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Strategic Framework for Improving Oral Health in the Americas University of California, San Francisc

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Title: Strategic Framework for Improving Oral Health in the Americas University of California, San Francisc


1
Strategic Framework for Improving Oral Health
in the Americas University of California, San
Francisco, School of DentistrySpring, 2007
Dental Public Health Seminar Series
1
Pan American Health Organization
  • Saskia Estupiñán-Day
  • Regional Advisor for Oral Health

2
2
GLOBAL CHANGES
Investors in global health
ENVIRONMENT
Greater strategic coherence into the
fragmented foreign aid Secure donor funding
Research into viable policies Scale up
cost-effective Interventions Best practice
models Best Buys Measurement of progress
Challenges
  • Pandemic and Epidemic Threats
  • Avian Flu
  • Emerging and reemerging infectious diseases
  • ATM
  • Natural and Human Disasters
  • Weather
  • Large scale industrial accidents
  • War
  • Terrorism
  • Biological attacks
  • Chemical attacks
  • Nuclear attacks

Fragmented foreign aid aid pours out of separate
spigots USA Policies/ transformational
democracies Dysfunctional governance in the
international system Less than 20 capita/year
on health care Average 11 capita/year Universa
l package 34 Long term donor commitments for
improving performance
3
USA FOREIGN AID REFORM
3
  • New Strategic Framework
  • 154 developing and transitional countries
    receive US aid
  • 5 categories for aid
  • Rebuilding Countries Afghanistan, Colombia,
    Iraq
  • Developing Countries Cambodia, Pakistan,
    Egypt, Ecuador
  • Transforming Countries
  • Sustaining Partnership Countries Mexico,
    Russia, Kuwait
  • Restrictive Countries Venezuela

4
THE WORLD'S RICHEST MEN IN 32 BILLION GIVEAWAY 
-  27 JUNE 2006 The world's richest men, the
computer magnate Bill Gates and the financier
Warren Buffett, announced a 60 billion (32
billion) alliance yesterday to attack global
poverty and disease.
4
5
FUNDING FOR INTERNATIONAL HEALTHU.S. DOLLARS
5
  • Gates 2006
  • 1.5 billion/year
  • 85 Grants
  • Gates 2009
  • 3.0 billion/year Gates/Buffet kick in
  • USAID 2006
  • 1.6 billion mostly through contracts
  • IADB 2005
  • 124 million loans
  • 4 million Grants

6
6
  • 1990-2005 population increased by 165 million
  • 2015 another 100 million will be added
  • 152 million without access to safe drinking
    water and basic sanitation
  • 120 million without access to health care
    poverty
  • 107 million without access to health service
    geographic conditions

Source PAHO 2005
7
7
8
Strategic planning
8
  • Where we are Old wine in new bottles?
  • Where we are going Survive and thrive!
  • How do we get there Marketing goals Reinvent
    yourself
  • How do we know we are making progress
    Evidence Based

9
Strategic Framework for Improving Oral Health
in the Americas University of California, San
Francisco, School of DentistrySpring, 2007
Dental Public Health Seminar Series
1
Pan American Health Organization
  • Saskia Estupiñán-Day
  • Regional Advisor for Oral Health

10
2
GLOBAL CHANGES
Investors in global health
ENVIRONMENT
Greater strategic coherence into the
fragmented foreign aid Secure donor funding
Research into viable policies Scale up
cost-effective Interventions Best practice
models Best Buys Measurement of progress
Challenges
  • Pandemic and Epidemic Threats
  • Avian Flu
  • Emerging and reemerging infectious diseases
  • ATM
  • Natural and Human Disasters
  • Weather
  • Large scale industrial accidents
  • War
  • Terrorism
  • Biological attacks
  • Chemical attacks
  • Nuclear attacks

Fragmented foreign aid aid pours out of separate
spigots USA Policies/ transformational
democracies Dysfunctional governance in the
international system Less than 20 capita/year
on health care Average 11 capita/year Universa
l package 34 Long term donor commitments for
improving performance
11
USA FOREIGN AID REFORM
3
  • New Strategic Framework
  • 154 developing and transitional countries
    receive US aid
  • 5 categories for aid
  • Rebuilding Countries Afghanistan, Colombia,
    Iraq
  • Developing Countries Cambodia, Pakistan,
    Egypt, Ecuador
  • Transforming Countries
  • Sustaining Partnership Countries Mexico,
    Russia, Kuwait
  • Restrictive Countries Venezuela

12
THE WORLD'S RICHEST MEN IN 32 BILLION GIVEAWAY 
-  27 JUNE 2006 The world's richest men, the
computer magnate Bill Gates and the financier
Warren Buffett, announced a 60 billion (32
billion) alliance yesterday to attack global
poverty and disease.
4
13
FUNDING FOR INTERNATIONAL HEALTHU.S. DOLLARS
5
  • Gates 2006
  • 1.5 billion/year
  • 85 Grants
  • Gates 2009
  • 3.0 billion/year Gates/Buffet kick in
  • USAID 2006
  • 1.6 billion mostly through contracts
  • IADB 2005
  • 124 million loans
  • 4 million Grants

14
6
  • 1990-2005 population increased by 165 million
  • 2015 another 100 million will be added
  • 152 million without access to safe drinking
    water and basic sanitation
  • 120 million without access to health care
    poverty
  • 107 million without access to health service
    geographic conditions

Source PAHO 2005
15
7
16
Strategic planning
8
  • Where we are Old wine in new bottles?
  • Where we are going Survive and thrive!
  • How do we get there Marketing goals Reinvent
    yourself
  • How do we know we are making progress
    Evidence Based

17
Where we were
9
  • 1970-00
  • Health-For-All and Alma Ata
  • Shift from emergency care to community programs
  • Lack of equity seen as a health problem
  • Better understanding of prevention and
    decentralization
  • DMFT-12 score introduced to gauge burden of
    disease, WHO goal DMFT-12 score lt 3 by 2000
  • Surveys reported an average DMFT-12 score of 5.5
    for the Region (24 countries gt3 )

18
10
Typology Table in Oral Health 1990 2004
19
Accomplishments Trends of DMFT-12 for the Region
of the Americas 1987-2003
11
Source PAHO 2005
20
LESSONS LEARNED
12
  • Forty national oral health surveys indicate a
    marked decline between 35 to 85 in the
    prevalence of dental caries, attributed mostly to
    cost-effective salt and water fluoridation
    programs
  • Burden of oral disease is severe and remains high
    in certain geographic areas and high risk
    populations
  • Strong scientific evidence suggests the
    associations between oral infections, chronic
    diseases and adverse pregnancy outcomes
  • Best Practice Models on prevention and delivery
    of oral care

Pan American Health Organization
21
ASSOCIATIONS OF ORAL INFECTIONS AND MANY DISEASES
13
CV Diseases
HIV
Trauma
Diabetes
Preterm LBW babies
Cancer
Nutritional problems
22
Scientific evidence suggest that pregnant women
with periodontal disease are seven times more
likely to deliver PTLBW baby. This risk is much
higher than tobacco and alcohol.
Oral Infections and Pregnancy Outcomes
14
Clinical trials suggest that treating oral
infection in pregnant women before 26 weeks of
gestation reduces the incidence of PTLBW by 28
to 82.
23
Under-5 causes of death
Causes of death in Children under 5 (2000 2003)
15
Neonatal causes of death
birth asphyxia,
diarrheal diseases,
23
3
congenital
anomalies, 8
severe infections,
26
preterm birth, 28
neonatal causes,
neonatal tetanus,
37
7
other neonatal, 7
WHO The World Health Report 2005
24
WHERE WE ARE GOING?
16
  • PAHOS PRIORITIES
  • Unfinished agenda
  • 8 MDGs developed in 2000 as a collective
    international responsibility to reduce poverty
  • Maternal health
  • Child health
  • HIV and other communicable disease
  • Facing new challenges
  • Mounting evidence linking oral and systemic
    health
  • Protect the achievements

25
Strategic planning
17
  • LINEAR vs. 3D
  • Dynamic world of doing business
  • OPTIMIZATION
  • Critical thinking and competitiveness
  • Real market
  • Real value
  • SUSTAINABLE SUCCESS
  • Plan, vision, mission, goals
  • Provide a sense of purpose and direction
  • STRATEGIC PLAN
  • Respond and anticipate changes
  • Business plan and implementation
  • STAY FOCUS

Where there is a great complexity, there is also
a great simplicityWinston Churchill
26
Framework for the strategy
18
  • Best Practice Model
  • Best Buys
  • Partnerships
  • Downstream Investment
  • Measurement of Progress
  • Primary priority countries
  • Bolivia, Haiti, Honduras, Guyana, Nicaragua
  • Secondary priority countries
  • Ecuador, Guatemala, and Paraguay
  • Priority groups
  • MCH, Children, Women in reproductive age groups,
    HIV/AIDS, Indigenous groups, Elderly

Pan American Health Organization
27
.
19
How do we get there?
The Road Map
  • Goals
  • Objectives
  • Strategies
  • Programs
  • Marketing

28
GOAL 1A Minimum Level of Oral Health
Care For All By Addressing Gaps in Care For the
Most Vulnerable Groups
20

29
Who are most vulnerable?
21
  • Poor of all age groups
  • Socially marginalized
  • Geographically isolated
  • Women and children
  • HIV/AIDS

30
22
31

23
Objectives Reduction of Oral Infections
Increasing Access to Oral Health Care

32
GOAL 2The Integration of Oral Health Into PHC
Services
24
  • Develop mechanism to integrate oral health within
    current PHC services
  • Incorporate oral health component into prenatal
    programs
  • Scale up best practice models


33
25
A different approach
Amalgam Restoration
ART Restoration
34
PAHO/IADB Clinical Trials in Ecuador, Panama and
Uruguay PRAT PROBABILITY OF SUCCESS AND
FAILURE
26
  • Success Failure
  • Dentist doing amalgam 0.943 0.057
  • Dentist doing ART 0.960 0.040
  • Auxiliary doing ART 0.942 0.058

35
27
Pan American Health Organization
36
Scale Up Oral Health Coverage Using
Cost-Effective and Simple Technologies, PRAT
1.50 to treat/seal a tooth
28
Mexico over 10 million restorations under PRAT
37
PRAT SYSTEM Best Buy
29
  • PRAT provided at the lowest cost service modality
    produces acceptable outcomes
  • PRAT as a best practice model provides a
    framework to implement at large scale oral
    health services and will reduce the inequities
    for access to care services
  • A PRAT-based strategy for expanding coverage at
    reduced cost should become a cornerstone of
    policy at the regional and country levels
  • This study has produced evidence to guide
    downstream investment to improve equity and
    efficiency and quality of life in the Americas

38
  • GOAL 3
  • Scaling-Up of Proven Cost Effective Interventions
  • Salt fluoridation
  • Support Bolivia, Ecuador, Haiti, Honduras,
    Nicaragua, Paraguay and Saint Lucia to reach full
    implementation of fluoridation programs
  • Consolidate fluoridation programs with
    appropriate surveillance

30
Sealants 21.17 FL Supplements
2.53 Water Fluoridation 0.54 Salt
Fluoridation 0.06
39
PAHOs 1994Multi-Year Plan for Water-Salt
Fluoridation Programs in the Region of the
Americas
31
Cuba
Haiti
Mexico
Jamaica
Belize
Guatemala
Suriname
El Salvador
Costa Rica
Colombia
Ecuador
Peru
Sao Paulo
Paraguay
Uruguay
40
32
PAHOS MULTI-YEAR PLAN FOR SALT FLUORIDATION IN
THE AMERICAS IN 2004
Advanced Programs Mexico, Belize Costa Rica,
Jamaica Venezuela, Colombia Ecuador,
Peru Bolivia, Uruguay
Commencing Programs Cuba, Dominican
Republic, Guatemala, El Salvador, Honduras,
Nicaragua, Paraguay
Source PAHO 11/00
41
SALT FLUORIDATION SYSTEMS
33
  • Salt fluoridation is the controlled addition of a
    fluoride compound to salt in sufficient quantity,
    so as to have an anti-cariostatic effect

42
DENTAL CARIES IN COUNTRIES WITH CONSOLIDATED
NATIONAL SALT FLUORIDATION PROGRAMS
34
COUNTRY
BASELINE STUDIES
FOLLOW-UP STUDIES
CARIES
YEAR DMFT-12 YEAR
DMFT-12 REDUCTION ()
Colombia Costa Rica Jamaica Mexico Uruguay
1980 1988 1984 1987 1992
4.8 8.4 6.7 4.6 4.1
1998 1999 1995 1996 1999
2.3 2.5 1.1 2.5 2.4
52.1 70.6 83.9 45.7 41.5
Source PAHO. Jan. 2001
43
Protect your achievements
35
  • Because it works!
  • Scale
  • Importance
  • Ability to prove and measure results
  • Improved health impact
  • Sustainable
  • Cost effective
  • Partnerships/multidisciplinary
  • Information/marketing

44
How do we know we are making progress?
36
  • Impact evaluations
  • measure results
  • Which interventions worked
  • - look at goals
  • - are beneficiaries better off in a meaningful
    and sustained way
  • Solid foundations for partnerships between public
    and private sectors is critical to protect the
    established progress, ensure sustainability

45
In Summary
37
  • Best practice model provides a framework to
    implement at large scale oral health programs
  • We have the evidence and the knowledge that it
    works
  • Evidence demonstrates feasibility with extreme
    cost-benefit
  • Implementation requires leadership, commitment to
    guide downstream investment to improve equity and
    efficiency and quality of life in the Americas
  • Action and government support for dental public
    health programs

Pan American Health Organization
46
Trends of DMFT-12 for the Region of the Americas
38
EVIDENCE 1987-2003
PROJECTIONS 2007-2010
47
39
When health improves, life improves by every
measure Bill Gates
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