Spatial pattern of health human resources factors associated with maternal mortality in Indonesia

Background: Indonesia's Maternal Mortality Rate (MMR) in 2022 was still higher than the Sustainable Development Goals (SDGs) target. Previous studies have not paid attention to inadequate Health Human Resources (HHR), its distribution over the country and association with MMR. Objectives: This study aimed to describe the spatial distribution of HHR and MMR and analyse the association between HHR and MMR in Indonesia. Methods: This cross-sectional study used the data from Indonesian Health Profile 2022, consist of 34 provinces for spatial pattern and 33 provinces for statistical analysis. The outcome of this study was MMR per 100,000 live births. The independent variables were the ratio of obstetricians per 10,000 population and the ratio of total midwives per 10,000 population. Results: Of the total 34 provinces in Indonesia, West Papua had the highest MMR, and 9 provinces with MMR<70/100,000 live births. The majority of the provinces (69.7%) had a high MMR (>70 per 100,000 live births). Similarly, most of the provinces (66.7%) had a ratio of obstetricians <0.19 per 10,000 population, and almost all provinces (81.8%) had a ratio of midwives >10 per 10,000 population. The lower ratio of obstetricians was most likely to have a high MMR 5.4 times (95% CI: 1.08-26.93; P-value: 0.042) compared to the higher ratio of obstetricians. Conclusion: Obstetricians were HHR associated with MMR in Indonesia but midwives were not. So, the government should increase the ratio of obstetricians and improve the quality of midwives.