates
Trihono
Indonesia Health Professions Board
Majelis Tenaga Kesehatan Indonesia
Bali, November 2019 1
Two big problems of health human resources
2
Student
in Health
University
Competency
test Not
passed
No job
Passed
Competency
certificate
Have job
Seeking job
The 1st Competency Test, 2013
Description Midwife Nurse
Number of question 180 180
Average score 41,08 43,03
Standard deviation 9,35 11,05
Highest score 72,20 73,33
Lowest score 7,78 10,00
Range 64,42 63,33
Passed score 40,14 37,47
Passed 3.582 (53,5%) 2.617 (67,5%)
Not passed 3.114 (46,5%) 1.260 (32,50%)
3
Comparison of Midwife Competency Test 2013 & 2017
Description 2013 2017
Participant (including re-taker 1 - 4) 6.696 11.927
Average score 41,08 36,80
Standard deviation 9,35 10,82
Highest score 72,20 76,11
Lowest score 7,78 3,89
Range 64,42 72,2
Passed 53,5% 20,4%
Not passed 46,5% 79,6%
4
Comparison of Nurse Competency Test 2013 & 2017
Description 2013 2017
Participant (including re-taker 1 - 4) 3.877 12.161
Average score 43,03 41.01
Standard deviation 11,05 11.70
Highest score 73,33 81.11
Lowest score 10,00 13.33
Range 63,33 67.78
Passed 67,5% 29,3%
Not passed 32,50% 70,7%
5
Midwife & nurse competency test, April 2018
Description Midwife Nurse
Participants (including re-taker 1-4) 19.326 12.127
Average score 39,48 36,91
Highest score 76,67 83,33
Lowest score 0,56 2,77
Passed score 44,47 45,57
Number of passed student 5.402 (27,95%) 2.185 (18,02%)
First taker passed (%) 50,73% 39,91%
Midwife Competency Test 3rd Round, 2018
Peserta Jumlah Kompeten Tidak Kompeten
Jumlah Persentase Jumlah Persentase
First Taker 19542 11876 60,77% 7666 39,23%
Re Taker_1 2300 375 16,30% 1925 83,70%
Re Taker_2 2355 145 6,16% 2210 93,84%
Re Taker_3 1858 87 4,68% 1771 95,32%
Re Taker_4 950 24 2,53% 926 97,47%
Re Taker_5 795 18 2,26% 777 97,74%
Re Taker_6 465 11 2,37% 454 97,63%
Re Taker_7 223 2 0,90% 221 99,10%
Re Taker_8 82 3 3,66% 79 96,34%
Jumlah Total 28570 12538 43,89% 15950 55,83%
Nurse Competency Test 3rd Round, 2018
Peserta Jumlah Kompeten Tidak Kompeten
Jumlah Persentase Jumlah Persentase
First Taker 19862 17791 89,57% 2071 10,43%
Re Taker_1 1826 1110 60,79% 716 39,21%
Re Taker_2 1633 718 43,97% 915 56,03%
Re Taker_3 1304 580 44,48% 724 55,52%
Re Taker_4 985 455 46,19% 530 53,81%
Re Taker_5 805 375 46,58% 430 53,42%
Re Taker_6 497 225 45,27% 272 54,73%
Re Taker_7 264 117 44,32% 147 55,68%
Re Taker_8 74 26 35,14% 48 64,86%
Jumlah Total 27250 21371 78,43% 5805 21,30%
Performance of Higher Education Based on
Result of competency Test
Health Workforce # Institution % passed
>75% 50-75% <50%
Miwife 602 106 127 369
17.6% 21.1% 61.3%
Nurse 430 251 110 69
58.4% 25.6% 16.0%
Professional Nurse 284 54 76 154
19.0% 26.8% 54.2%
Passed Score of Health Workforce Competency Test. 2018
No Program Studi NBL
1 D III Kesehatan Lingkungan 41,78
2 D III Rekam Medis 39,17
3 D III Teknik Gigi 39,59
4 D III Terapis Gigi Dan Mulut 39,83
5 D IV Elektomedik 37,58
6 D IV Gizi 43,33
7 D III Akupuntur 41,06
8 D III Elektromedik 37,03
9 D III Gizi 42,50
10 D III Okupasi Terapi 40,80
No Program Studi NBL
11 D III Radiografi 37,74
12 D III Refraksi Optisi 40,29
13
D III Teknik Lab. Medis
40,77
14 D III Terapi Wicara 40,48
15 D IV Kesehatan Lingkungan 40,53
16 D IV Terapis Gigi Dan Mulut 38,83
17 Profesi Bidan 40,14
18 D IV Kebidanan 43,14
19 D IV Keperawatan 39,40
Research in
health workforce vocational education (Diploma III in NURSING, midwifery, PHARMACY, NUTRITION, AND ENVIRONMENTAL HEALTH)
Centre for research and development on health resources and services Ministry of health, indonesia
2017
Mieska Despitasari & Team
Despitasari, HRH Vocational Education, 2017 12
Sampling Method
Study program
West Region
Accredited A
Public Private
Accredited B
Public Private
Accredited C
Public Private
Middle Region
…
East Region
…
22 Provinces
35 district/ municipal
Study Programs: 13 nursing
12 midwifery 10 pharmacy
9 nutrition 10 env. health
Conceptual Framework
Approximately 30 1st grade
students per study program
Approximately 30 3rd grade
students per study program
STUDY PROGRAM
Recruitment Questionnaire
Knowledge Questionnaire
Inclusion criterias: Listed on DIKTI database
Willing to participate Exclusion criteria:
No longer active in providing education
Results
14
Respondents:1st Grade Students
Despitasari, HRH Vocational Education, 2017
Results Respondents: 3rd Grade Students
Despitasari, HRH Vocational Education, 2017
Results
16
No Items midwifery (n=12)
Nursing (n=13)
Env. Health (n=10)
Nutrition (n=9)
Pharmacy (n=10)
Students Recruitment
1. SOP Not all study
program (SP)
have it
Not all study
program (SP)
have it
Not all study
program (SP)
have it
Not all study
program (SP)
have it
Not all study
program (SP)
have it
2. Medical Check-up All SP have
done it, except
thorax photo
All SP have
done it, except
thorax photo
Not all SP have
done it
completely
Not all SP have
done it
completely
Not all SP have
done it
completely
3. Local students
representation, poor
family, achievement
entrance path
Mostly not yet Mostly not yet Mostly not yet Mostly not yet Mostly not yet
Despitasari, HRH Vocational Education, 2017
Results
17
No Items midwifery
(n=12)
Nursing
(n=13)
Env. Health
(n=10)
Nutrition
(n=9)
Pharmacy
(n=10)
4. Lecturer : Students
= 1:23
Not all study program
(SP) have fulfill it
Not all study
program (SP) have
fulfill it
Not all study
program (SP) have
fulfill it
Fulfilled Mostly haven’t
fulfill it
5. Lecturer
Competencies
Some, still didn’t match
the educational
background.
21% not updated their
substances knowledge
by training
Some, still didn’t
match the
educational
background
13,3% not updated
their knowledge
substances by
training
Some, still didn’t
match the
educational
background
57,5% not updated
their knowledge
substances by
training
Some, still didn’t
match the
educational
background
55,2% not
updated their
substances
knowledge by
training
Some, still didn’t
match the
educational
background
65,6% not
updated their
substances
knowledge by
training
6. Lecturer Workload Mostly, 2-5 subjects.
None of them >5
Mostly 2-5 subjects.
14% > 5 subjects
Mostly 2-5 subjects.
15,5% > 5 subjects
Mostly 2-5
subjects. 6,9% >
5 subjects
Mostly 2-5
subjects. 2,8% >
5 subjects
Despitasari, HRH Vocational Education, 2017
Results
18
No Items midwifery
(n=12)
Nursing
(n=13)
Env. Health
(n=10)
Nutrition
(n=9)
Pharmacy
(n=10)
7. Training as CI All CI have done it Mostly have done
it
N/A N/A N/A
8. CI : students 1:2 – 1:10 1:4 – 1:30 N/A N/A N/A
9. Curriculum KKNI
Only 1 SP have
complete Semester
Learning Plan (SLP)
documents
In general,
implemented as
written in SLP
KKNI
<50% SP have
complete Semester
Learning Plan (SLP)
documents
In general,
implemented as
written in SLP
KKNI
All SP didn’t
have complete
Semester
Learning Plan
(SLP)
documents
KKNI
>50% have
complete
Semester
Learning Plan
(SLP) documents
Not all SLP
described the
exact learning
method
KKNI
All SP didn’t have
complete Semester
Learning Plan (SLP)
documents
Not all SLP
described the exact
learning method
Despitasari, HRH Vocational Education, 2017
Results
19
No Items midwifery
(n=12)
Nursing
(n=13)
Env. Health
(n=10)
Nutrition
(n=9)
Pharmacy
(n=10)
10. Learning Process at PHC/
hospital : Guidance
All have it All have it,
including
targets and
planning
N/A N/A N/A
11. PHC/ hospitas/ clinics
evaluation
Not all SP have
done it
Not all SP
have done it
N/A N/A N/A
12. Facilities of PHC/
hospital
Some was still
poor
Some was
still poor
N/A N/A N/A
13. Academic atmosphere &
Learning Process
(campus)
Students lack of
initiatives and
undisciplined
Students lack
of initiatives,
lazy, and
undisciplined
Learning method didn’t
match graduate
competency standard.
Lack of discussion and
scientific studies.
Despitasari, HRH Vocational Education, 2017
Results No Items midwifery
(n=12)
Nursing
(n=13)
Env. Health
(n=10)
Nutrition
(n=9)
Pharmacy
(n=10)
14. Facilities and
infrastructures
Some SP didn’t have
LCD projector,
discussion room.,
laptop, student
center, computer
room, internet
connections
Lab : all SP didn’t
have complete
standardized lab
Some SP didn’t
have LCD
projector,
discussion room.
Lab : <50% have
complete
standardized lab
Practice was done
out off the campus.
Lack of laboratory
equipment and
workshop
Lab : Only 1 SP that
have complete
standardized lab
Some SP didn’t
have discussion
room, computer
room, internet
connections
Lab : all SP
didn’t have
complete
standardized
lab
Some SP didn’t
have LCD
projector (still
use OHP),
discussion room.,
laptop,
laboratory,
computer room
Lab : all SP didn’t
have complete
standardized lab
Despitasari, HRH Vocational Education, 2017
Results No Items midwifery
(n=12)
Nursing
(n=13)
Env. Health
(n=10)
Nutrition
(n=9)
Pharmacy
(n=10)
Learning outcome
15. Mean GPA (2015/2016) 3,22 3,27 3,20 3,17 2,93
16. Competency test (2016) 65,18% passed 43,2% passed N/A N/A N/A
17. Knowledge test score
(this research)
46,8 (8,0-72,0) 43,6 (10,0-66,0) 36,9 (14,0-60,0) 21,5 (9,0-37,0) 33,5 (10,0-74,0)
18. Job vacancy information
from SP
All SP gave the
information
All SP gave the
information
All SP gave the
information
Mostly gave
the
information
Mostly gave the
information
Despitasari, HRH Vocational Education, 2017
Results
No Items midwifery
(n=12)
Nursing
(n=13)
Env. Health
(n=10)
Nutrition
(n=9)
Pharmacy
(n=10)
19. Tracer study Mostly have
done it
Mostly have
done it
All have done
it
All have done
it
Mostly have
done it
20. Evaluating graduate
performance in the
workplace
50% SP have
done it
>50% SP have
done it
Still SP which
haven’t done
it
Still SP which
haven’t done it
50% SP have
done it
21. Waiting time to work
(months)
3-12 2-12 3-16 4-12 2-6
Despitasari, HRH Vocational Education, 2017
Standardization
• Standardization is a must: – Student recruitment
– Input: human resources, facilities, equipment, curriculum, money, etc.
– Process: learning methodology
– Output: comprehensive competency test
– Accreditation for the institution
• Accreditation only is not enough
• The regular report of the “quality” should be done yearly making
rank of institution based on: – The proportion of student who passed the competency test
– The average score of competency test at the institution
Rank of provinces based on PHDI
(Public Health Development Index), 2018
0.4888
0.6889
0.0000
0.1000
0.2000
0.3000
0.4000
0.5000
0.6000
0.7000
0.8000
0.9000
1.0000P
ap
ua
Pap
ua B
ara
t
Malu
ku
Ka
lim
an
tan
Ba
rat
Ka
lim
an
tan
Ten
ga
h
Su
law
esi
Te
ng
ah
Malu
ku
Uta
ra
Go
ron
talo
Nu
sa
Ten
gg
ara
Tim
ur
Su
law
esi
Te
ng
ga
ra
Ka
lim
an
tan
Se
lata
n
Su
law
esi
Bara
t
Ac
eh
Su
mate
ra S
ela
tan
Su
mate
ra U
tara
Ria
u
Be
ng
ku
lu
Su
law
esi
Uta
ra
Su
law
esi
Sela
tan
Ba
nte
n
Ka
lim
an
tan
Uta
ra
Ja
mb
i
Su
mate
ra B
ara
t
Nu
sa
Ten
gg
ara
Ba
rat
Lam
pu
ng
Ka
lim
an
tan
Tim
ur
Ke
p.B
an
gka
Beli
tun
g
Ja
wa
Bara
t
Ja
wa
Tim
ur
Ja
wa
Te
ng
ah
DK
I Ja
ka
rta
Ke
pu
lau
an
Ria
u
DI
Yo
gya
ka
rta
Ba
li
Provinsi Maksimum Minimum
9
Changes of score and provincial rank based on PHDI 2018 Provinsi IPKM
2018
Peringk
at 2018
IPKM
2013
Peringkat
2013
Bali 0.6889 1 0.6503 1
D.I. Yogyakarta 0.6797 2 0.5733 4
Kepulauan Riau 0.6633 3 0.6081 3
DKI Jakarta 0.6618 4 0.6085 2
Jawa Tengah 0.6433 5 0.5631 7
Jawa Timur 0.6302 6 0.5411 12
Jawa Barat 0.6249 7 0.5458 9
Kepulauan Bangka Belitung 0.6234 8 0.5363 17
Kalimantan Timur 0.6217 9 0.5757 5
Lampung 0.6213 10 0.5449 11
Nusa Tenggara Barat 0.6190 11 0.5236 19
Sumatera Barat 0.6177 12 0.5462 13
Jambi 0.6162 13 0.5343 15
Kalimantan Utara 0.6125 14
Banten 0.6125 15 0.5682 6
Sulawesi Selatan 0.6103 16 0.5244 20
INDONESIA 0.6087 0.5404 25
Provinsi IPKM
2018
Peringkat
2018
IPKM
2013
Peringkat
2013
Sulawesi Utara 0.6064 17 0.5427 14
Bengkulu 0.6063 18 0.5328 16
Riau 0.6021 19 0.5535 8
Sumatera Utara 0.5956 20 0.5415 10
Sumatera Selatan 0.5939 21 0.5301 18
Aceh 0.5924 22 0.5051 24
Sulawesi Barat 0.5891 23 0.4985 26
Kalimantan Selatan 0.5879 24 0.4857 31
Sulawesi Tenggara 0.5787 25 0.5161 22
Nusa Tenggara Timur 0.5770 26 0.4622 32
Gorontalo 0.5714 27 0.5108 21
Maluku Utara 0.5705 28 0.4960 28
Sulawesi Tengah 0.5613 29 0.4889 30
Kalimantan Tengah 0.5580 30 0.5053 25
Kalimantan Barat 0.5502 31 0.5145 23
Maluku 0.5502 32 0.4937 29
Papua Barat 0.5491 33 0.4966 27
Papua 0.4888 34 0.4387 33 10
The best 10 Districts and the worst based on PHDI, 2018
Kab/ Kota Nilai IPKM Peringkat Kab/ Kota Nilai IPKM Peringkat
Gianyar 0.7470 1 Pegunungan Arfak 0.4100 505
Kota Solok 0.7333 2 Deiyai 0.4067 506
Kota Magelang 0.7319 3 Yalimo 0.4046 507
Tabanan 0.7293 4 Mamberamo Raya 0.4005 508
Kota Denpasar 0.7254 5 Puncak 0.3945 509
Badung 0.7170 6 Pegunungan Bintang 0.3939 510
Kota Salatiga 0.7139 7 Nduga 0.3916 511
Sarolangun 0.7014 8 Tolikara 0.3734 512
Sleman 0.7012 9 Dogiyai 0.3727 513
Kota Blitar 0.6994 10 Paniai 0.3469 514 12
27 Sumber: Dashboard Indikator Keluarga Sehat, Juli 2019
Indonesia 0,18 18% families categorized as healthy family
Family Health Index (FHI) by provinces, June 2019
FHI rank among Districts in NTB Province
0.094
0.117
0.12
0.134
0.166
0.172
0.172
0.183
0.245
0.254
0.147
BIMA
LOMBOK TIMUR
LOMBOK TENGAH
SUMBAWA
KOTA BIMA
DOMPU
LOMBOK BARAT
KOTA MATARAM
LOMBOK UTARA
SUMBAWA BARAT
PROV. NTB
Suggestions for Public Health Competency Test
• Should be an exit exam as soon as possible
• Not only knowledge but also skill
• For skill competency test:
–Conducted in the latest semester
–Healthy Indonesia Through Family Approach is an appropriate
media for skill competency test all Helath Centers have
implemented this approach
–A group of students (3 – 5 students) posted in the village for 6-12
months
–The success indicator is the improvement of Family Health Index
– FHI is an transparent indicator all parties can check the data
Puskesmas Tambakrejo Surabaya (Contoh)
No Indikator KAPASAN TAMBAK-
REJO SIMO-KERTO Puskesmas
1 Keluarga mengikuti KB *) 28.4% 34.3% 41.4% 35.8%
2 Persalinan Ibu di faskes 80.0% 82.1% 89.9% 85.2%
3 Bayi : imunisasi dasar lengkap *) 88.6% 90.2% 92.3% 90.4%
4 Bayi mendapatkan ASI Eksklusif 69.6% 88.4% 87.0% 82.8%
5 Pertumbuhan Balita dipantau 93.0% 92.3% 95.1% 93.6%
6 Penderita TB berobat sesuai standar 32.0% 24.2% 39.7% 30.9%
7 Penderita hipertensi berobat teratur 44.4% 66.7% 62.3% 59.0%
8 ODGJ diobati, tidak ditelantarkan 14.3% 34.5% 6.0% 16.0%
9 Anggota keluarga tidak merokok *) 54.3% 57.6% 64.3% 59.4%
10 Keluarga menjadi anggota JKN 44.1% 48.0% 39.4% 44.1%
11 Keluarga akses/gunakan air bersih 98.3% 98.2% 98.9% 98.5%
12 Keluarga akses/gunakan jamban 98.0% 97.4% 98.4% 97.9%
Indeks Keluarga Sehat (IKS) 0.164 0.192 0.204 0.191
Tomalau Health Center, Kota Tidore Kepulauan,
North Maluku Province
Watas Marga Healh Center Rejang Lebong District,
Bengkulu Province
Summary
• Standardization is a must for all aspect of the education
• Accreditation for the institution is important
• Standardized comprehensive competency test (knowledge & skill)
should be done for all Health Workforce: academic, vocation and
profession
• Competency test is an exit exam
• Rank of Education Institution should be made yearly based on: – The propotion of student who passed the competency test
– The average score of competency test at the institution
