SCIENTIFIC COMMITTEE ON ORAL HEALTH WHO EASTERN MEDITERRANEAN REGION

SCIENTIFIC COMMITTEE ON ORAL HEALTH WHO EASTERN MEDITERRANEAN REGION

Baghdad, 15-19 December 1979

The views expressed i n t h i s report do not necessarily r e f l e c t the o f f i c i a l policy of the World Health Organization.

WHO EMRO

TABLE O F CONTENTS

INTRCDUCTION DENLAL C A R I E S PERIODONTAL D I S E A S E

PLANNING

GLOBAL STRATEGY FOR HEALTH FOR ALL FOR THE YEAR 2000 DTSCUSSION O F S P E C I F I C S I T U A T I O N REPORTS

SOMALIA

YEMEN ARAB REPUBLIC OMAN

SAUDI ARABIA SUDAN PAKISTAN IRAQ EGYPT MAIJPOWER

:lt:irELOPMENT O F A REGIONAL PLAN I N ORAL HEALTH COUNTRY A C T I V I T I E S

REGIONAL A C T I V I T I E S S i t u a t i o n A n a l y s e s P r e v e n t i v e P r o g r a m m e s M o n i t o r i n g o f P r o g r a m m e s RECOMMENDATTONS

Planning and Implrurr~ltdtiu~~ uL Oral H e a l ~ h S e r v i c e s r r a i n i n g o f O r a l H e a l t h P e r s o n n e l

P r e v e n t i o n S e r v i c e s R e s e a r c h L7-iO References

EMIDENTI37 page ii

TABLES ANNEX I

TABLE OF CONTENTS (Cont'd)

WELCOMING ADDRESS OF H.E. DR RIAD IBRAHIM EL HAJ HUSAIN, MINISTER OF HEALTH

P - - -- -- .- - --

WHO EMRO

ANNEX I1

ANNEX I11 ANNEX IV ANNEX V ANNEX VI ANNEX VII ANNEX VIII ANNEX IX ANNEX X

MESSAGE BY DR A.H. TABA, DIRECTOR, WHO EASTERN MEDITERRANEAN REGION TO THE WHO SCIENTIFIC COMMITTEE MEETING ON

ORAL HEALTH, BAGHDAD, 15

-

19 DECEMBER 1979 THE SITUATION ANALYSIS IN FIGURES

PROTOTYPE FOR PLANNING ORAL HEALTH SERVICES IN ANY COUNTRY SYSTEMATIC CARE PROGRAMME

DENTAL AUXILIARY CATEGORIES SURVEYS

AGENDA PROGRAMME

LIST OF PARTICIPANTS

WHO EMRO INTRODUCTION

F o l l o w i n g t h e o f f i c i a l o p e n i n g ceremonv w h i c h commenced w i t h a n a d d r e s s * by t h e M i n i s t e r o f H e a l t h , D r R i a d I . H u s a i n , a n d was f o l l o w e d b v a m e s s a e e * from D r A . H . T a b a , D i r e c t o r , E a s t e r n M e d i t e r r a n e a n R e g i o n o f WHO, D r Gogan opened t h e f i r s t w o r k i n g s e s s i o n o f t h e m e e t i n g . He t h a n k e d t h e i r a a i h o s t s f o r t h e i r h o s p i t a l i t y a n d o r g a n i z a t i o n , a n d made s p e c i a l ~ e f e r e n c e t o c h e c o m p r e h e n s i v e o r a l h e a l t h p l a n f o r I r a q , d e s c r i b e d by t h e M i n i s t e r o f H e a l t h .

D r N a j a t Z a k a r i a Y o u s s e f was a s k e d c a c h a i r t h e m e e t i n g and U r Ahmed H a s s a n S h e h a t a t o b e r a p p o r t e u r . I t was s u g g e s t e d t h a t i n v i e w o f t h e s i z e o f

t h e g r o u p i t would n o t b e n e c e s s a r y t o d i v i d e i n t o s u b g r o u p s f o r a n y o f t h e w o r k i n g s e s s i o n s .

The c h a i r p e r s o n t h e n a s k e d D r B a r n e s t o p r e s e n t t h e g l o b a l e p i d e m i o l o g y p i c t u r e f o r c a r i e s a n d p e r i o d o n t a l d i s e a s e s a n d t o o u t l i n e a m e t h o d o l o g y f o r i n t e g r a t e d o r a l h e a l t h s e r v i c e s p l a n n i n g .

D e n t a l C a r i e s

C a r i e s was c a t e g o r i z e d i n t o f i v e l e v e l s ( T a b l e 3 1 f r o m v e r y l a w t o v e r y h i g h p r e v a l e n c e . It was s t r e s s e d t h a t l e v e l s o n e a n d two a r e t h e moyt

i m p o r t a n t f o r t h e EMR, w i t h some Member S t a t e s r e a c h i n g l e v e l t h r e e - m o d e r a t e p r e v a l e n c e . V e r y h i g h l e v e l s o f c a r i e s e x i s t i n N o r t h a n d L a t i n A m e r i c a , E u r o p e , A u s t r a l i a a n d New Z e a l a n d ; l o w , v e r y l o w o r a t m o s t m o d e r a t e l e v e l s a r e f o u n d i n A s i a , A f r i c a , EMR o r a p p r o x i m a t e l y 80% o f t h e w o r l d ' s p o p u l a t i o r ~ .

D a t a o n t r e n d s i n c a r i e s w e r e p r e s e n t e d , t h e m a i n f e a t u r e s b e i n g t h e i n c r e a s e s o c c u r r i n g i n n e a r l y a l l p o p u l a t i o n s w i t h low t o m o d e r a t e l e v e l s , some v e r y l a r z e i n c r e a s e s h a v i n g b e e n e x p e r i e n c e d i n t h e s p a c e o f 10-15 y e a r s ( T a b l e s 4 a n d 5 ) . By c o n t r a s t i n c e r t a i n d e v e l o p e d c o u n t r i e s , w h e r e

communrty p r e v e n t i v e p r o g r a m m e s , i n c l u d i n g w a t e r f l u o r i d a t i o n , h a v e b e e n i m p l e m e n t e d , t h e r e i s now e v i d e n c e o f d e c r e a s e s i n c a r i e s t o a l e v e l o f

b e t w e e n 2 . 5 a n d 3 . 0 D e c a y e d , M i s s i n g a n d F i l l e d T e e t h (DFIF) a t 12 y e a r s o f a g e ( T a b l e s 6 a n d 7 ) .

*See a n n e x e s 1 a n d 2 .

WHO EMRO

The d r a m a t i c c h a n g e s i n c a r i e s i n some o t h e r i s o l a t e d g r o u p s . e . g . Eskimos and P o l y n e s i a n s , o v e r t h e l a s t 2 5 y e a r s w e r e m e n t i o n e d . A d i s c u s s i o n o f d i e t a r y c h a n g e s e n s u e d a n d p o s s i b l e i n v e s t i g a t i o n s o f t h e s e f a c t o r s w e r e c o n s i d e r e d .

The r e p r e s e n t a t i v e n e s s o f some o f t h e c o u n t r y d a t a p r e s e n t e d was

c o n s i d e r e d . It was s u g g e s r e d t h a t more e x t e n s i v e s u r v e y s m i g h t b e u s e f u l i n s e v e r a l c o n t r i e s , t h o u g h s u c h a c t i v i t i e s s h o u l d m a i n t a i n t h e p a t h f i n d e r a p p r o a c h a n d economy i n s a m p l i n g .

The u s e o f v e r y s w e e t f o o d s i n t r a d i t i o n a l d i e t s by many o f t h e

p o p u l a t i o n s i n t h e R e g i o n who h a v e low a n d v e r y low c a r i e s l e v e l s was n o t e d . T h i s i s a n a r e a o f s p e c i a l i n t e r e s t f o r r e s e a r c h . i n c a r i e s a e t i o l o g y i n t h e R e g i o n , t o g e t h e r w i t h c h a n g e s i n p r e v a l e n c e a s more r e f i n e d f o o d s a r e s u b s t i t u t e d f o r t r a d i t i o n a l o n e s .

When t h e c a r i e s d a t a f o r 35-44 y e a r o l d s w e r e c o n s l a e r e a . i t was n o t e d t h a t a t t r i t i o n o f t h e t e e t h d u e t o a b r a s i v e d i e t s may c o n t r i b u t e t o low c a r i e s i n c i d e n c e i n c e r t a i n g r o u p s w h e r e t h e p r e v a l e n c e o f c a r i e s i s v e r y l o w .

The e c o n o m i c i m p l i c a t i o n s o f e v e n m o d e r a t e i n c r e a s e s i n c a r i e s i n l a r g e p o p u l a t i o n s was r e c o p p i z e d a n d e m p h a s i z e d .

P e r i o d o n t a l D i s e a s e

-

The g l o b a l s i t u a t i o n r e l a t i n g t o p e r i o d o n t a l d i s e a s e p r e v a l e n c e was t h e n p r e s e n t e d a n d d i s c u s s e d . A l t h o u g h t h e e p i d e m i o l o g i c a l m e t h o d o l o g y i s n o t a s r e l i a b l e a n d o b j e c t i v e a s t h e DMF i n d e x f o r c a r i e s , t h e r e i s a w i d e v a r i a t i o n i n d i s e a s e l e v e l s t h r o u g h o u t t h e w o r l d ; many c o u n t r i e s w i t h low c a r i e s p r e v a l e n c e h a v i n g h i g h p e r i o d o n t a l d i s e a s e p r e v a l e n c e , a n d v i c e v e r s a . However, a f e w c o u n t r i e s h a v e b o t h l o w c a r i e s a n d l o w p e r i o d o n t a l d i s e a s e p r e v a l e n c e .

O t h e r

T o o t h m o r t a l i t y d a t a a t 35-44 y e a r s o f a g e i s p r o b a b l y a c o m b i n a t i o n oE l o s s d u e t o b o t h c a r i e s a n d p e r i o d o n t a l d i s e a s e a n d , i n som? s i t u a t i o n s , t o a p r e f e r e n c e f o r e x t r a c t i o n r a t h e r t h a n c o n s e r v a t i v e c a r e

able

8 )

.

The v e r y

P l a n n i n g

A d i s c u s s i o n o f t h e s t r a g i e s t o be used i n p l a n n i n g o r a l h e a l t h s e r v i c e s e n s u e d .

The f o l l o w i n g 5 f a c t o r s were c o n s i d e r e d :

1. P r e v e n t i o n i n c l u d i n g h e a l t h e d u c a t i o n .

2 . Tar-get groups ' s e r v i c e s , p a r t i c u l a r 1 y s c h o o l d e n t a l s e r v i c e s .

3 . D e n t a l s e r v i c e s f o r a l l n o n - t a r g e t e d s e c t i o n s .

4 . Manpower p r o d u c t i o n i n amount and k i n d .

5 . M o n i t o r i n g and e v a l u a t i o n .

The n e c e s s i t y t o e n s u r e c o o p e r a t i o n between t h e v a r i o u s p a r t i c i p a t i n g a g e n c i e s was n o t e d . For example, s c h o o l h e a l t h s e r v i c e s may b e t h e

r e s p o n s i b i l i t y o f t h e M i n i s t r y o f E d u c a t i o n o r M u n i c i p a l a u t h o r i t i e s , w h i l e o t h e r h e a l t h s e r v i c e s a r e p r o v i d e d by t h e M i n i s t r y o f H e a l t h . Moreover, i t was r e c o g n i z e d t h a t t h e h e l p o f t e a c h e r s was v i t a l i n o r a l h e a l t h e d u c a t i o n and a l l s c h o o l programmes. S e v e r a l examples were t h e n p r e s e n t e d o f p l a n n i n g a c c o r d i n g t o t h e g i v e n b a s i c f a c t o r s f o r s i t u a t i o n s r e l e v a n t t o t h e R e g i o n . It was s t r e s s e d , however, t h a t t h e r a ' t i o o f d e n t a l manpower t o p o p u l a t i o n s h o u l d b e c a l c u l a t e d a c c o r d i n g t o t h e n e e d s and s o c i o p o l i t i c a l o r g a n i z a t i o n o f each c o u n t r y o r a r e a , and t h a t t h e d u t i e s and t r a i n i n g o f e a c h manpower t y p e s h o u l d b e s p e c i f i e d f o r each s i t u a t i o n .

G l o b a l S t r a t e g y f o r H e a l t h f o r A l l f o r t h e Year 2000

I t was r e p o r t e d t h a t a G l o b a l Goal o f 3 DMF t e e t h a t 1 2 , , y e a r s o f a g e d e v e l o p e d w i t h i n t h e WHO O r a l H e a l t h programme was u n d e r s e r i o u s c o n s i d e r a t i o n b y MI0 and t h e FDI.

WHO E W E M / D E ~ T / ~ ~

page 3 h ~ g h f i g u r e s f o r New Zealand and S c o t l a n d were n o t e d . The v a r i a b l e e f f e c t s of t h i r d p a r t y schemes on t r e a t m e n t a p p r o a c h e s and p o p u l a t i o n c o v e r a g e were d i s c u s s e d and i t was s u g g e s t e d t h a t t h e c o n d i t i o n s under which such schemes a r e I n t r o d u c e d i n c o u n t r y programmes s h o u l d b e c a r e f u l l y c o n s i d e r e d s o t h a t t h e d e s i r e d e f f e c t may b e promoted.

EM/DENT/37 WHO EMRO p a g e 4

D e f i n i t i o n o f s p e c i f i c t a r g e t s f o r i n d i v i d u a l c o u n t r i e s s h o u l d b e p a r t o f t h e o v e r a l l r e g i o n a l s t r a t e g y b e i n g recommended. G o a l s f o r individ1:al

a d m i n i s t r a t i v e a r e a s s h o u l d b e s p e c i f i e d , i n p a r t i c u l a r , i n a r e a s w h e r e t h e DMF l e v e l i s s t i l l l e s s t h a t 3 . I n t h e s e s i t u a t i o n s t h e g o a l s h o u l d p e r h a p s be t o p r e v e n t i n c r e a s e s i n p r e s e n t l e v e l s .

S p e c i f i c g o a l s f o r t h e EMR m i g h t b e d e f i n e d n o t o n l y f o r d e n t a l c a r i e s , b u t i n r e s p e c t o f a r a n g e o f o r a l d i s e a s e s and c o n d i t i o n s b u t w i t h t h e o v e r a l l g l o b a l g o a l a s a " g u i d i n g l i g h t " and benchmark.

D i s c u s s i o n o f s p e c i f i c s i t u a t i o n r e p o r t s

C o u n t r y s i t u a t i o n a n a l y s e s had been c o m p l e t e d i n e i g h t o u t o f t h e 2 3 c o u n t r i e s i n t h e r e g i o n ( E ~ Y P ~ , I r a q , Oman, P a k i s t a ? , S a u d i A r a b i a , S o m a l i a , Sudan and yemen), b y p r s . Barmes, M o l l e r and Zahran.

The e s s e n t i a l d a t a used were:

1. R e s u l t s o f a p a t h f i n d e r s u r v e y o f 1 2 and 15 y e a r o l d s ;

2 . Sociodemographic and h e a l t h economic i n f o r m a t i o n ;

3 . C l i n i c a l r e c o r d s and h o s p i t a l s e r v i c e s d a t a ;

4 . P r e s e n t and p r o j e c t e d h e a l t h manpower and f a c i l i t i e s .

The e i g h t s i t u a t i o n a n a l y s e s were r e v i e w e d i n o r d e r o f i n c r e a s i n g c o m p l e x i t y . A t t h e c o m p l e t i o n o f t h e r e v i e w o f e a c h a n a l y s i s , a summary o f main f e a t u r e s , p a r t i c u l a r l y a s t h e y b u i l t on t h e p r e v i o u s r e v i e w , was g i v e n ,

t h u s :

1. SOMALIA ( 1 d e n t i s t : 1 000 000)

-

low d i s e a s e l e v e l

-

i n d i g e n o u s p r a c t i t i o n e r s

-

s c a r c e manpower

-

need f o r a u x i l i a r y t r a i n i n g

-

s i m p l e p r e v e n t i v e programme i n s c h o o l s s u p e r v i s e d by . $ e a c h e r s .

WHO EMRO

2 . YEMEN ARAB REPUBLIC (1 dent is t : 380 000)

-

sipilar to patterns for Somalia, but very poor oral hygiene

-

salivary gland affections and oral mucosa conditions related to Khat and Shamme habits

-

emphasis on oral hygiene improvement - need for defluoridation in Ta'iz.

3. -

OMAN (1 dentist : 100 000)

- higher caries level except in the South - need to restrict sale of sweets in schools

-

need for fluoride programme in schools

-

high economic potential

-

need for administrative reorientation to the preventive first approach.

4.

SAUDI ARABIA (1 dentist :

38

000)

-

similar disease levels to Oman

-

special emphasis on careful planning and reorientation of both services and manpower development policies. including programming which takes note of use of auxiliaries, prevention, records and evall~ation.

5 . SUDAN (1 dentist :

78

000)

-

disease Levels between Somalia and Oman

-

further development and utilization of auxiliaries and professional manpower, with maximum use and careful administration of existing and available facilities. Development and expansion of school health and associated preventive schemes. Review of dental school and auxiliary curricula.

6. P A K I S W N ( 1 dentist :

62

000)

-

higher levels of periodontal disease and increasing severity of dental caries

- _a

national oral health pathfinder survey as a basis for promotion of

dental services f

-

establishment of schools for dental auxiliaries

E M / D E N T / ~ ~ WHO EMRO page 6

-

establishment of systematic school dental services ircluding preventive measures

-

upgrading of indigenous prac~itioners by courses g i v e r 1 i t 1 one of L!IZ

suggested auxiliary schools

-

establishment of administrative direction for the dental services at the Federal level, assisted by chief dental officers at the individual state level

-

avoidance of brain drain of dental personnel.

IRAQ

(1 dentist : 9 500)

7.

-

-

caries increases to the moderatelhigh level of severity is a major problem for adults

-

promotion of dental auxiliary ,staff to b e used in the preventive scheme w i t h i n t h e school d e n t a l h e a l t h services

-

upgrading o f services to adults to overcome the problem of periodontal diseases.

8. EGYPT

(1 dentist :

8

500)

-

caries increases to the moderatelhigh levels in some sections of the population and periodontal disease at the high level

-

national oral health programmes including prevention, fluoridation, school dental health services and oral health education

-

improvement of manpower utilization

-

training of preventive non-operatingdental auxiliaries

-

promotion o f dental research

-

national surveys for monitoring and evaluation of the ongoing programme.

WHO EMRO

Discussion concentrated on the following features:

- training of dental auxiliaries

- national pathfinder surveys for monitoring and evaluation

- proper planning and programming for correct utilization of existing resources

- promotion of dental research

- more attention to preventive dental programmes

Dr Ali Khogali gave a br'ief review of the main features of manpower in EMR. The supply varies from almost aero to oversupply if related to demand.

In all countries the rural population is underserved; there is imbalance between professionals and. auxiliary workers of all types; in several countries there are large numbers of traditional/illegal practitioners providing various services to the public.

It was stressed that the manpower process should consist of three areas:

1. planning for needs;

2. production and training;

3.

utilization and management, including supervision, continuing education, etc.

N . B : Dentofacial anomalies

-

There were no major and outstanding features

r e l a t e d t o d e n t o f a c i a l a n o m a l i e s . I t w a s n o t e d t h a t t r e a t m e n t r c q u i r c m e n t

data wereprovided in the situation analysis for Saudi Arabia, Sudan and Yemen Arab Republic which were unifo'rmly low

- 5

to

9%

at 12 years and 6 to

13%

at 15 years. The need was also in that range in Oman, though the numerical data were not provided. However, in Somalia, Pakistan and Iraq no treatment requirement data were given and the system of recording individual occlusal traits vas used. This system provided percentages ranging"from

25

to

78%

which are 5 y no means unusual for such measurements. Treatment requirement data can be checked but the likely relationship to percentages of anomalies is about one in four, thus placing treatment requirements.at about the same level as for the other analyses.

WHO EMRO Factors which affect the three areas were presented and discussed thus:

I. in no country h a s a manpower plan heen d e v e l n p e d nn t h e h l s i s o f

epidemiological data;

2.

there is a lack of integration between the sectors responsible for training and utilization of personnel; some mechanisms for ensuring close collaboration and coordination between these two sectors must be identified ;

3.

analyses of tasks and job descriptions need to be made for all levels of personnel, including professionals, on the basis of the defined needs and available resources;

4 . training programmes and curricula need to be ddsigned on the basis of

tasks to be performed and facilities available for services;

existing curricula need to be revised and reoriented;

5.

a programme of training and reorienting teachers needs to be

c i n d e r t a k e n s n that they are aware of t h e conditions and tasks of graduating students and of the new and efficient teaching methodology and materials available:

6. evaluation of training programmes must be part of the course;

7.

it should be possible for countries to collaborate, thus making full use of available experience;

8. one of the major obstacles to change is professional antagonism, especially in the area of realistic training for defined tasks;

9 . it should be remembered that as the needs of the population and the

resources available change, there will be a need to relate the changed situation to the training programmes;

10. curricula for professional training should include training in supervision and the provision of continuing education t o auxiliaries.

It

was noted that auxiliary personnel+should be recruited from a basic education level which is much lower than the level for professional categories;

WHO EMRO

E M / D E N T / ~ ~ page

9

11. one of the difficulties facing oral health administration is the fact

that the oral health sector is not usually integrated, effectively, into national health planning;

12. it was felt that auxiliary duties should be related more to preventive than to curative therapy and services.

DEVELOPMENT OF A REGIONAL

PLAN

IN

ORAL

HEALTH

After the discussion of the general manpower situatiun, Dr ydller

presented the paper entitled "A Plan of Action for an Oral Health Programme in the Eastern Mediterranean Region", concentrating on the activities and flow diagram in pages

8

and

9

of that paper.

This presentation led to a consideration of what individual councries need to do to develop national. integrated oral health programmes, as well as the activities

WHO

should generate in order to catalyse this development.

The meeting agreed that the basic approach used in the first

8

situation analyses was sufficient to enable countries to proceed with planning and implementation. It was recognized, however, that at the same time as the implementation proceeded there would be a need to collect additional data, this need being greater in large countries with a federal structure, e.g.

Pakistan, and least in a situation of early development of dental services, e.g. Yemen Arab Republic

It was agreed that a further set of situation analyses would be formulated during the next 18-24 months (see Annex 111 for prototype statistical sheet).

COUNTRY ACTIVITIES

The various factors each country needed to consider to establish a national oral health plan (see A n n e x ~ v for check list) were:

1. Monitoring and evaluating, including:

(a) an initial situation analysis,

I

(b) periodic monitoring and evaluation in time for redirection and replann ing

.

EMIDENTI37 page

10

Data needed for a situation analysis:

WHO

EMRO

i. official policy and commitments, including present budget and projection for the period of the plan;

ii. demographic and socioeconomic data, (population estimates by rural and urban, relevant age groupings, and main ethnic

subdivisions, and information on nutrition and fluoride content of water) ;

iii. general health staristics on services, manpower, training institutions and facilities;

iv. oral disease data and qervice utilization estimates.

In the situations "here it is felt that additional data are needed, further data on e~idemiology of dental caries, periodontal disease as well as other diseases, as relevant, and on nutritional status for different aress a n d subgroups of the population might be collected. Information on legislation should also be reviewed.

2. Formulation of specific goals for a 10 year period.

The following goals are examples of the type of approach recommended:

(a) Preventive

-

prevent any increase in the dental caries prevalence measured' in the situation analysis; or reduce dental caries prevalence to

3

teeth at 12 years where it exceeds this level;

-

maintain healthy enamel structure by ensuring that there is an optimal fluoride environment for a specified percentage of the population;

-

control periodontal diseases to maintain a level of periodontal health to be reflected by an average of no more than one segment with calculus and gingivitis by age 15 (NB. Goals could also be expressed in terms of other indices).

?

WHO EMRO EMIDENTI37

page 11

S p e c i f i c g o a l s f o r o t h e r o r a l d i s e a s e s may be a p p l i c a b l e i n some s i t u a t i o n s .

( b ) Systematic s e r v i c e s

promotion o f s y s t e m a t i c school d e n t a l s e r v i c e s s o t h a t :

-

A% of s c h o o l c h i l d r e n w i l l be r e g i s t e r e d i n a s y s t e m a t i c school d e n t a l s e r v i c e ; X% of t h e DMF average a t 12 y e a r s w i l l be accounted f o r . b y t h e F component and no more than 2% w i l l be M;

-

f o r t h e c o n t r o l of p e r i o d o n t a l d i s e a s e s r e f e r t o 2 ( a ) , t h i r d item.

( c ) S e r v i c e s on demand

-

w i t h i n A y e a r s t o provide a s a t i s f a c t o r y f i r s t a i d and emergency c a r e s e r v i c e w i t h i n a v a i l a b l e h e a l t h c a r e f a c i l i t i e s f o r B% o f t h e p o p u l a t i o n :

-

t o respond t o an a n t i c i p a t e d i n c r e a s e i n demand f o r s e r v i c e s from G% t o HZ, a v a i l a b l e s e r v i c e s should b e d i r e c t e d t o s p e c i f i e d p r i o r i t y groups.

3. Plans t o a t t a i n s t a t e d g o a l s .

The f o l l ~ w i n g c h e c k l i s t was c o n s t r u c t e d from which programmes could be c o n s t r u c t e d :

( a ) p r e v e n t i v e s e r v i c e s

a d j u s t m e n t o f f l u o r i d e c o n t e n t o f d r i n k i n g w a t e r t o t h e optimal l e v e l ;

t o p i c a l a p p l i c a t i o n o f f l u o r i d e ;

h e a l t h e d u c a t i o n programme f a r t h e whole p o p u l a t i o n ;

' r'

d i e t a e c o n t r o l , e s p e c i a l l y s u g a r ;

E M / D E N T / ~ ~

page 12

WHO EMRO

oral hygiene programme for plaque control;

education of health and other manpower.

(b) Systematic services

As a component of the overall health system:

- establish priorities based on situation analyses for population coverage and select minimal or systematic care service (see Annex

V)

according to existing or projected resources;

- establish recording/reporting sys tem including base line r-ecords;

- provide refe-rral sys tern for provision of treament and follow-up.

(c) Services on demand

- establish appropriate facilities, rural or urban public or private, fixed or mobile;

- establish priorities for quality and types of care;

- implement programmes and integrate with existing services;

- establish basic uniform recording and reporting system.

4. Manpower estimates

( a )

Preventive programme

Depending on the situation in each country many different types of personnel will be participating in the provision of health services,

particularly preventive programmes. The following activities to ensure that each category* is appropriately trained and motivated will be necessary;

*

¹

Annex VI provides a list of titles used for auxiliary types and the broad

functions which apply.

WHO EMRO E M / D E N T / ~ ~ page 13

i specify job description

r i

. .

analyse tasks to be performed

i i i develop curricula on the basis of tasks;

iv train the teachers v implement the programme vi evaluate and monitor

Proerammes

H e a l t h education:

systematic (schools) Teacher, nurse, health worker, auxiliary, dentist.

other groups of populatioq Nurse, health worker, auxiliary, dentisc.

Oral hygiene programme:

in schools

general population

Fluoride programme in schools

Fluoridation

*Supervision by dental personnel.

Teacher

*

Mass media

*

Teacher or teacher's assistant*

Water engineer and assistant

Whatever is the final decision for utilization of manpower types, allocation of time per activity by non-dental staff will need to be used to calculate man/year requirements of such personnel. Full time dental staff will also need to be allocated probably on che basis of a Small number.

perhaps only one or two, per administrative district.

4(b) Systematic services

Estimates of staff for these services can be made very accurately from

?

situation analysis data on the basis of:

E M / D E N T / ~ ~

WHO

EMRO page

14

-

task definition, usually comprising examination, prophylaxis extraction and filling;

- decision on manpower type

-

specialist, dentist, auxiliary;

-

time allotment/eligible person;

-

consequent ratio of personnel needed to treatment group.

4(c) Services on demand

Less precise estimates ,are possible in this area based on:

-

estimation of demand provided in the situation analysis in terms of both percentage of the population demanding care and time needed for

care ;

-

decision on level of services to be provided;

-

decision on manpower type, specialist, dentist, auxiliary;

-

consequent ratio of personnel needed to treatment group.

4(d) Manpower requirements

After deciding on the type of services possible, given the resources of manpower and training facilities and the disease levels, estimates from the

three previous sectors are combined with manpower needed for central functions and For training to reach an estimate of total manpower requirements. The

tasks and functions to be performed are specified for the various activities and then the decision as to which manpower types will staff the service should be made. If operating auxiliaries are used in the school dental services

their d u t i e s would include f i l l i n g s , u r a l hygiene instruction, exrraccion of primary teeth, prophylaxis and, possibly, extraction of permanent teeth.

As a guide to the most usual outcome of such estimations, ratios have been calculated using the 5 part planning scheme (see page 3 ) and include staff for creatment/curative work; administration and organization, preventive services and training programmes. It should be noted that the main ixes of variation in Table

8

are the dental caries levels and the type of school dental service chosen.

WHO EMRO E M / D E N T / ~ ~ T a b l e -1 Example D e n t a l Manpower R a t i o s page 1 5

1. For v e r y low c a r i e s p r e v a l e n c e and no s c h o o l d e n t a l s e r v i c e s ( i . e . o n l y p r e v e n t i v e s e r v i c e s

i n s c h o o l s ) . 1 : 8 0 0 0 0

2. For v e r y low c a r i e s p r e v a l e n c e and minimal s c h o o l d e n t a l s e r v i c e .

3 . For v e r y low c a r i e s p r e v a l e n c e and a more d e v e l o p e d ( l i m i t e d ) s c h o o l d e n t a l s e r v i c e . 4 . For low c a r i e s re valence and incremental

s c h o o l d e n t a l c a r e ( 2 y e a r r e c a l l )

5. For moderate c a r i e s p r e v a l e n c e ( i . e . DMF a t

12 y e a r s = 3 ) and a 2 y e a r r e c a l l i n c r e m e n t a l s e r v i c e . 1 : 4 000

- T a b l e 2 summarizes t h e o v e r a l l p o p u l a t i o n t o o p e r a t o r r a t i o s t h a t were recommended f o r 1990 i n t h e s i t u a t i o n a n a l y s i s .

E s t i m a t e d T o t a l number R a t i o p o p u l a t i o n /

Country p o p u l a t i o n o f o p e r a t o r s o p e r a t o r 1990

1990 ( m i l l i o n s )

Oman 1.5 105 1 : 1 5 000

Yemen Arab R e p u b l i c 9 300 1 : 3 0 000

Sudan 22 1000 1 : 2 2 0 0 0

S a u d i A r a b i a 11 1375 1: 8 000

The c o r r e s p o n d i n g f i g u r e s f o r S o m a l i a , P a k i s t a n , I r a q and Eqypt h a v e b e e n c a l c u l a t e d u s i n g T a b l e 1 l e v e l s , Somalia a t . l e v e l 1 and I r a q , Egypt and P a k i s t a n a t l e v e l 5 .

Soma1 i a P a k i s t a n I r a q Egypt

E M / D E N T / ~ ~ page 1 6

4 ( c ) Manpower P r o d u c t i o n

WHO EMRO

F o l l o w i n g a l l t h e c a l c u l a t i o n s o f manpower r e q u i r e m e n t s and when t h e manpower t y p e s h a v e been d e c i d e d u p o n , t h e a p p r o p r i a t e t r a i n i n g programme n e e d s t o be a g r e e d o n t h e b a s i s o f t h e job d e s c r i p t i o n , s k i l l s n e e d e d and t a s k s t o be p e r f o r m e d . The c o u r s e s s h o u l d e n s u r e t h a t t r a i n e e s g a i n t h o s e s p e c i f i c s k i l l s and t h e g r a d u a t i n g s t u d e n t s h o u l d b e e v a l u a t e d a c c o r d i n g l y . Such c o u r s e s w i l l b e needed f o r a l l manpower t y p e s , namely d e n t i s t s , a u x i l i a r y p e r s o n n e l , o t h e r s , e . g . m e d i c a l a u x i l i a r i e s , s c h o o l t e a c h e r s and p h y s i c i a n s and f o r t e a c h e r s t h e m s e l v e s .

C o n t i n u i n g e d u c a t i o n s h o u l d b e a v a i l a b l e t o a l r e a d y t r a i n e d s t a f f .

I t w i l l b e n e c e s s a r y t o p r o v i d e t h e r e l e v a n t c o u r s e m a t e r i a l s - i n A r a b i c i f p o s s i b l e .

E v a l u a t i o n o f c u r r i c u l a and t r a i n i n g programmes a s w e l l a s end o f c o u r s e e v a l u a t i o n f o r each s t u d e n t s h o u l d b e made. The p r o c e s s o f e v a l u a t i o n .

m o d i f i c a t i o n o f p r i o r i t i e s , r e o r i e n t a t i o n and u a c r a d i n g o f t r a i n i n g c o u r s e s i s a dynamic one and s h o u l d be c o n t i n u o u s , s e : f i g . 1.

The q u e s t i o n o f what t o do a b o u t t r a d i t i o n a l p r a c t i t i o n e r s was d i s c u s s e d . I n some s i t u a t i o n s i t h a s b e e n p o s s i b l e t o p r o v i d e them w i t h f u r t h e r t r a i n i n g s o t h a t t h e y c a n o p e r a t e w i t h i n t h e a u x i l i a r y o r p r i m a r y h e a l t h c a r e s y s t e m . However, i t was s t a t e d t h a t t h i s i s n o t a l w a y s p o s s i b l e .

The i l l e g a l c a t e g o r y o f a u x i l i a r y , c a l l e d d e n t u r i s t , s h o u l d b e c o n t r o l l e d by l e g i s l a t i o n , b u t i t was r e c o g n i z e d t h a t t h i s i s o f t e n a d i f f i c u l t t a s k . I t was t h o u g h t t h a t i t i s b e s t t o p r e v e n t o c c u r r e n c e o f t h e problem by c a r e f u l s e l e c t i o n o f t r a i n i n g e n t r y l e v e l s , i . e . a u x i l i a r y t r a i n e e s s h o u l d b e s e l e c t e d a t t h e end o f p r i m a r y s c h o o l o r a f t e r o n e o r two y e a r s o f s e c o n d a r y s c h o o l .

5 . Resources

P l a n s , programmes and manpower p r o d u c t i o n t a b l e s s h o u l d a l w a y s i n c l u d e a p r o j e c t i o n o f t h e f a c i l i t i e s , equipment and m a t e r i a l s t h a t w i l l b e , r e q u i r e d f o r a p p r o p r i a t e and p r o d u c t i v e employment o f a v a i l a b l e manpower. T h i s i s p a r t i c u l a r l y i n p o r t a n t i n t h e f i e l d o f d e n t i s t r y , where b o t h d e n t i s t s and a u x i l i a r i e s r e q u i r e a b a s i c minimum o f r a t h e r e x p e n s i v e o p e r i t i n g f a c i l i t i e s

WHO EMRO EMIDENTI37 page

17

Coordination between training and employment authorities in this area is so important and so often neglected that the following specific recommendation was made. "At the moment that a group of individuals start training, an order to the reponsible Ministry, stating the clinic and equipment facilities

that will be required for their employment at the end of the course,should be standard procedure. ^"

I t is very important to ensure that the training equipment is of a similar type to the service equipment that will be available. The production of standard,robust,easily maintained sets of equipment of reasonable cost is needed.

When contracts for supply of dental equipment are being negotiated it is important to include specifications for correct installation and testing of the equipment as well as provision for adequate maintenance, incltldine the training of maintenance technicians.

It was indicated that all of these factors need to be part of an established system for budgetary projection coordinated with salaries and other coet for the plan.

REGIONAL A C T I V I T I E S

The following specific activities were requested of W0:

S i ~ u a ~ i o n Analyses

provision of simple appropriate forms and criteria for situation analyses,

pathfinder surveys

consultant assistance with situation analyses and plans calibration of examiners

standardized recording/repnrting f n r m a and systems

provision of training courses in epidemiology and application of results

fellowships to attend relevant courses

organization of short courses in planning of services, particularly preventive services, to be held for small groups of countries with

similar problems +

E M / D E N T / ~ ~ page 18

WHO

EMRO

Preventive programmm

-

bulk buying of preventive agents, e.g. fluoride salts

-

fluoride analytical services

-

assistance with establishment and organization of supply services

-

appropriate oral health education material and production of a catalogue of materials for oral health education

-

library of WHO documents

-

assistance with journals and other materials from DANIDA.

Monitoring of programmes

A regional advisory group should monitor progress in the Region, possibly through follow-up meetings at regular intervals:

a

global newsletter

reporting on all activities in oral health may assist in this area.

RECOMMENDAT IONS

Planning and implementation of oral health services

A.

Further situation analyses should be made in the Region using the Pathfinder survey methodology (see Annex VII).

B.

Countries should define their own targets, keeping in mind suggested caries preventive goals, either reduction to

3

DMF teeth at 12 or maintaining present levels.

C. The prototype for planning oral health services (Annex IV should be used as a basic activity check list in developing oral health plans.

D.

Mechanisms for ensuring that (i) the oral.health sector is included in the general health plans and programmes, and (ii) collaboration and

coordination between training and employing authorities providing or affecting health services should be identified.

E. Careful :sns;deration should be given to the probable effects of any type of third party payment schemes and to the availability of sufficient and appropriate manpower before they are introduced. ₊

WHO EMRO E M / D E N T / ~ ~

page

19

F. Senior government dental staff should receive salaries and working

conditions commensurate with their responsibilities so that they are not obliged to practise privately part tlme and can devote sufficient time to administration, evaluation and planning.

G. Each country should choose its manpower type(s) in accordance with its needs and available resources as identified in the situation analysis, and only after carefully defining the functions to be performed.

H. A u x i l i a r y personnel should be specifically o r i e n t e d towards the p r e v e n t i v e

aspects of oral health care.

I. A

policy should be formulated on how to handle the illegal practice and practitioners of dentis try where they exist

.

Training of oral health personnel

A. Each country should define the tasks and functions to be performed in accordance with available facilities and resources as identified in the situation analyses.

B.

The types of manpower to perform these tasks should then be determined.

C.

Where auxiliary personnel are to be utilized, dentists should be specially trained to supervise and help provide continuing training and guidance to the auxiliary staff.

D.

Auxiliary personnel should be specially oriented towards preventive care

E.

Special reorientation/in-service training for teachers of oral health personnel should be available at regular intervals.

F. WHO should assist with establishment of new training and research institutions and help to promote TCDC in this area.

G. Care should be exercised in choosing entry levels for auxiliary trainees far enough below the entry level for dentists so that the risk of large scale development of illegal practice is minimized. I

EM/DENT/37 page

20

WHO EMRO

H.

Evaluation of training programmes should be part of pla~ning.

Prevention

A . Fluoridated drinking water should be monitored and adjusted to optimal levels, taking account of ingestion from food and other sources.

B.

Alternative uses of fluorides should be introduced.

C. The sale of s w e e t s in and near schools should be prohibited or strongly discouraged.

D. Appropriate oral health education material should be developed.

Services

A. The establishment of efficient running of stores and equipment, including spare parts,should be a high priority. When services are being planned, use of standard equipment in the public sector should be encouraged and careful planning for its timely availability is required.

B.

Greater use of the regional centre for training health equipment maintenance technicians should be made.

C. Continuing pressure for the manufacture of robust, easily maintainable economic dental units and other equipment is needed.

D.

Standard recording/reporting systems should be used in all public dental services and a standardized system for evaluation of other services should be established.

E. A review of legislation relating t o provision o f o r a l h e a l t h s e r v i c ~ s and employment of personnel in the Region should be made, and examples of model legislation prepared.

Research

A . Studies of populations, as traditional diets are changea to a more refined diet, should be developed.

WHO EMRO EM/DENT/37 page 2 1 B . Research i n t o a n t i - m i c r o b i a l p r o p e r t i e s o f miswak c h e w s t i c k s h o u l d be

u n d e r t a k e n .

C . Research i n t o s p e c i a l problems o f d i f f e r e n t c o u n t r i e s s h o u l d b e e n c o u r a g e d , e . g . Khat and t o b a c c o chewing h a b i t s .

WHO R e f e r e n c e s

1 . O r a l H e a l t h S e r v i c e s , B a s i c Methods, Geneva 1977.

2 . P l a n n i n g O r a l H e a l t h S e r v i c e s , Geneva, i n p r e p a r a r i o n 1 9 8 0 .

3 . D e n t a l C a t a l o g u e

-

A Guide t o B a s i c r e q u i r e m e n t s f o r D e n t a l P r a c t i c e , Geneva, 1978.

4 . O r a l H e a l t h R e c o r d i n g / R e p o r t i n g Manual, Geneva, i n p r e p a r a t i o n 1980.

5 . Guide t o Epidemiology and D i a g n o s i s o f O r a l Mucosal D i s e a s e s a n d C o n d i t i o n s , Community d e n t . & O r a l E p i d e m i o l . 1 , 1980.

6 . Common O r a l D i s e a s e s

-

P r e v e n t i o n & Emergency C a r e

-

^A Manual f o r T e a c h e r s Geneva, 1980.

E M / D E N T / ~ ~ page 22

WHO EMRO

WHO EMRO E M / D E N T / ~ ~

page 2 3

Tab 1 e .4 TRENDS FOR DENTAL CARIES AT 12 YEARS

COUNTRY

YEAR DMFT

^LEVEL

-

YEAR DMFT

-

^LEVEL

E t h i o p i a 1958 0 . 2 Very l o w 1975 1 . 5 Low

Kenya 1 9 5 2 0 . 1 Very low 1 9 7 3 1 . 7 Low

N i g e r i a 1963 . 1 . 1 Very l o w 1 9 7 3 2 . 5 LOW

N b r t h e r n P r o v i n c e

mlEA

JRFNDS FOR DFNTAL C A R I E S AT 12 YEARS

COUNTRY YEAR DMFT LEVEL YEAR DMFT ^LEVEL

LEBANON

1961 1 1 2 ^LOW 1974 3,6

^MODERATE

SYRIA

1964 2,2

LOW

1974 4.5

MODERATE

1963 - ^ALL

AREAS VERY HIGH

GllEI

1974 - ⁷⁵ -

^ZURICH

3.9

MODERATE

-

SCHOOL BASED PREVENTION SINCE

1964

BASEL

2.3 LOW - ^WATER

FLUORIDATION SINCE

1962

SOLOTHURN

7,3

V E R Y H I G H

VAUD

5.4 - 4.4 HI

GH-MODERATE

-

SALT FLUOR IDATION

- AND

TABLETS

s

INCE

1969- 70

GLARUS

7,O

V E R Y H I G H

LUCERNE

4.8

HIGH

-

FLUORIDE TABLETS PROGRAMME

AUSTRALIA CARIES DMF TEETH 12 YEARS

DMFT

-. .. .

- 4.7

HIGH

-

FLUORIDE TABLET PROGRAMMES TOWNSVI

LLE 4,O

MODERATE

- ¹⁰

YEARS WATER FLUORIDATION

CANBERRA 2.9

MODERATE

- ¹²

YEARS WATER FLUORIDATION ADELAIDE

4.6

HrGH

- ⁶

YEARS WATER FLUORIDATION

WHO EMRO

Table 8

TOOTH MORTALITY

% Edentulous a t a g e 35-44

N e w Zealand (Canterbury) 36

Scot land 35

England d Wales 2 2

Finlaqd 18

A u s t r a l i a 1 5

USA 8

Norway (Trondelag) 6

Fed. Rep. o f Germany (Hannover) 2

Japan (Yamanas h i ) 0

EMIDENTI37 page 25

WHO OH.;

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.

, _.

-

,..#> ,.iR%\. ..*ILA ^{-r,:- iP.1}

EMIDENTI37

I

x s s i ~ 4 Annex I ii ra8q page i

bnr. esU5rzi, ~3 ,i:>.i, 3 0 3nr!&x'q 9r!J jnsvsxq o f bar rnta rdorq a r r l ~ :o (fivirxa nkdfkt fislqrns33o .-sd ei zidT ^{.nrsd., nor3} j1uzs-r bLuo.7 rl3ldw anrsldo-rq d l loxfno3

WELCOMING ADDRESS OF H.E. DR RIAD 1BRAHJ.M EL HAJ HUSAIN

.

" S ~ f i I 4 o ~ q b3nsfiIq MINISTER OF

HEALTH

1

:

~ivoi' ^2.43 bs-isbieno~ svsri 4w ,zsmsxgoxq xuo 30 3rro gfildxow 8:!3 nl Ladies :and y ~ 7 a s - 2 Genplemen

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^{,isc'. 2 ; - D J sd bIrrsrIs} a-rgo-rq rdf ltarIT

-

It is my pleasure to welcome you all to Baghdad,

;@?d%&?&&%

d#a&l~@OJnd

It has been the policy of the Ministry of Health, in the re aration and*

bsd-raw

38

^b8,oda 3i ~ s r '

-

execution of it6 d&1~df~~&&&2&2$;

P C &$tt'%",3&

7;eventive and curative measures, 4smm1g.

- g

sdy oi ::v33oLIo b c i ~ s q r 1

within the framework of a larger plan for' v a r i o d s e c l l t h programmes. In t l ~ i a , i L

has depended on.nationa1 sta ~ s t i c

.

-.

.,

^,

^-

^{,,jl sdj}

^5;

~ , & $ ~ ~ i ~ f ~ ~ ~ 9 8 ~ ~ ~ \ i d & . 5 affd X+th:*e~pr*ent

-

availability of manpower and our estimation of future n e e d - ~ s Q , f m # 4 K g $ ~ t ~ r l ~ o ~ + $ d e r a - tion the element of time to enable us to cope with the progress conducted by the

!ev?,lu t iongry

<,%*

~t;Pp~J3aa t h . 1 P ~ f i d @ h * U ~ 6 z . ~ d ~ p b & ~ $ d i s i # basic principles of the National Development Programme.

.

ssL?sa,rmmon rtnslrvff t b 3 0

Furthermore, we have taken into consideration the pres

E

q i f t f l + ~ g ~ o ~ n ~ k ~ Q e r & ~ t u r e : a o v ; J ~ a t d o pniwolLo~ 963 3 1 ~ 0 fSa S V Y.4 ~

fi

ones which could develop when the plan is implemented in its various aspects: social, econo$cr Faltj;@seB

fpj @fi:

~ j i f g i ~ p j ~ ~ g p ~ ~ k b i B 8 wbiob-.f;cid W WSYS~ qf otfhe -co&

m ~ i t ~ * ~ $ " . a ~ f o @ t ~ g ~ $ f ~ h $ f ~ @ r & 3 ~ & ~ ~ g x @ 4 : , ~ r 4 9 ~ & ~ & ~ a l i s l l f 1 ~ i f r 1 3 3 33 bf16

;as~kbnk

Iraq is confronted with two epidemiological dental problems: mainly periodontal

disease and,

-

^den

.

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t i & l l ~ in the more developed socio-economic c o m m u n i t ~ ~ & perkoiodrmtd -still

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In addition to these two major problems, we suffer from shortage of manpower and d e n t a l , h ~ ~ ~ ~ d an&: ~ r

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in patients coming too late,

a&

X& kH&sb-s% ?fia%?F adv&hc~%'s?~~e~"?6~~? treated

-

a situation which demands tooth extraction and, in turn, raises the curve of missing teeth. Consequently, it was necessary to adopt certain measures to minimize the

EM/DENT/ 37 Annex I page ii

WHO

EMRO

g r a v i t y of t h i s problem and t o prevent t h e prevalence of t h e s e two d i s e a s e s and c o n t r o l t h e problems which could r e s u l t from them. This i s being attempted w i t h i n planned p r o g r a m e s .

In t h e working o u t of our programmes, we have considered t h e following p o i n t s :

-

^That t h e programme should be w e l l d e f i n e d , e x p r e s s i n g i t s e l f c l e a r l y i n comon b a s i c p r i n c i p l e s ;

- that it should embody the objectives for which it has been planned and presented w i t h i n a t h e o r e t i c a l frame s u i t a b l e f o r t h e p r e s e n t s i t u a t i o n and f o r implementation;

-

t h a t it should be worked o u t according t o t h e s o c i a l development and w i t h i n t h e period a l l o t t e d t o t h e programme;

-

t h a t i t must be i n harmony w i t h t h e p r i n c i p l e s of t h e Revolutionary Conrmand and t h e Baath P a r t y ;

-

t h a t it ohould complement t h e g e n e r a l p o l i c y of planning f o r t h e requirements of d i f f e r e n t communities.

For t h i s long-run p l a n we have s e t o u t t h e following o b j e c t i v e s :

1

-

t o prevent t h e i n i t i a t i o n of c h r o n i c o r a l and d e n t a l d i s e a s e s i n I r a q , and t o c o n t r o l t h e i r prevalence according t o s c i e n t i f i c a l l y acknowledged i n d i c e s ;

2

-

t o c o n t r o l t h e p r e s e n t c h r o n i c o r a l and d e n t a l d i s e a s e s w i t h i n o u r p r e s e n t c a p a c i t y

-

and t h e f u t u r e one;

3

-

t o prevent any f u t u r e problems which could develop as a r e s u l t of t h e s e d i s e a s e s ;

4

-

t o p r e v e n t t h e v e r t i c a l r i s i n g of t h e main problem r e s u l t i n g from t h e p r e s e n t oro-dental d i s e a s e s (.extracted t e e t h ) ;

WHO EMRO EMIDENTI37 Annex I page iii

5 - t o change the present epidemic i n d i c e s , a d preverlL Lhe problems which

could develop i n t h e f u t u r e a s they a r e i n d i c a t e d i n t h e r i s i n g v e r t i c a l curves, and t o minimize t h e s e i n d i c e s through p r e v e n t i v e measures and according t o p r i o r i t i e s

-

p r e s e n t and f u t u r e

-

and t h e p r e v a l e n c e and s e v e r i t y of t h e s e oro-dental d i s e a s e s i n t h e d i f f e r e n t communities, which form t h e mother community;

6

-

t o have a l t e r n a t i v e s f o r t h e main p l a n t o be adopted i n t h e l i g h t of t h e high or low prevalence and s e v e r i t y of thc diacaae;

7

-

t o choose t h e b e s t and most economical methods t o c o n t r o l t h e c h r o n i c oro-dental d i s e a s e s and t h e main problems r e s u l t i n g from them;

8

-

t o e s t i m a t e t h e need f o r c o l l e g e - o r i e n t e d f u t u r e d e n t a l manpower t o cope w i t 1 1 Ll~e process of lmplemencaclon of che programme;

9

-

t o adopt t h e system of team-work t o t r a i n o u r d e n t i s t s t o become p r o f e s s i o n a l s i n t h i s kind of work;

1 0

-

t o e s t i m a t e t h e n a t i o n a l need f o r d e n t a l equipment r e q u i r e d f o r p r e v e n t i v e and c u r a t i v e measures.

For t h e p r e v e n t i o n and c o n t r o l of oro-dental d i s e a s e s i n I r a q i communities, important p r i o r i t i e s have been e s t a b l i s h e d which a r e v i t a l f o r t h e implementation of t h e s t r a t e g i e s and programmes. These i n c l u d e :

1

-

s c h o o l h e a l t h s e r v i c e s w i t h c o n c e n t r a t i o n on s t u d e n t s of primary s c h o o l s

-

on a n a t i o n a l s c a l e , and w i t h i n t h e measures t a k e n t o change t h e a c t u a l d e n t a l h e a l t h s e r v i c e s f o r t h e s e p r i o r i t i e s from demand t o need. This i s worked o u t according t o t h e o b j e c t i v e s of t h e P l a n and i t s r e q u i r e - ments; i . e . p r e p a r i n g team-work and a d o p t i n g team-work w i t h i n t h e g r a d u a l t o t a l coverage of a l l primary s c h o o l s ;

2

-

^Maternity iuld C l ~ l l d dental h e a l c h s e r v l c e s which o f f e r p r e v e n t l v e and c u r a t i v e d e n t a l h e a l t h s e r v i c e s f o r l a c t a t i n g mothers, pregnant women, mothers and pre-school c h i l d r e n , w i t h i n t h e g r a d u a l t o t a l coverage f o r a l l Maternity and Child Welfare c e n t r e s on a n a t i o n a l b a s i s . S e r v i c e s

EM/ DENT/37 Annex I page i v

WHO EMRO

a r e o f f e r e d through d e n t a l h e a l t h s e c t i o n s which a r e e s t a b l i s h e d a c c o r d i n g t o t h e p r e v a l e n c e and s e v e r i t y of o r o - d e n t a l d i s e a s e s and complementary t o t h e s c h o o l h e a l t h s e r v i c e s mentioned above;

3

-

t o i n c r e a s e t h e demand and improve t h e q u a l i t y of d e n t a l h e a l t h s e r v i c e s , t h e f o l l o w i n g measures have been taken:

a. t o expand t h e e s t a b l i s h m e n t of d e n t a l p o l y c l i n i c s and d e n t a l s e c t i o n s i n o u r h e a l t h c e n t r e s , which a r e k e p t i n l i n e w i t h t h e g e o g r a p h i c a l d i s t r i b u t i o n of t h e p o p u l a t i o n and d e n t a l epidemics;

b. t o adopt d e n t a l . h e a l t h and d e n t a l e d u c a t i o n a s measures t o implement p a r t of t h e p l a n , t h a t i s by o f f e r i n g o r i e n t e d and r e f r e s h e r c o u r s e s f o r d e n t i s t s and a n c i l l a r y d e n t a l workers and t e a c h i n g s t a f f . The o b j e c t i v e s of t h e s e c o u r s e s a r e :

i. t o c o ~ u n i c a t e p r e v e n t i v e and c u r a t i v e knowledge, means of implementation and p r e v e n t i v e c o n t r o l t o t h e d e n t i s t s working i n p r e v e n t i v e and c u r a t i v e f i e l d s ;

ii. t o s t a n d a r d i z e methods a c c o r d i n g t o s p e c i f i c c h a r t s s p e c i a l l y prepared f o r i n c r e m e n t a l d e n t a l c a r e , t a k i n g i n t o c o n s i d e r a t i o n t h e t i m e f a c t o r , t o e s t a b l i s h b a s e - l i n e d a t a f o r d i a g n o s t i c p u r p o s e s and f u t u r e e v a l u a t i o n and t h e implementation of t h e p l a n a c c o r d i n g t o t h e l i n e s drawn above;

iii. t o b e n e f i t from t h e knowledge o f f e r e d by s p e c i a l i s t s i n d i f f e r e n t advanced d e n t a l s c i e n c e s f o r e d u c a t i o n a l p u r p o s e s which some p r o v i n c e s l a c k ;

i v . t o t r a i n p e r s o n n e l , t e c h n i c a l l y and a d m i n i s t r a t i v e l y t o cope w i t h t h e f u t u r e expansion and t o implement t h e proposed p l a n ;

WHO EMRO EMIDENTI37 Annex I Page v

v. to improve the quality of dental health services and minimise the pressure by referring difficult cases which could be handled locally by the centre of the provinces;

vi. to improve the quality of productivity and to control chronic dental diseases to lower the vertical curve of the main problem (tooth loss);

vii. to propagate the most recent and advanced scientific findings to the denrlscs In che provinces to acquaint them w l L h L l ~ a rliIIacent fields of dentistry and train them until specialists become available;

viii.to provide information about dental health to the teaching staff in primary schools to complement dental services;

ix. to disseminate information to the public to increase awareness and motivation, individually and community-wise, on dental health.

The concerned body for the implementation of this plan is a central organization in Baghdad which comprises: ,

-

The Directorate General of Medical Services, for curative services;

-

The Directorate General of Preventive Medicine, for preventive services;

-

Rural Health Foundation for supervision of dental health services in rural areas and for dental laboratories;

-

The Directorate General of Medical Equipment, for the supply of dental equipment;

Finally,

I

hope that this Scientific Committee will be able to achieve its objectives and

I

wish you a very pleasant and fruitful stay in our beloved Iraq.

WHO EMRO EM/DENT/37 Annex I1 page 1

- . .

ANNEX I1

MESSAGE BY DR A. H. TABA DIRECTOR

WHO W S T E R N ?fEDITERRZNWN REGION TO THE

lJHO SCIENTTFTC COMMITTEE MEETING ON OR4L HEALTH

Baghdad, 1 5

-

19 December 1979

I n welcoming you a l l to c h i s m e e t i n g o f a S p e c i a l Committee o n O r a l H e a l t h , I h a v e much pleasure i n e x p r e s s i n g our thanks to the G o v e r n m e n t

of Iraq f o r h o s t i n g t h i s m e e t i n g a n d f o r t h e e x c e l l e n t a r r a n g e m e n t s made.

As you a r e a w a r e , t h e O r a l H e a l t h Programme o f WHCI s t r o n g l y e m p h a s i z e s t h e p r e v e n t i v e a s p e c t s o f o r a l h e a l t h . With v e r y few e x c e p t i o n s , i t i s u n l i k e l y t h a t most c o u n t r i e s , e v e n when v e r y p r o s p e r o u s , c a n p r o v i d e e u f f i c i e n t manpower t o s a t i s f y a l l t h e n e e d s o f t h e p e o p l e f o r c u r a t i v e d e n t i s t r y .

The b a s e l i n e s f o r t h e d e v e l o p m e n t o f o u r f u t u r e c o l l a b o r a t i o n w r t h t h e c o u n t r i e s w i l l b e d e r i v e d from a s e r i e s o f s i t u a t i o n a n a l y s e s which h a v e b e e n c a r r i e d o u t i n t h e p a s t few y e a r s . F o r t u n a t q L y , o u r c o n s u 1 t a : l t s h a v e b e e n a b l e t o u s e a new s i m p l i f i e d s a m p l i n g t e c h n i q u e w h i c h has

p e r m i t t e d t h e c a r r y i n g o u t o f t h e s e e x e r c i s e s a t a f a i r l y r e a s o n a b l e c o s t , and which p r o d u c e s much v a l u a b l e i n f o r m a t i o n . T h e s e s i t u a t i o n a n a l y s e s ^, h a v e b e e n c a r r i e d o u t i n I r a q , Oman, P a k i s t a n , S a u d i A r a b i a , S o n a l i a , Sudan a n d Yemen. D u r i n g t h e n e x t f e u y e a r s i t i s p l a n n e d t h a t t h e p v i 11 b e e x t e n d e d t o many o t h e r c o u n t r i e s oE t h e E a s t e r n N e d i t e r r a n r a n R q i o n . The s i t u a t i o n a n a l y s e s h a v e a l s o g i v e n us v a l u a b l e i n s i g h t s i n t o t h e h e a l t h manpower s i t u a t i o n . I hope t h a t t h i s g r o u p w i l l b e a b l e t o a s s i s t

+