POLICY GUIDELINES FOR ORAL HEALTH CARE IN TANZANIA

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POLICY GUIDELINES FOR ORAL HEALTHCARE IN TANZANIA

• Mariam J. Mwaffisi
• Permanent Secretary
• Ministry of Health
• Tanzania

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United Republic of Tanzania

• Population 34 million (2002 Census)
• Population growth rate 2.8

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Provision Of Health Services

• Since Independence (1961) free of charge, paid by
  the Government and centralized
• Health Sector Reforms introduced in 1994

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The Health Sector Reforms (1994) in Tanzania

• Came as a result of poor quality and quantify of
  health services provided in the public health
  facilities

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The main objectives of the Health Sector Reforms

• Is the development of sustainable and equitable
  health care based on the efficient use of
  available resources and health care providers

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Essential Health Interventions in Tanzania

• Identifies
• Intervention which will most effectively and
  efficiently reduce the leading causes of
  morbidity and mortality
• And which the government can afford to make
  available to the whole population

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The Tanzanian package of Essential Health
Interventions

• Five components
• Reproductive and child health services
• Communicable diseases control
• Non-communicable disease control
• Treatment and care of other common diseases, eg
  oral conditions, eye conditions etc
• Community Health Promotion and Disease Prevention

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The Vision of the Health Policy

• Improving the health status of the population and
  higher coverage of quality health services for
  the poor

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Burden of Oral Diseases

• 80 of the population is affected by gingivitis
• Periodontal breakdown is low
• Dental caries affects more the older population
• High to very high prevalence of endemic dental
  fluorosis in regions with high fluoride leveles
  in water

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Policy guidelines for Oral Health Care in
Tanzania (2002)

• Objective
• To improve the oral health of Tanzanians with
  focus on those most at risk by ensuring
• Oral health services are available and accessible
  to both urban and rural areas
• Sufficiency of oral health care personnel at all
  levels
• To sensitize Communities on preventable oral
  health problems and involve the community in
  solving them

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Strategies

• Promotion of lifestyles conductive to oral health
• Reduction of preventable oral conditions
• Provision of basic curative and rehabilitative
  oral health services
• Oral health services to cover the majority of the
  Tanzanian population

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Management of Oral Health Services

• According to Health Sector Framework
• Decentralization of responsibility for the
  delivery of oral health services to the local
  government authority/district councils
• Regional level to support the districts and offer
  link with central/national level

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Management of Oral Health Services (Cont..)

• Core function of central level (MoH) is
  monitoring, policy formulation, regulation, human
  resourse development and resourse mobilazation
  and allocation
• At central/national level (MoH) Oral Health
  Services are under the Directorate of Hospital
  Services

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National Essential Oral Health Interventions

• Includes
• Dental Caries
• Periodontal Diseases
• Oral Neoplasms
• Maxillofacial Trauma
• Endemic Dental Fluorosis

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The Essential Package of Oral Health Care in
Tanzania includes

• Emergency Oral Health Care Services in Health
  centres and dispensaries
• Prevention of Oral Diseases (School Dental
  Services and Oral Health Education at the
  Reproductive and Child Health Services Clinics)
• Oral health promotion in the communities
• Provision of curative and rehabilitative oral
  health care services at levels I,II, and III
  hospitals

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The budget for Oral Health Care in Tanzania

• Is in line with the Package of Essential Health
  Intrventions as reflected in the Health Sector
  Strategic Plan (HSSP) 2003-2008 and Medium Term
  Expenditure Framework (MTEF)

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HSSP 2003-2008 Oral Health Issues

• Provision of quality OHS at all hospital levels
  and emergency oral health care at Health Centrers
  and Dispensaries
• Dental clinics at all hospital levels
  rehabilitated and equipped
• Quality, safe, adequate and effective dental
  supplies made available in all Public and Faith
  Based Organizations Health Facilities
• Preventive maintenance system established

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Achievements

• The Central Oral Health Unit is an established
  body within MoH to coordinate Oral Health
  Services
• Policy guidelines for Oral Health Care in
  Tanzania have been prepared and approved by MoH
  (2002)
• Standard treatment Guidelines for Oral Health
  Care in Tanzania have been prepared and approved
  by MoH (2001)
• Plan for rehabilitation and equipping dental
  clinics at all hospital levels has been prepared
  and approved by MoH (2001). As a result of
  implementing the plan

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Achievements (Cont..)

• Fifty one Council/District Dental Clinics out of
  121 council dental clinics in Tanzania have been
  rehabilitated and equipped
• Two hundred and seventy PHC facilities
  (Dispensaries HCs) are providing emergency oral
  health care using non dental personnel (clinical
  officers)
• Manuals for oral health education in primary
  schools and reproductive and child health
  services have been reviewed and are in use
• Thirty two Dental Officers, 66 Assistant Dental
  Officers, 98 Dental Therapists and 16 Dental
  Laboratory Technicians are providing services
  through the country

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Achievements (Cont..)

• Thirty Seven Dental Officers, 2 Assistant Dental
  Officers and 5 Dental Laboratory Technicians are
  teaching at the 5 oral health training schools in
  Tanzania ( 1 Dental School , 1 ADO Training
  School, 2 Dental Therapist schools and 1 Dental
  Laboratory School) Technologist
• Intake at the Dental School has been increased
  from 12 to 25 students annually
• Evaluation of the Oral Heath status of 5-6, 12,
  18, 35-44 and 55 year olds has been evaluated
  (2004). Data analysis is on going and final
  report will be available in June 2004

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Achievements (Cont..)

• A Meeting for Regional Dental Officers is held
  annually to discuss progress, achievements and
  constraints in the implementation of oral health
  care packages
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Achievements (Contd)

• A central workshop has been established for
  maintenance of dental equipment and preventive
  maintenance of equipment is tought in the oral
  health training institutions
• There is an exemption mechanism for those who
  cannot pay
• Community health fund/national health insurance
  fund established

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Constraints  

• Inadequate number of oral health personnel to
  provide services (especially Dental Surgeons and
  Technicians) at all levels
• This is due to the fact that some Dental Surgeons
  have gone for greener pastures and some do not
  report for work in remote areas
• The scarcity of appropriate and adequate
  facilities to provide services is reflected in
  low demand for some types of oral health care by
  the communities

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Constraints (Cont..)

• Low morale among health workers because of lack
  of equipement and supplies
• Inadequate funding for planned Oral Health Care
  Activities because of limited resourses
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Future Plans

• Increase the coverage of the rural population
  where possible with minimal oral health care
  services
• To sensitize Councils to employ oral health
  personnel for the different levels of health
  facility
• To finalize rehabilitation/establishment of
  district dental clinics and provision of
  appropriate equipment, instruments and supplies

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Future Plans (Cont..)

• To work together with the private sector to
  participate in the provision or Oral Health
  Services by providing them with guidelines and
  monitor their performance
• The role of Traditional Oral Health Care
  providers to be explored for possible utilization
  of their services
• Quality assurance of services to be monitored
• To provide incentives and motivations to Oral
  Health Personnel for maximum productivity
• Identification of alternate funding mechanisms in
  addition to government sources

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Conclusion

• In order to attain the specific objectives of
  the basic package for oral health care Oral
  Health Care personnel in Tanzania must
• Set-targets based on available resourse for the
  provision of care and demands of communities
• Have a working plan for appropriate utilization
  of their working time

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Conclusion (Cont..)

• Move out of the dental clinics for outreach
  services (school Dental Services and Health
  Education at The Reproductive and Child Health
  Care Clinics
• Be cost effective by using with care dental
  equipment, instruments and supplies
• Should abide to professional ethics when
  performing their duties
• Be smart in requesting for resource allocation

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Thank You for Listening

• Asante Sana