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Printable Version
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Overview
Improving Access to Oral Care Using Community Workers
Access to oral care is a major problem in many low-income countries. One of the reasons for this situation is the lack of dental manpower. For example, while most industrialised countries have a ratio of 1 dentist per 2000 people, a ratio of 1 dentist per 250,000 people is common in rural Nepal (Yee and McDonald, 2002) and in Africa the dentist to population ratio is 1:150,000 (Peterson, 2003). Training more dentists is not the answer to the problem as highly skilled dentists prefer to live and work in urban centres, leaving rural populations underserved.
Many low-income countries have a primary health care system, employing primary health care workers (health assistants, paramedics, auxiliary nurse midwives, midwives) who live and work in rural villages as well as urban centres. Most primary health care workers receive formal short course medical training while others such as village doctors in China are trained to educate and dispense medicine. In some low-income countries such as Nepal, Tanzania, Cambodia, Peru, China, Laos and Peru, primary health care workers are being trained to promote oral health and also provide a Basic Package or Oral Care recommended by WHO (Frencken et al, 2002). The essential components of the BPOC are:
• Oral Urgent Treatment (OUT) - emergency care, extraction of painful teeth and referral for advanced care.
• Affordable Fluoride Toothpastes (AFT) – promote the use of proven preventive measure
• Atraumatic Restorative Treatment (ART) – simple restorative treatment for decayed teeth using hand instruments and glass ionomer filling material.
There are a number of advantages in training existing primary health care personnel in oral care. These include:
• Equity: Primary health care workers usually live in the vicinity of the community where they are employed facilitating the development of oral health promotion activities and the provision of basic oral care within the community, especially rural communities where oral health care and prevention are not readily available.
• Low cost: Existing primary health care personnel are not as expensive to train and
employ.
• Appropriate training: The training may build on existing clinical and health promotion skills and the training required can be a short course in simple routine work such as the provision of dental emergency work and oral health promotion in conjunction with their other duties.
• Integration of oral health into general health: Primary health care workers provide an integrated approach to health as the small community situation provides an
excellent context for the integration of preventive oral health care with general health promotion activities.
• Relevance: Primary health care workers are trained to meet the expressed needs and demands of the community. Currently, the demand for oral health care at the first level of patient contact in communities of low- and middle-income countries is mainly for emergency treatment, which does not justify the employment of more
highly technically trained personnel. Patients requiring more specialised care can be referred to a dental clinic.
• Feasibility: It is the only foreseeable way to ensure equity in basic oral health care for the populations in low- and middle-income countries since a system of health posts or clinics are typically already be in place.
• Sustainability: It leads to a sustainable primary oral health care system because it makes use of existing management, communication, pay, support systems and physical facilities.
References:
Frencken JE, Holmgren CJ, van Palenstein Helderman WH. Basic Package of Oral Care. Nijmegen: WHO Collaborating Centre; 2002. http://www.whocc-nijmegen.nl/index.html
Petersen PE. The world oral health report 2003. Community Dent Oral Epidemiol 2003; 31 (Suppl. 1): 3-24.
Yee R, McDonald FN. Caries experience of 5-6-year-old and 12-13-year-old schoolchildren in central and western Nepal. International Dental Journal 2002; 52: 453-460.
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Practices members have applied in their own situations
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This topic is convened by: |
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Dr. Robert Yee
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