Factors influencing the retention of specialist doctors in the placement area: realist evaluation approach in the specialist doctor utilization program

Introduction: The utilization of specialist doctors is one of the government’s efforts in distributing healthcare workers in Indonesia. This initiative has been led by Ministry of Health as national regulator in ensuring the health workforce especially medical specialists available in the community. It is hoped that the community will get better health services with the presence of specialist doctors in regional hospitals. The main objective of this study was to explore the contextual factors that influence the retention of specialist doctors in the continuous and noncontinuous placement areas.
Methods: The design of this study used a realist evaluation approach through the configuration of context, mechanism, and outcome (C-M-O). Qualitative data was collected through in-depth interviews with specialist doctors, the Provincial Health Office, and professional organizations. The study locations are in eight provinces representing seven regions of Indonesia, namely South Sumatra, West Java, Bali, East Nusa Tenggara, Central Kalimantan, Southeast Sulawesi, North Maluku, and West Papua. The contextual narrative is obtained from the thematic analysis of the interviews.
Results: The research results show that the specialist doctor utilization program has succeeded in attracting specialist doctors to become participants when the context of individual considerations such as geographic, demographic, and socioeconomic factors are met. This program also increases the retention of specialist doctors in the context of regional commitments such as providing appropriate incentives, the fulfillment of infrastructure for program participants and hospitals, and opportunities for career development.
Conclusions: This study recommends that local governments fulfill their commitments, so that specialist doctors can work comfortably until the assignment period is over and perhaps extend their assignment period. Furthermore, there is also a need for strong coordination between local and central governments regarding the utilization of these specialist doctors to ensure the program’s sustainability.