Call to Action to Accelerating Action Towards Achieving Oral Health for All through Universal Health Coverage in the WHO South-East Asia and Western Pacific Regions
Chief Dental Officers of Ministries of Health of the WHO South-East Asia and Western Pacific Regions, representatives of WHO Collaborating Centres (WHO CCs) on oral health, other experts and supporting partners from The Borrow Foundation & La Trobe University, gathered for an informal regional WHO consultation on 24 October 2019 as a side-event of the 11th Asian Chief Dental Officers Meeting in Mandalay, Myanmar.
We, the participants of this meeting from 22 countries, appreciate with excitement the renewed global interest for oral health. The Lancet Series on Oral Health (July 2019) put oral health in the spotlight of international public health audiences and evidenced the challenges to all world regions related to oral diseases (such as untreated tooth decay, severe periodontitis, tooth loss and oral cancer, as well as other disabling oral conditions). The burden has remained mostly unchanged over the last decades; therefore, there is an urgent need for reform of oral health systems to achieve substantial reductions in disease burden.
We gratefully noted the recognition of oral diseases in the first-ever Political Declaration on Universal Health Coverage (UHC) that was adopted on 23 September 2019 by the UN General Assembly’s 1 st High-level Meeting on UHC in New York. Paragraph 34 states that UN Member States will step up efforts to strengthen UHC with full inclusion of oral diseases. Together with the inclusion of oral diseases in the 1 st High-level Political Declaration on noncommunicable diseases (NCD) in 2011, this will guide advocacy and programming towards achieving the 2030 development agenda.
The upcoming WHO Global Oral Health Report will be another milestone in this context, and we look forward to this timely publication. We expect the publication to detail the persisting challenge that oral diseases pose to our two WHO regions, particularly to the Pacific Small Island Developing States, while also presenting perspectives for moving towards universal oral health coverage.
We also note with appreciation the Call to Action developed by Chief Dental Officers, WHO CCs and other stakeholders of 20 Member States of the WHO African region during a regional meeting held in Brazzaville, Republic of Congo, in February 2019. The meeting was reviewing the implementation progress of the Regional Strategy on Oral health 2016-2025 (AFR/66/5). The Call to Action outlines important policy measures and recommendations for achieving Universal Oral Health Coverage relevant for all regions.
While these global and regional developments are much-needed major political advocacy achievements, there is a responsibility for us to accelerate the implementation of effective population-based preventive interventions and patient-centred care as part of inclusive NCD and UHC agendas. Many high- and middle-income countries in the two regions have already made significant progress, several are addressing common NCD risk factors through fiscal, and other policy regulations; innovative workforce models including mid-level and other health care providers are pioneered to address critical shortages; and health insurance schemes are being introduced to increase access to care without financial hardship for patients.
However, progress is not universal. We are acutely aware of a number of bottlenecks that may impact effective health systems responses to oral diseases, such as a general shortage of resources (financing & workforce), a mismatch between workforce training and population needs, inadequate infrastructure and supplies, lack of equitable access, high costs of care and significant out-of-pocket patient payments, high and increasing exposure to risk factors such as high sugar consumption, tobacco use and harmful use of alcohol, but also challenges such as growing and ageing populations, just to name a few. Many countries are also challenged by weak surveillance systems resulting in a lack of reliable oral health data.
We renew our commitment to oral health as part of the human right to general health and reaffirm that we will strive towards equitable, affordable universal access to essential oral health services, including prevention through fluorides and reduction of risks to oral health.
In alignment with the priority action areas of the Strategy for oral health in South-East Asia 2013-2020 (SEA/NCD/90) and joining the Call to Action of our African colleagues, we, therefore, commit to prioritizing the following actions:
Action area 1: Prioritizing reduction of common NCD risk factors & improving adequate utilization of fluorides for the prevention
- Use fiscal measures through increased taxation and other statutory regulations of products with a high content of sugars, alcohol and tobacco; and reserve the tax revenues for actions to promote health
- Reduce or eliminate taxes and levies on preventive oral hygiene products such as fluoride toothpaste to increase access and affordability
- Advocate for the recognition of quality fluoridated toothpaste as an essential health product that qualifies for reduced or removed taxation
Action area 2: Strengthening of integrated health system capacity towards Universal Oral Health Coverage
- Full integration of essential oral care in primary health care as an essential element of UHC
- Ensure availability of functional health facilities, adequate water, sanitation and hygiene (WASH) services, as well as availability and affordability of essential medicines and supplies through increased and effective investments
- Accelerate the phase-down of using dental amalgam, including measures to improve the affordability of safe and environment-friendly alternatives in the context of the Minamata Convention on Mercury
- Develop, test and implement competency-based workforce models based on population needs and inter-professional collaboration; and develop supportive policy frameworks to allow for flexible and effective delivery of quality services, including by non-dental health professionals
Action area 3: Improve integrated disease surveillance, service monitoring and evaluation
• Encourage and promote the inclusion of the optional Oral Health module in ongoing and future national STEPS surveys; and use all existing information sources to monitor and evaluate service coverage quality, outcomes and costs
• Encourage the application of oral health indicators comparable with other disease indicators that are understandable and usable by non-oral health professionals in addition to traditional oral diseasespecific indicators
• Improve national capacities for surveillance and service monitoring, led by a competent and functional Chief Dental Officer as part of NCD surveillance
Action area 4: Accelerating advocacy, leadership and partnership
- Facilitate effective collaboration among stakeholders from different sectors and disciplines based on clear roles, responsibilities and agreements
- Foster political leadership for UHC with essential interventions for oral diseases and NCDs as key components, including alignment of national oral health policies with regional and global health agendas
- Establish or increase domestic oral health budget allocations based on intervention costing and investment cases to allow for improved population coverage
All participants commend the WHO for its leadership and initiative and commit to supporting WHOs actions to improve integrated prevention and control of oral diseases. We call on WHO and its partners, including the network of WHO CCs, to:
- Consider follow-up and updating of Oral health: an action plan for promotion and integrated disease prevention. (World Health Assembly Resolution WHA60/R172007) in the light of recent developments and renewed momentum towards NCD and UHC agendas
- Accelerate the development of essential oral care packages with evidence-based and cost-effective interventions, addressing the most common population needs
- Ensure adequate technical support to the Member States through the appointment of WHO regional advisers on oral health to both SEARO and WPRO as well as WHO country focal point officers for oral health
- Support and facilitate regional networks, including WHO CCs on oral health for information sharing among stakeholders and to foster the integration of oral health within NCDs and UHC.