Oral health services
More than 20 years after widespread adoption, the strategy of Health for All through primary health care still has not been fully implemented. In many countries, national capacity and resources - human, financial and material - are still insufficient to ensure availability of and access to essential health services of high quality for individuals and populations, especially in deprived communities. Several countries are now engaged in the processes of change. Some are reforming the public sector as a whole. Other countries are reforming the health sector only, by decentralizing public services, fostering private sector participation and reorganizing ways to finance and provide health services. The objective of these changes is primarily to reduce inequities in access to health services, promote universal coverage, and improve the efficiency of the health system.
Oral health services transition coincides with the general trend in health services reform. In several Western industrialized countries, oral health services are made available to the population, comprise preventive and curative services and are based on either private or public systems. Meanwhile, people in deprived communities, certain ethnic minorities, homeless people, homebound or disabled individuals and the elderly are not sufficiently covered by oral health care. In countries of central and eastern Europe, decentralization and deregulation of oral health services has taken place during recent years. With privatisation, growing numbers of people cannot afford private dental care. In some east European countries, third-party payment systems have been introduced but priority is not given to preventive oral care. The demand for radical treatment services has increased particularly for low-income groups. In addition, many children are not covered by oral health programmes since the school dental services formerly offered in most east European countries have now been discontinued.
In developing countries, oral health services are mostly offered from regional or central hospitals of urban centres and little, if any, priority is given to preventive or restorative dental care. Many countries in Africa, Asia and Latin-America have a shortage of oral health personnel and by and large the capacity of the systems is limited to pain relief or emergency care. In Africa, the dentist to population ratio is approximately 1:150000 against about 1:2000 in most industrialized countries.
The WHO Oral Health Programme supports the development of oral health services that matches the needs of the country. The work to reorient oral health services towards prevention and oral health promotion is carried out in collaboration with the Regional Offices and the WHO Country Offices. A basic package of oral care has been developed to meet the principles of Primary Health Care and the model may be feasible to certain countries. Particularly for the developing countries, community care models for essential oral health are encouraged and several demonstration projects based on socio-cultural conditions are supported or carried out jointly with the WHO Oral Health Programme. Moreover, the WHO Oral Health Programme has designed an oral health component of the project Integrated Management of Adolescent/Adult Illness - Guidelines for First-level Facility Health Workers in Low Resource Settings.
Oral health personnel
The issue of oral health personnel - which categories of personnel need to be educated, their duties and the numbers of each - has for many years been of great concern. The importance of this matter really has become evident in a number of countries where the production of dentists appears irrelevant to the oral health needs and demands. The problem of production of inappropriate types and numbers of oral health professionals is still being faced by some countries. It has been reported, particularly in countries where over-production exists, that duties which traditionally have been performed by assisting personnel are now being carried out by the dentists themselves. In those countries, the introduction of ancillary personnel has been delayed. The changing pattern of oral disease and socio-demographic factors imply that adjustment of existing oral health manpower structures are needed for several developed countries. In developing countries, the challenge is to stimulate training programmes for types of personnel which would match the oral health needs and the infrastructure of the country.