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Oral Health in the African Region:
A Regional Strategy
1999 - 2008
AFR/RC48/9
World Health OrganizationRegional Office for Africa
Harare, Zimbabwe
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World Health OrganizationRegional Office for Africa
Harare, Zimbabwe
Oral Health in the African Region:
A Regional Strategy
1999 - 2008
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Publications of the World Health Organization enjoy copyright protection in accordance with the
provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved.
The designations and the presentation of the material in this publication do not imply the expression of any
opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of
any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries.
The mention of specific companies or of certain manufacturers' products does not imply that they are
endorsed or recommended by the World Health Organization in preference to others of a similar nature that are
not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial
capital letters.
Printed in the Republic of South Africa
WHO Regional Office for Africa
(2000)
©
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CONTENTS
Oral Health
iii
Page
EXECUTIVE SUMMARY.....................................................................iii
INTRODUCTION .................................................................................1
JUSTIFICATION AND POLICY BASIS ............................................3
ORAL HEALTH PRIORITIES..............................................................5Severe problems ...............................................................................5Other problems................................................................................6Determinants of oral health problems in Africa............................7Development needs .........................................................................8
THE REGIONAL ORAL HEALTH STRATEGY...............................9Long-term vision..............................................................................9Guiding principles............................................................................9Strategic framework.........................................................................9Implementation framework ..........................................................14
MANAGERIAL FRAMEWORK .........................................................16Resource mobilization...................................................................16Coordination..................................................................................17Monitoring and evaluation ............................................................18
CONCLUSION.....................................................................................19
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ANNEXES
1. RESOLUTION AFR/RC48/R5: ORAL HEALTH IN THE AFRICAN REGION: A REGIONAL STRATEGY .........................................................21
2. EPIDEMIOLOGICAL BASIS FOR RANKING ORAL DISEASE BURDEN IN LOW-ECONOMICSTATUS COMMUNITY ..............................................................25
3. CONCLUSIONS OF THE CONSULTATIVE MEETING ON IMPLEMENTATION OF THE REGIONAL ORAL HEALTH STRATEGY INAFRICAN COUNTRIES .............................................................14
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EXECUTIVE SUMMARY
1. The important contribution of oral health to general community
health and well-being has been highlighted in resolutions adopted at
the World Health Assembly (WHA) and Regional Committees.
However, these resolutions have had limited impact.
2. Previous approaches to oral health in Africa have failed to recognize
the epidemiological priorities of the Region or to identify reliable
and appropriate strategies to address them. Efforts have consisted
in the provision of unplanned, ad hoc and spasmodic curative oral
health services, which in most cases are poorly distributed and only
reach affluent or urban communities.
3. There was therefore a compelling need to review existing strategies
and develop a comprehensive strategic framework to support
countries in the Region.
4. This document focuses on the most severe oral problems that people
have to live with, like noma, oral cancer and oral consequences of
HIV/AIDS infection. It proposes a strategy for assisting Member
States and partners to identify priorities and interventions at various
levels of the health system, particularly at the district level.
5. The strategy aims at strengthening the capacity of countries to
improve community oral health by effectively using proven
interventions to address specific oral health needs. It represents a
new approach that has the potential to fundamentally improve
community oral health in the African Region.
6. In the light of the foregoing, the Regional Committee at its forty-
eighth session, reviewed the proposed oral health strategy for the
African Region for the period 1999-2008 and provided orientations
for the enhancement of oral health in Member States in the Region.
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INTRODUCTION
Oral health describes the well-being of the oral cavity, including the
dentition and its supporting structures and tissues. It is the absence of
disease and the optimal functioning of the mouth and its tissues, in a
manner which preserves the highest level of self-esteem.
Oral diseases affect all human beings irrespective of location, country,
nationality, race or colour. In the African Region there is a
disproportionate amount of oral disease which has grave and often fatal
consequences. Some of these diseases seem to be growing in prevalence as
a result of the massive social disruption on the continent. Although many
oral diseases are not always life-threatening, they too are important public
health problems because of their high prevalence, public demand and their
impact on individuals and society in terms of pain, discomfort, social and
functional limitations and handicap, and the effect on the quality of life.
In addition, the financial impact on the individual and community is very
high.
Because oral health is so fundamentally influenced by many of the
environmental factors that influence general health, an effective oral
health policy or programme must address both generic and specific
influences on oral health. Such policy or programme may include:
• support for generic programmes which are effective in reducing
poverty and promoting equity in the Region;
• support for generic programmes which are effective in providing
clean water, proper sanitation and durable housing for all;
• participation in health promotion and education programmes to
control tobacco and alcohol use and promote correct nutritional
practices, including prudent use of sugar.
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The strategy is a tool for assisting Member States and their partners to
more systematically identify priorities and plan viable programmes,
particularly at the district level. It aims to strengthen the capacity of
countries to improve community oral health by effectively matching
proven interventions to specific oral health needs. This in turn will
require countries to refocus the education and training of the personnel
required to address these new demands on the oral health system.
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JUSTIFICATION AND POLICY BASIS
There is a compelling need to review existing strategies and develop a
comprehensive strategic framework to support countries, considering
that:
• previous approaches to oral health in Africa have failed to recognize
the epidemiological priorities of the Region or to identify reliable
and appropriate strategies to address them;
• only 14 out of the 46 countries (30%) of the Region have a national
oral health plan. Very few countries have made any progress towards
implementation and none have evaluated what has been done, which
strongly suggests that such plans are fundamentally flawed or too
ambitious;
• efforts have consisted in the provision of unplanned, ad hoc and
spasmodic curative oral health services. An emphasis on the
production of the kind of personnel demanded by this approach has
led to a number of African countries creating institutions where
students in the oral health sciences receive training in sophisticated,
inappropriate forms of oral health care, while in others little or no
training at all is available;
• the oral health care available in the Region is almost entirely curative
and largely directed towards combating one main problem namely:
dental caries. Severe oral diseases such as noma, oral cancer, the oral
manifestations of HIV infection and trauma have been largely
omitted in both public and private care systems in the Region as they
have been from the educational programmes for oral health
personnel. These are the diseases which increasingly have the
greatest morbidity and mortality of all oral conditions in the Region.
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The important contribution of oral health to general community health
and well-being has been highlighted in resolutions adopted at the World
Health Assembly (WHA) and the Regional Committee (RC) namely:
• resolution WHA36.14(1983), which called on Member States to
follow available health strategies when developing their national oral
health strategies;
• resolution AFR/RC24/R9 (1974), which requested the WHO
Regional Director for Africa to provide for the establishment of
dental advisory services within the Regional Office;
• resolution AFR/RC30/R4 (1980), which called on Member States
of the African Region to integrate oral health into primary health
care programmes;
• resolution AFR/RC44/R13 (1994), which called on Member States
to formulate a comprehensive national oral health policy and plan
based on primary health care (PHC) and to develop appropriate
training programmes for oral health care workers at all levels,
particularly at the district level.
Furthermore, the Conference of Heads of Dental Health Services in the
African Region (1969) and the Regional Experts Committee on Oral
Health (1978) recommended the establishment of oral health services
based on the public health approach. Various international conferences
on oral health and other related initiatives have also endorsed the need for
a comprehensive approach to oral health.
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ORAL HEALTH PRIORITIES
Dental caries and periodontal disease have historically been considered
the most important oral health problems around the world. However, in
African countries, these appear to be neither as common nor of the same
order of severity as in the developed world. The oral health profile of
Africa today is very different from that perceived previously. This profile
of oral disease is not homogeneous across Africa. Thus, oral diseases
known to exist in each community need to be individually assessed in
terms of the basic epidemiological criteria of prevalence and severity. This
is a prerequisite for the meaningful ranking of community needs and the
development of intervention programmes with which to address them.
There is no doubt that the African Region has to urgently address a
number of very serious oral conditions, either because of their high
prevalence or because of the severe damage or death that can arise from
them.
Severe problems
Cancrum oris (NOMA) and acute necrotizing ulcerative gingivitis
(ANUG) with which it is known to be associated is still common among
children in Africa. The most recently available annual incidence figure for
NOMA is 20 cases per 100 000. About 90% of these children die without
receiving any care. With increasing poverty and given the fact that many
children are malnourished or undernourished and have compromised
immune systems, the prevalence of conditions such as NOMA is likely to
increase. The prevalence of oral cancer is also on the increase in Africa.
Annual incidence figures for oral and pharyngeal cancer are estimated at
25 cases per 100 000 in developing countries. Rapid urbanization and
increasing use of tobacco and alcohol are considered to greatly increase
the incidence of oral pre-cancer and cancer. The highest prevalence of
infections by Human Immunodeficiency Virus (HIV) and Acquired
Immunodeficiency Syndrome (AIDS) is found in Africa. Studies have
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shown that oral manifestations of HIV/AIDS are very widespread, and
most commonly include fungal infections such as those caused by
candida, necrotizing gingivitis or oral hairy leukoplakia. National surveys
and smaller studies in Africa have shown the prevalence of dental caries to
be quite low but with substantial regional variations. Most of these cases
(90%) remain untreated.
Other problems
Maxillo-facial trauma has increased in many countries as a result of inter-
personal violence, motor vehicle accidents and war. Chronic destructive
periodontal disease is known to occur in a small proportion of most
populations, regardless of location or socioeconomic status. Harmful
practices such as the removal of tooth germs of deciduous canines,
extraction of upper and lower anterior teeth and the trimming or
sharpening of upper anterior teeth still prevail. Fluorosis is very common
in certain parts of Africa such as the Rift Valley area of East Africa. The
presence of malnutrition is known to increase the likelihood of fluorosis
in children. Edentulism, congenital malformations and benign tumors
occur but little prevalence data is available.
The African Region also faces an acute lack of recent, reliable and
comparable data and the relative absence of processes for converting data
into information for planning.
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Determinants of oral health problems in Africa
Poverty is an important determinant of health and ill-health. The
prevalence of oral diseases closely mimics prevailing levels of social
deprivation. In a continent where the majority of the population are
desperately poor, preventable oral diseases such as NOMA and oral
cancer are rife. High levels of bottle feeding in the urban parts of the
Region have been associated with high rates of baby bottle tooth decay.
Increasing urbanization has also been shown to lead to observable
increases in the prevalence of oral disease. Greater access to alcohol is
associated with higher levels of interpersonal trauma and oral cancer.
The presence of widespread poverty and underdevelopment in Africa
means that communities are increasingly exposed to all the major
environmental determinants of oral disease.
By adopting a predominantly Western model of oral health care, African
health systems have failed to address these important determinants of oral
health. Oral health systems are characterized by the predominance of
dentists, most of whom are in private practice in urban settings. Where
public or private oral health services do function, they are treatment-
oriented, mainly providing for the relief of pain and sepsis and
occasionally other curative forms of care.
Development needs
It is clear from this analysis of oral health in the African context that a
successful approach to oral health in the Region needs to take account of
these circumstances to effectively focus on the real determinants of oral
disease.
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The needs to be addressed using this strategy include equitable and
universal access to affordable and appropriate quality oral health services
through:
• community involvement in identifying oral health problems, needs
and interventions;
• proper planning, administration and evaluation of services;
• prevention-oriented services and multisectoral action especially in
relation to participatory health education and promotion;
• proper balance between personnel types and population needs.
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THE REGIONAL ORAL HEALTH STRATEGY
Long-term vision
Within the next 25 years, all people of the region should enjoy improved
levels of oral health and function through a significant reduction of all oral
diseases and conditions that are prevalent in the Region, equitable access
to cost-effective quality oral health care and adoption of healthy lifestyles.
Guiding principles
The effective implementation of this strategy and its sustainability will be
guided by the following principles:
• high priority to promotion of oral health and prevention of oral
diseases;• focus of oral health interventions on the district and its communities
with particular emphasis on children, pregnant women and other
vulnerable groups;• use of only interventions which have proven efficacy;• integration of oral health programmes across all appropriate sectors;• participation of communities in oral health activities that affect
them.
Strategic framework
Strategic objectives
Country targets:
It is expected that by 2008, all countries of the African Region would have:
• developed national oral health strategies and implementation plans
focusing on the district and the community levels;
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• integrated oral health activities in other health and related
programmes and institutions (e.g. maternal and child health,
nutrition, schools, water related programmes);
• strengthened their health facilities with appropriate oral health
technologies, methods, equipment and human resources;
• integrated training in essential oral health skills in the curricula of
health personnel and others who have the responsibility for oral
health promotion;
• set up effective oral health management information systems;
• begun to carry out essential research on oral health priority
problems and needs.
Regional objective:
To assist countries develop and implement oral health strategies and plans
that will ensure equitable and universal access to quality oral health
services through the district health system.
Priority programmatic areas
Based on the oral health priorities indicated earlier, the following
programmatic areas and objectives have been identified.
(a) Development of national oral health strategies and
implementation plans
Objective 1: To formulate national oral health strategies and plans.
(b) Integration of oral health in other programmes
Objective 2: To integrate oral health in programmes for vulnerable
groups and in the training programmes of primary and
pre-school teachers.
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Objective 3: To deliver optimal levels of fluoride through water
supplies or other methods where indicated and feasible,
and introduce defluoridation water systems in areas
where fluorosis is endemic.
(c) Delivery of effective and safe oral health services
Objective 4: To ensure equitable population access to quality oral
health care through the district system.
Objective 5: To ensure that district oral health service is adjusted to
focus on community oral health needs and that
appropriate forms of technology are selected.
Objective 6: To establish effective control measures for cross
infection.
(d) Regional approach to education and training for oral health
Objective 7: To share common approaches to oral health education for
the level and type of care needed in the African Region.
(e) Development of effective oral health management information
systems
Objective 8: To gather and coordinate the collection of information
needed for planning, monitoring and evaluating oral
health activities.
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Strategic orientations
(a) Advocacy and social mobilization
Implementation of the strategic orientations must be sustained
through continued advocacy for oral health. This will involve using
social marketing and participatory methods to mobilize support
from policy-makers, political and community leaders, training
institutions, NGOs, professional associations, business and social
groups and industry.
(b) Capacity building
This will involve the development of human resources through
appropriate training and re-training programmes related to the
priority oral health problems. Training needs and processes should
be coordinated and standardized as far as possible, and draw upon
the combined expertise and resources of the Region.
(c) Information and education
Appropriate information should be provided to individuals, families
and communities for the promotion of healthy oral health
behaviour and lifestyles. People should be involved in all stages of
developing oral health education, promotion and information
materials.
(d) Equitable access to quality oral health services
This requires the achievement of greater equity in oral health and
access to quality oral health services particularly for rural, peri-urban
and underserved communities. Recent advances in oral health and
available technical excellence must be adapted in the forms that are
economically, technologically and culturally appropriate for the
African Region.
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(e) Promotion of operational research
In order to strengthen research capacity and promote relevant
research that responds to the oral health needs of communities, a
research culture should be developed within national oral health
programmes and the findings widely disseminated and used for
planning purposes.
Implementation framework
At country level
The district remains the location with the greatest potential for successful
integration of oral health programme planning and implementation with
other health and development programmes. An implementation matrix
which illustrates a framework for planning priority interventions will be
developed.
At intercountry and regional level
Mechanisms to secure the exchange of experiences in implementing the
oral health strategy need to be established between countries in the
Region, in the spirit of Technical Cooperation among Developing
Countries. Maximum use will be made of the expertise and resources of
WHO collaborating centres for oral health, particularly in the areas of
capacity building and research promotion. In collaboration with
international partners, WHO will provide technical support to Member
countries in the following areas:
• development of comparable national data systems on oral health and
disease trends for use in planning, including the identification of
suitable indicators with which to evaluate progress;
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• development of effective interventions for the promotion of oral
health;
• development of national oral health strategies and implementation
plans;
• estimation of personnel needs and development of suitable training
programmes for the effective delivery of oral health programmes.
Partnerships
Partners who can assist the process should be identified as early as
possible. A wide network of interested parties must be established at
country level to facilitate implementation of the strategy and mobilization
of resources.
The district health management team has the primary responsibility for
implementing the programmes, strategies and interventions. It is here that
interaction and partnership between community interest groups, health
and development workers occur in order to successfully operationalize
district oral health plans. Districts will also benefit from sharing
information, experiences and problems with one another and from
collaborating in programmes of mutual interest to them.
Partners that may be engaged at the national level include professional
associations, commerce, industry, dental, medical and allied professions,
NGOs, aid agencies, WHO and other UN agencies. The national level
must ensure that good communication occurs between all levels of the
health system and various partners. It should therefore be well equipped
to facilitate partnerships and collaboration.
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MANAGERIAL FRAMEWORK
Resource mobilization
Financial resources
Mobilization of internal and external resources is essential for the
execution of national oral health programmes. Oral health programmes
should be adjusted to the funds that are actually available. The oral health
sector should also set aside a share of the general health care budget
allocated to fund integrated health programmes and activities in which
oral health is a component. Ministries of health and NGOs will be
encouraged to mobilize extrabudgetary funds for oral health. Other cost-
sharing initiatives must also be explored to support oral health
interventions.
Human and institutional resources
At country level, Government needs to support the training of adequate
numbers of appropriate personnel to support the delivery of the oral
health strategies it has selected. Negotiations with training institutions,
Government and other stakeholders to establish appropriate post
structures, career paths and job descriptions, etc. for staffing public oral
health services will be necessary. At regional level, WHO will facilitate the
training of experts who can provide technical support to the oral health
strategy process and assist in the monitoring and evaluation of
programmes. These experts will also support the development of country
research capacities in collaboration with the International Association for
Dental Research (African Division), World Dental Federation,
Commonwealth Dental Association, Aide Odontologique Internationale
and others.
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Material resources
All efforts should be made internally and externally to generate funding
for oral health programmes. Development and acquisition of appropriate
and robust equipment that suits the African environment should be
promoted. Whilst bulk purchases of equipment and supplies should be
undertaken where appropriate, more efficient ways of making available
low cost toothpastes, toothbrushes, chewing sticks and other items
should also be explored.
Coordination
The setting up of coordination mechanisms among partners is crucial for
the implementation of the oral health strategy. Emphasis should be placed
on the coordination of activities instead of structures and extend well
beyond the mere sharing of information. Where a regional or provincial
level exists in a country, it has the responsibility for providing support to
district health activities and for coordinating programmes that extend
across district boundaries. It has to provide the link between district and
national levels of activity. It can help districts with coordination of tender
processes, information collection and analysis activities, planning
processes and resource allocation. The national level is primarily
responsible for coordination, as opposed to programme or service
delivery and must be properly equipped for this role. Existing subregional
development organizations should also be involved in coordination
efforts. At the regional level, implementation will be coordinated by the
Division of Health Protection and Promotion in collaboration with
existing WHO structures and governing bodies.
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Monitoring and Evaluation
Monitoring
It will be important to monitor the process of negotiating acceptance,
adoption and dissemination of the strategy by WHO structures, country
chief dental officers and their respective ministers of health. After this,
the strategy must reach the provincial and district structures responsible
for its implementation. This process must be monitored against the
proposed time frame. After this, it will be important to monitor outcome
indicators that reflect the extent to which the strategy and priority
programmatic areas have been responded to and implemented. The
indicators to be assessed include the country targets selected.
Evaluation
WHO has a particularly important role in facilitating the implementation
process as well as monitoring and evaluating the progress of the strategy
as a whole. Periodic reviews and evaluations will be undertaken and
regular reports will be made available in accordance with WHO
resolutions.
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CONCLUSION
This document has set out a process that WHO plans to follow to assist
countries improve and sustain the oral health of their communities. It
provides technical and managerial orientations that countries can use to
streamline oral health services to efficiently and effectively deliver
interventions that are affordable and that match the oral health needs of
the community. This strategy represents a new approach that has the
potential to fundamentally improve community oral health in the African
Region.
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ANNEX 1: RESOLUTION AFR/RC48/R5
ORAL HEALTH IN THE WHO AFRICAN REGION:
A REGIONAL STRATEGY
The Regional Committee,
Bearing in mind that health and well-being directly influence oral health;
Concerned about the deterioration of oral health in the African Region;
Recognizing that previous approaches to oral health in the Region have
neither taken account of the epidemiological priorities of the Region nor
identified reliable and appropriate strategies to address them;
Noting that previous efforts have consisted of an unplanned and ad hoc
evolution of curative oral health services which, in most cases, are poorly
distributed and only reach affluent or urban communities;
Mindful of World Health Assembly resolution WHA36.14 and Regional
Committee resolutions AFR/RC30/R4 and AFR/RC44/R13 adopted in
the past; and
Having carefully examined the report of the Regional Director contained
in document AFR/RC48/9 outlining a WHO regional strategy for oral
health;
1. APPROVES the proposed strategy aimed at strengthening the
capacity of the Member States to improve community oral health;
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2. CALLS on the Member States to:
(i) develop national oral health strategies and implementation
plans with emphasis on prevention, early detection and
management of oral diseases;
(ii) systematically and meaningfully interpret oral health
epidemiological information by describing oral disease
prevalence, severity and age-wise distribution in the
population;
(iii) give particular attention to the most severe oral problems that
people have to live with (e.g. NOMA, oral cancer and oral
manifestations of HIV infection/AIDS);
(iv) develop appropriate and affordable programmes that match
the oral health needs of the community;
(v) integrate oral health activities in all primary health care
programmes;
(vi) integrate training in essential oral health skills in the curricula
of health personnel and others who have the responsibility for
oral health promotion;
(vii) strengthen health facilities with appropriate oral health
technologies, methods, equipment and human resources;
(viii) undertake operational research on oral health priority
problems and needs; and
(ix) integrate oral health in national health management
information systems; and
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3. REQUESTS the Regional Director to:
(i) provide technical support to the Member States for the
development of national oral health strategies and
implementation plans;
(ii) provide support to all countries to enable them to strengthen
or develop and implement cost-effective oral health care
services, particularly at the district level;
(iii) provide guidelines and technical support that will facilitate the
proper identification of oral health priority problems and
appropriate cost-effective interventions;
(iv) promote and support the development of suitable training
programmes for effective delivery of oral health services;
(v) promote and support relevant research activities aimed at
providing solutions to oral health problems; and
(vi) report to the 50th session of the Regional Committee on the
progress made in the implementation of the strategy.
Tenth meeting, 2 September 1998
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ANNEXE 2
EPIDEMIOLOGICAL BASIS FOR RANKING ORAL DISEASE
BURDEN IN LOW-ECONOMIC STATUS COMMUNITY
1
2
3
4
5
6
7
8
9
10
11
Cancrum oris (Noma)
Oral manifestations of HIV/AIDS
Oral cancer
Facial trauma
Congenital abnormalities
Harmful practices
Dental caries
Chronic periodontal disease
Fluorosis
Benign tumours
Edentulism
Oral Disease
High
High
Medium
Very High
High
High
Medium
Medium
Medium
Low
Low
Prevalence
High
High
High
Medium
Medium
Medium
Medium
Low
Low
Medium
Medium
Morbidity
High
High
High
Medium
Medium
Low
Low
Low
Low
Low
Mortality
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ANNEX 3:
CONCLUSIONS OF THE CONSULTATIVE MEETING ON
IMPLEMENTATION OF THE REGIONAL ORAL HEALTH
STRATEGY IN AFRICAN COUNTRIES
Brief Summary
In September 1998, the African Ministers of Health attending the forty-
eighth session of the WHO Regional Committee Meeting in Harare,
Zimbabwe, adopted the oral health strategy for the African Region for a
ten-year period (1999-2008). A corresponding resolution was also
adopted.
As a follow-up to the adopted regional oral health strategy, a Consultative
Meeting jointly organized by WHO/AFRO and WHO/HQ took place
in Harare, Zimbabwe from 30 March to 01 April 1999. The purpose of the
meeting was to identify concrete actions to assist Member States in
implementing the strategy.
There were thirty-nine participants from four main groups, namely:
experts on oral health in Africa, chief dental officers (CDOs) from
selected countries in the Region, some oral health partners and heads of
some WHO collaborating centres for oral health. There were also
representatives from WHO/HQ and WHO/AFRO.
In his opening address, the WHO Regional Director for Africa, Dr E. M.
Samba noted that previous approaches to oral health in Africa had failed to
recognize the epidemiological priorities of the Region or to identify
reliable and appropriate strategies to address them.Efforts had consisted
of an unplanned, ad hoc and spasmodic evolution of curative oral health
services. Dr Samba stressed that the new strategy focused on the most
severe oral problems that people have to live with, like noma, oral cancer
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24
and the oral consequences of HIV/AIDS infection. The strategy was a
tool for assisting Member States and partners to identify priorities and
interventions at various levels of the health system particularly at the
district level. He further indicated that the strategy aimed at
strengthening the capacity of countries to improve community oral health
by effectively using proven interventions to address specific oral health
needs. The Regional Director charged participants to identify practical
cost-effective ways of implementing the regional oral health strategy.
The following are the main outcomes of the Consultative Meeting.
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25
IMP
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the
imp
lem
enta
tio
n
and
eva
luat
ion
of
the
pre
par
ed
stra
tegy
an
d p
lan
.
Ad
voca
te f
or
mu
ltid
isci
pli
nar
y
app
roac
h.
Mo
bil
ize
the
pri
vate
sec
tor
and
ci
ty/t
ow
n h
ealt
h
man
agem
ent
to
pro
mo
te o
ral
hea
lth
.
En
sure
th
ere
is
inst
itu
tio
nal
cap
acit
y
for
trai
nin
g ap
pro
pri
ate
ora
l h
ealt
h p
erso
nn
el.
Ass
ist
and
en
cou
rage
th
e d
evel
op
men
t o
f ap
pro
pri
ate
pro
toco
ls
wh
ere
ind
icat
ed.
Incl
ud
e n
on
-ora
l h
ealt
h w
ork
ers
in
trai
nin
g p
rogr
amm
es.
Pro
mo
te c
oll
abo
ra-
tio
n f
or
regi
on
al
edu
cati
on
an
d t
rain
ing.
Dis
sem
inat
e an
d
exp
lain
th
e st
rate
gy
and
pla
n a
t al
l le
vels
.
En
sure
th
at s
trat
egy
and
pla
n i
nvo
lve
op
inio
ns
and
nee
ds
at t
he
low
est
leve
ls
of
the
syst
em
Des
ign
an
d
dis
sem
inat
e p
arti
cip
ato
ry o
ral
hea
lth
ed
uca
tio
n
and
pro
mo
tio
n
mat
eria
ls f
or
use
in
sch
oo
ls a
nd
co
mm
un
itie
s.
En
sure
pri
ori
ties
id
enti
fied
are
d
irec
ted
at
the
mo
st v
uln
erab
le
All
oca
te r
eso
urc
es
on
th
e b
asis
of
nee
d.
Est
abli
sh d
istr
ict-
focu
s se
rvic
es.
Pro
mo
te u
se o
f ap
pro
pri
ate
tech
no
logy
.
Iden
tify
are
as w
her
e ex
isti
ng
dat
a n
eed
to
b
e st
ren
gth
ened
an
d
dev
ise
app
rop
riat
e re
sear
ch p
roto
cols
Init
iate
op
erat
ion
al
rese
arch
at
all
leve
ls.
Dev
elo
p a
sim
pli
fied
re
vise
d o
ral
hea
lth
su
rvey
met
ho
do
logy
b
ased
on
th
e p
erce
pti
on
o
f n
eed
, res
ou
rce
avai
lab
ilit
y a
nd
po
ten
tial
o
utc
om
e o
f in
terv
enti
on
at
th
e lo
cal
leve
l.
Pro
mo
te r
esea
rch
in
ap
pro
pri
ate
tech
no
logy
.
-
A Regional Strategy
26
An
nex
3A
dv
oca
cy a
nd
so
cial
mo
bil
izat
ion
Cap
acit
y b
uil
din
gIn
form
atio
n e
du
cati
on
an
d c
om
mu
nic
atio
nE
qu
itab
le a
cces
s to
q
ual
ity
ora
l h
ealt
h s
erv
ices
Pro
mo
tio
n o
f o
per
atio
nal
res
earc
h
Inte
gra
tio
n o
f o
ral
hea
lth
in
oth
er
pro
gra
mm
es.
Ad
voca
te f
or
inte
grat
ion
of
ora
l h
ealt
h w
ith
o
ther
pro
gram
mes
.
Ad
voca
te f
or
issu
es
such
as
foo
d a
nd
ag
ricu
ltu
ral
po
licy
, to
bac
co u
se a
nd
al
coh
ol
con
sum
pti
on
, d
rin
k a
nd
dri
vin
g an
d
road
saf
ety.
Ad
voca
te f
or
flu
ori
-d
atio
n a
nd
def
luo
rid
a-ti
on
wh
ere
ind
icat
ed
and
fea
sib
le.
Rai
se a
war
enes
s th
at
ora
l h
ealt
h a
rise
s fr
om
th
e sa
me
con
dit
ion
s as
gen
eral
hea
lth
.
Tra
in a
ll d
istr
ict
hea
lth
p
erso
nn
el a
nd
sch
oo
l te
ach
ers
on
ora
l h
ealt
h
edu
cati
on
an
d
pro
mo
tio
n a
s w
ell
as
reco
gnit
ion
of
ora
l d
isea
ses,
th
eir
man
agem
ent
and
re
ferr
al.
Exp
and
ora
l hea
lth
se
rvic
es w
ith
in d
istr
ict
hea
lth
ser
vice
s.
Pro
vid
e ad
equ
ate
infr
astr
uct
ure
fo
r th
e p
rovi
sio
n o
f o
ral h
ealt
h
care
.
Intr
od
uce
ora
l hea
lth
ca
re in
saf
e m
oth
erh
oo
d
pro
gram
mes
.
Sup
po
rt o
per
atio
nal
re
sear
ch in
to t
he
pro
visi
on
of
ora
l hea
lth
se
rvic
es t
hat
are
in
tegr
ated
into
gen
eral
h
ealt
h s
ervi
ces
and
sc
ho
ol p
rogr
amm
es
(eg.
co
st-b
enef
it,
ou
tco
me
mea
sure
s,
earl
y d
iagn
osi
s, e
tc.)
Pro
mo
te r
esea
rch
into
th
e ef
fect
iven
ess
of
edu
cati
on
an
d t
rain
ing
for
inte
grat
ed s
ervi
ces.
Dis
sem
inat
e in
form
atio
n o
n t
he
det
erm
inan
ts o
f o
ral
hea
lth
an
d d
isea
se.
Inte
grat
e o
ral
hea
lth
m
essa
ges
in:
-M
CH
cli
nic
s an
d
pro
gram
mes
.-
curr
icu
lum
of
pri
mar
y s
cho
ols
.-
nat
ion
al n
utr
itio
n
pro
gram
mes
.-
pro
gram
mes
fo
r th
e el
der
ly.
-ca
mp
aign
s ag
ain
st
vio
len
ce.
-ca
mp
aign
s ag
ain
st
tob
acco
use
-ca
mp
aign
s ag
ain
st
alco
ho
l co
nsu
mp
tio
n.
Ob
ject
ives
:
2.
To
inte
grat
e or
al
heal
th i
n a
ll P
HC
pr
ogra
mm
es a
nd
in
th
e tr
ain
ing
prog
ram
mes
of
prim
ary
and
pre
-sc
hool
tea
cher
s
3.
To
del
iver
opt
imal
le
vel
s of
flu
orid
e th
rou
gh w
ater
su
ppli
es
or o
ther
met
hod
s w
here
in
dic
ated
an
d
feas
ible
, an
d t
o in
trod
uce
d
eflu
orid
atio
n w
ater
sy
stem
s in
are
as w
here
fl
uor
osis
is
end
emic
PR
IOR
ITY
PR
OG
RA
MM
AT
ICA
RE
A
-
Oral Health
27
An
nex
3
Ad
vo
cacy
an
d s
oci
al
mo
bil
izat
ion
Cap
acit
y
bu
ild
ing
Info
rmat
ion
ed
uca
tio
n a
nd
co
mm
un
icat
ion
ST
RA
TE
GIC
OR
IEN
TA
TIO
NS
Eq
uit
able
acc
ess
to
qu
alit
y o
ral
hea
lth
se
rvic
es
Pro
mo
tio
n o
f o
per
atio
nal
re
sear
ch
Del
iver
y o
f ef
fect
ive
and
sa
fe o
ral
hea
lth
ser
vic
e.
Ob
ject
ives
:
4.
To
ensu
re e
quit
able
po
pula
tion
acc
ess
to q
ual
ity
oral
hea
lth
care
thr
ough
the
d
istr
ict
syst
em.
5.T
o en
sure
dis
tric
t or
al h
ealt
h se
rvic
e is
ad
just
ed t
o fo
cus
on
com
mu
nit
y or
al h
ealt
h n
eed
s an
d t
hat
appr
opri
ate
form
s of
te
chn
olog
y ar
e se
lect
ed.
6.T
o es
tabl
ish
effe
ctiv
e co
ntr
ol
mea
sure
s fo
r cr
oss-
infe
ctio
n.
Ad
voca
te f
or
the
crea
tio
n
of
infr
astr
uct
ure
n
eces
sary
to
en
sure
saf
e an
d e
ffec
tive
del
iver
y o
f o
ral
hea
lth
car
e at
dis
tric
t le
vel.
Mo
bil
ize
no
n-h
ealt
h
sect
ors
su
ch a
s lo
cal
auth
ori
ties
an
d N
GO
s to
pro
mo
te o
ral
hea
lth
.
Ad
voca
te f
or
ora
l h
ealt
h
mat
eria
ls a
nd
dru
gs t
o b
e p
art
of
the
esse
nti
al d
rug
list
(in
clu
din
g fl
uo
rid
e to
oth
pas
te).
Tra
in a
ll d
istr
ict
hea
lth
per
son
nel
o
n i
nfe
ctio
n
con
tro
l m
easu
res.
En
sure
th
ere
are
trai
ned
per
son
nel
fo
r m
ain
ten
ance
o
f eq
uip
men
t.
Tra
in o
ral
hea
lth
p
erso
nn
el i
n
rese
arch
.
Dis
sem
inat
e in
form
atio
n o
n
infe
ctio
n c
on
tro
l.
Pro
mo
te t
he
use
of
evid
ence
-bas
ed
inte
rven
tio
ns.
Pro
mo
te c
amp
aign
s ag
ain
st t
he
use
of
tob
acco
an
d a
lco
ho
l co
nsu
mp
tio
n.
Pro
mo
te c
om
pet
itio
n
amo
ng
ora
l h
ealt
h
pro
gram
mes
.
Pro
mo
te r
eco
rdin
g an
d a
nal
ysi
s o
f d
ata
rele
van
t to
th
e p
roce
sses
an
d
inte
rven
tio
n u
sed
.
Est
abli
sh o
r ex
pan
d o
ral
hea
lth
ser
vice
s to
all
d
istr
icts
as
par
t o
f ex
isti
ng
hea
lth
ser
vice
s.
En
sure
all
oca
tio
n o
f ap
pro
pri
ate
reso
urc
es a
nd
in
fras
tru
ctu
re b
ased
on
n
eed
an
d v
uln
erab
ilit
y.
En
sure
ava
ilab
ilit
y o
f ap
pro
pri
ate
equ
ipm
ent
and
ad
equ
ate
sto
ck o
f m
ater
ials
, in
stru
men
ts a
nd
sp
are
par
ts.
En
sure
reg
ula
r m
ain
ten
ance
o
f eq
uip
men
t.
PR
IOR
ITY
PR
OG
RA
MM
AT
ICA
RE
A
-
A Regional Strategy
28
An
nex
3
Ad
vo
cacy
an
d s
oci
al
mo
bil
izat
ion
Cap
acit
y b
uil
din
gIn
form
atio
n
edu
cati
on
an
d
com
mu
nic
atio
n
Eq
uit
able
acc
ess
to
qu
alit
y o
ral
hea
lth
se
rvic
es
Pro
mo
tio
n o
f o
per
atio
nal
re
sear
ch
ST
RA
TE
GIC
OR
IEN
TA
TIO
NS
Reg
ion
al a
pp
roac
h t
o
edu
cati
on
an
d t
rain
ing
fo
r o
ral
hea
lth
Ob
ject
ive:
7.
To
shar
e co
mm
on
appr
oach
es t
o or
al
heal
th e
du
cati
on f
or
the
lev
el a
nd
typ
e of
ca
re n
eed
ed i
n t
he
Afr
ican
reg
ion
.
Ad
voca
te a
nd
mo
bil
ize
cou
ntr
ies
of
the
regi
on
to d
evel
op
co
mm
on
ap
pro
ach
to
ed
uca
tio
n
and
tra
inin
g o
f p
erso
nn
el
for
ora
l h
ealt
h.
Ad
voca
te f
or
syst
em o
f co
mm
on
en
try
bas
ed o
n
nee
ds
of
bo
th c
ou
ntr
y o
f o
rigi
n a
nd
th
e re
gio
n a
s a
wh
ole
.
Ad
voca
te f
or
the
edu
cati
on
an
d t
rain
ing
of
mo
re a
uxi
llar
ies.
En
sure
ed
uca
tio
n
and
tra
inin
g ar
e re
late
d t
o n
eed
s an
d
stra
tegi
es i
den
tifi
ed.
Info
rm r
elev
ant
role
-pla
yer
s o
f ad
van
tage
s o
f a
regi
on
al a
pp
roac
h.
Ass
ess
nu
mb
er, t
yp
e an
d d
istr
ibu
tio
n o
f tr
ain
ing
inst
itu
tio
ns
req
uir
ed.
En
sure
op
tim
al u
se o
f ex
isti
ng
inst
itu
tio
ns
and
th
eir
avai
lab
ilit
y
to a
ll c
ou
ntr
ies
in t
he
regi
on
.
Dev
elo
p m
easu
res
to
asse
ss e
ffec
tive
nes
s an
d a
pp
rop
riat
enes
s o
f ex
isti
ng
edu
cati
on
al
pro
gram
mes
.
Co
nti
nu
ally
ass
ess
geo
grap
hic
al
dis
trib
uti
on
of
per
son
nel
fo
un
d i
n
each
in
stit
uti
on
in
th
e re
gio
n.
PR
IOR
ITY
PR
OG
RA
MM
AT
ICA
RE
A
-
Oral Health
29
An
nex
3
ST
RA
TE
GIC
OR
IEN
TA
TIO
NS
Ad
vo
cacy
an
d
soci
al m
ob
iliz
atio
nC
apac
ity
bu
ild
ing
Info
rmat
ion
ed
uca
tio
n a
nd
co
mm
un
icat
ion
Eq
uit
able
acc
ess
to
qu
alit
y o
ral
hea
lth
se
rvic
es
Pro
mo
tio
n o
f o
per
atio
nal
re
sear
ch
Eff
ecti
ve
inte
gra
tio
n
of
ora
l h
ealt
h i
n
nat
ion
al h
ealt
h
man
agem
ent
info
rmat
ion
sy
stem
s
Ob
ject
ive:
8.
To
gath
er a
nd
co
ord
inat
e th
e co
llec
tion
of
info
rmat
ion
nee
ded
fo
r pl
ann
ing,
m
onit
orin
g an
d
eval
uat
ing
ora
l he
alth
ac
tiv
itie
s
Ad
voca
te f
or
the
coll
ecti
on
of
dat
a fo
r p
lan
nin
g, m
on
ito
rin
g an
d e
valu
atio
n a
t ea
ch
leve
l.
Ad
voca
te f
or
map
pin
g o
f ge
ogr
aph
ical
are
as
wit
h e
nd
emic
flu
oro
sis.
Dev
elo
p c
apac
ity
to
co
llec
t, c
oll
ate,
an
aly
se
and
in
terp
rete
dat
a at
al
l le
vels
esp
ecia
lly
at
the
dis
tric
t le
vel.
Dev
elo
p c
om
pu
ter
skil
ls w
her
e n
eces
sary
.
Co
nti
nu
ally
ass
ess
and
d
efin
e in
form
atio
n f
or
pla
nn
ing
pro
cess
.
Co
mm
un
icat
e n
eed
to
co
llec
t an
d u
se t
his
d
ata
to a
ll h
ealt
h
wo
rker
s.
En
sure
co
ord
inat
ion
o
f in
form
atio
n a
t al
l le
vels
.
En
sure
rel
evan
t in
form
atio
n i
s co
llec
ted
an
d
pro
per
ly u
tili
sed
.
Det
erm
ine
the
min
imu
m d
ata
set.
Ass
ess
app
rop
riat
enes
s o
f th
e d
ata
coll
ecte
d.
PR
IOR
ITY
PR
OG
RA
MM
AT
ICA
RE
A
-
A Regional Strategy
30
An
nex
3F
RA
ME
WO
RK
TO
AD
DR
ES
S P
RIO
RIT
Y A
RE
AS
OF
PR
EV
EN
TIO
N A
ND
OT
HE
R I
NT
ER
VE
NT
ION
S A
T C
OU
NT
RY
LE
VE
LP
RE
AM
BL
E :
Th
e si
tuat
ion
of
each
co
un
try
an
d t
he
nat
ure
of
the
ora
l hea
lth
pro
ble
m e
ach
co
un
try
has
to
dea
l wit
h a
re d
iffe
ren
t.
Th
is m
ean
s th
at e
ach
co
un
try
nee
ds
to b
egin
th
e p
roce
ss o
f o
ral
hea
lth
str
ateg
y d
evel
op
men
t b
y i
den
tify
ing
and
pri
ori
tizi
ng
tho
se p
rob
lem
s th
at a
re
par
ticu
larl
y im
po
rtan
t to
th
em.
Th
e fr
amew
ork
pro
vid
ed b
elo
w s
ho
uld
ass
ist
in s
ifti
ng
thro
ugh
th
e av
aila
ble
op
tio
ns
for
inte
rven
tio
n t
hat
eac
h
cou
ntr
y w
ish
es t
o s
elec
t, b
ased
on
th
e re
sou
rces
th
ey h
ave
and
an
ass
essm
ent
of
wh
ich
op
tio
n i
s li
kel
y t
o w
ork
bes
t fo
r th
em.
It
is n
ot
a p
resc
rip
tive
lis
t th
at c
ou
ntr
ies
sho
uld
fee
l o
bli
ged
to
ad
op
t in
its
en
tire
ty.
Fo
r ex
amp
le,
wit
h n
om
a, d
iffe
ren
t co
un
trie
s/d
istr
icts
wil
l re
qu
ire
dif
fere
nt
leve
ls a
nd
SU
RV
EIL
LA
NC
E
PR
EV
EN
TIO
N A
ND
P
RO
MO
TIO
N
Can
cru
m
Ori
s/N
om
aP
rom
ote
b
asic
an
d
op
erat
ion
al
rese
arch
.
(i)
Est
abli
sh a
su
rvei
llan
ce
syst
em b
ased
on
id
enti
fiab
le
reco
rds
fro
m a
ll
avai
lab
le s
ou
rces
o
f d
ata.
(ii)
In
clu
de
dem
ogr
aph
ic,
soci
olo
gica
l,
inte
rven
tio
n a
nd
o
ther
ou
tco
me
vari
able
s.
(i)
Imp
rove
en
viro
nm
enta
l an
d
per
son
al h
ygi
ene
and
d
ieta
ry p
ract
ices
.(i
i) E
arly
det
ecti
on
an
d
refe
rral
(o
f p
recu
rso
r co
nd
itio
ns)
usi
ng
exis
tin
g so
cial
an
d
hea
lth
str
uct
ure
s.(i
ii)P
arti
cip
atio
n i
n
nat
ion
al p
rogr
amm
es
and
cam
pai
gns
on
im
pro
ved
nu
trit
ion
an
d i
mm
un
izat
ion
.
(i)
Pri
mar
y c
are
:A
rran
gin
g fo
r h
ealt
h s
ervi
ces
to t
reat
pat
ien
ts.
Mak
e su
re n
eces
sary
dru
gs a
nd
n
utr
itio
nal
su
pp
lem
ents
are
av
aila
ble
. (i
i) S
pec
iali
zed
ora
l ca
re -
surg
ery
an
d r
ehab
ilit
atio
n :
refe
rrin
g p
atie
nts
wh
o h
ave
seq
uel
ae f
or
surg
ical
tre
atm
ent
sett
ing
up
sp
ecia
lize
d c
entr
esfo
r tr
eatm
ent.
(iii
)Co
mp
lex
case
s m
anag
emen
t
of
soci
al a
nd
psy
cho
logi
cal
effe
cts,
in
clu
din
g so
cial
in
tegr
atio
n a
fter
su
rgic
al
trea
tmen
t.
Fo
rmu
late
tar
gets
fo
r tr
ain
ing
at a
ll l
evel
s fo
r h
ealt
h p
erso
nn
el a
nd
o
ther
ty
pes
of
reso
urc
e p
erso
n (
par
ents
, te
ach
ers,
hea
ds
of
vill
ages
, lea
der
s o
f o
pin
ion
) in
:Id
enti
fica
tio
n o
f h
igh
ri
sk g
rou
ps
det
ecti
on
of
intr
a-o
ral
lesi
on
s, a
nd
man
agem
ent
at a
ll l
evel
s o
f th
e d
isea
se.
DIS
EA
SE
MA
NA
GE
ME
NT
RE
SE
AR
CH
CA
PA
CIT
Y
BU
ILD
ING
/T
RA
ININ
G
-
Oral Health
31
An
nex
3S
UR
VE
ILL
AN
CE
PR
EV
EN
TIO
N A
ND
P
RO
MO
TIO
ND
ISE
AS
E M
AN
AG
EM
EN
TR
ES
EA
RC
HC
AP
AC
ITY
BU
ILD
ING
/T
RA
ININ
G
HIV
/AID
SO
ral
Man
ifes
tati
on
s
Ora
l C
ance
r
Fac
ial
Tra
um
a
(i)
Est
abli
sh s
urv
eill
ance
sy
stem
s to
mo
nit
or
pre
vale
nce
, sev
erit
y a
nd
in
terv
enti
on
ou
tco
mes
fo
r o
ral
mu
cosa
l le
sio
ns
asso
ciat
ed w
ith
H
IV/A
IDS.
(ii)
Se
t u
p s
elec
ted
ad
dit
ion
al
surv
eys
wh
ere
nec
essa
ry.
(i)
Est
abli
sh s
imil
ar r
eco
rd-
bas
ed s
urv
eill
ance
sy
stem
s as
fo
r H
IV t
o m
on
ito
r th
e p
reve
lan
ce o
f o
ral
pre
can
cer
and
can
cer.
(ii)
E
stab
lish
a c
ance
r re
gist
er.
(i)
Dev
elo
p a
rec
ord
-bas
ed
surv
eill
ance
sy
stem
to
m
on
ito
r th
e p
reva
len
ce o
f fa
cial
tra
um
a an
d i
ts c
ause
s
(i)
Par
tici
pat
ion
of
ora
l h
ealt
h p
erso
nn
el i
n
cam
pai
gns
agai
nst
all
fo
rms
of
vio
len
ce a
nd
it
s co
nse
qu
ence
s.
(i)
Dra
ft p
roto
col
for
trea
tmen
t at
pri
mar
y
care
lev
el.
(ii)
E
arly
dia
gno
sis
and
re
ferr
al t
o a
pp
rop
riat
e h
osp
ital
s.(i
ii)
Est
abli
sh n
etw
ork
of
cen
tres
to
sh
are
exp
erti
se f
or
all
typ
es
of
reco
nst
ruct
ive
surg
ery.
(i)
Res
earc
h o
n b
ehav
iou
r an
d l
ifes
tyle
s, v
ehic
les
and
ro
ad s
afet
y e
tc.
(i)
Tra
in t
he
com
mu
nit
y i
n
firs
t ai
d a
nd
hea
lth
p
erso
nn
el i
n e
mer
gen
cy
man
agem
ent
of
faci
al
inju
ries
.
(i)
En
gage
wit
h n
atio
nal
ca
mp
aign
s ag
ain
st t
ob
acco
an
d a
lco
ho
l et
c.(i
i)
Die
tary
ad
vice
on
an
tio
xid
ants
an
d u
se o
f ar
eca
nu
t.(i
ii)
Pro
mo
te s
yst
emat
ic
exam
inat
ion
of
the
wh
ole
m
ou
th.
(i)
Ap
pro
pri
ate
refe
rral
.(i
i)
Man
agem
ent
of
case
s in
n
atio
nal
an
d r
egio
nal
tr
eatm
ent
cen
tres
.(i
ii)
Cam
pai
gn f
or
ind
igen
ou
s tr
ain
ing
of
max
illo
-fac
ial
ora
l su
rger
y s
taff
.
(i)
Res
earc
h o
n b
ehav
iou
r an
d l
ifes
tyle
s.(i
i)
Ko
la n
ut
inve
stig
atio
ns.
(iii
) L
ink
bet
wee
n v
iral
in
fect
ion
s an
d c
ance
r.(i
v)
Eva
luat
e in
terv
enti
on
s
(i)
Tra
in h
ealt
h p
erso
nn
el a
t d
istr
ict
leve
l in
th
e ea
rly
d
iagn
osi
s o
f o
ral
can
cer
and
ref
erra
l fo
r ap
pro
pri
ate
man
agem
ent.
(ii)
T
each
rec
ogn
itio
n o
f su
spic
iou
s le
sio
ns.
(i)
Par
tici
pat
ion
of
ora
l h
ealt
h p
erso
nn
el i
n
nat
ion
al p
rogr
amm
es
and
cam
pai
gns
on
p
reve
nti
on
an
d
con
tro
l o
f H
IV/A
IDS.
(ii)
H
igh
ligh
t tr
ansm
issi
on
ris
k i
n
hea
lth
car
e se
rvic
es
amo
ng
hea
lth
p
erso
nn
el.
(iii
) P
rep
are
man
ual
s fo
r p
atie
nts
an
d h
ealt
h
wo
rker
s o
n s
elf
care
an
d p
reve
nti
on
of
HIV
.
(i)
Em
ph
asis
on
car
efu
l an
d
con
tin
uo
us
ora
l h
ygi
ene/
mo
uth
car
e at
h
om
e an
d t
reat
men
t ce
ntr
es t
o m
ain
tain
a
hea
lth
y o
ral
envi
ron
men
t.(i
i)
Uti
lize
ora
l an
tise
pti
cs
and
tra
dit
ion
al
med
icat
ion
s.(i
ii)
Wri
te t
reat
men
t p
roto
cols
.
(i)
Res
earc
h o
n t
he
mo
st
pre
dic
tive
val
ue
of
ora
l m
anif
esta
tio
ns
of
HIV
/AID
S, l
abo
rato
ry
sali
va t
ests
, in
fect
ion
co
ntr
ol
etc.
(ii)
Se
t u
p c
oll
abo
rati
ve
rese
arch
wit
h o
ther
co
un
trie
s.
(i)
Dev
ise
a sp
ecif
ic
cou
ntr
y p
lan
fo
r tr
ain
ing.
(ii)
G
et a
fo
cal
per
son
to
co
-ord
inat
e tr
ain
ing.
(iii
) C
oll
abo
rate
wit
h A
IDS
un
its
and
oth
er g
rou
ps.
(iv)
T
rain
all
ora
l h
ealt
h a
nd
ge
ner
al h
ealt
h p
erso
nn
el
in i
den
tifi
cati
on
an
d
man
agem
ent
of
thes
e co
nd
itio
ns.
-
A Regional Strategy
32
An
nex
3S
UR
VE
ILL
AN
CE
PR
EV
EN
TIO
N A
ND
P
RO
MO
TIO
ND
ISE
AS
E
MA
NA
GE
ME
NT
RE
SE
AR
CH
CA
PA
CIT
Y B
UIL
DIN
G/
TR
AIN
ING
Flu
oro
sis
Den
tal
Car
ies
(i)
Sele
ctiv
e ep
idem
iolo
gica
l st
ud
ies
on
th
e ex
ten
t o
f co
smet
ical
ly d
isfi
guri
ng
flu
rosi
s th
at r
equ
ires
p
rofe
ssio
nal
in
terv
enti
on
an
d o
n
skel
etal
flu
oro
sis
(i)
Sele
cted
pat
hfi
nd
er-
typ
e ep
idem
iolo
gica
l st
ud
ies
on
pre
vale
nce
w
her
e ex
isti
ng
dat
a is
in
adeq
uat
e.
(i)
Inte
grat
e ef
fect
ive
ora
l h
ealt
h
pro
mo
tio
n m
ater
ials
.(i
i)
Pro
mo
te m
ou
th
clea
nin
g u
sin
g in
dig
eno
us
and
oth
er
ora
l h
ygi
ene
aid
s,
incl
ud
ing
chew
ing
stic
ks.
(iii
) In
tegr
ate
die
tary
m
easu
res
wit
h
exis
tin
g n
utr
itio
n
pro
gram
me
effo
rts
to
ensu
re a
void
ance
of
freq
uen
t ex
cess
su
gar
inta
ke.
(iv)
Pro
mo
tio
n o
f af
ford
able
flu
ori
de
too
thp
aste
.(v
) C
on
sid
er v
iab
ilit
y o
f w
ater
flu
ori
dat
ion
.
(i)
Em
erge
ncy
tre
atm
ent
for
pai
n r
elie
f (e
xtra
ctio
n,
tem
po
rary
fil
lin
gs
etc)
(i
i)
Pre
ven
tive
fil
lin
gs
usi
ng
AR
T t
ech
niq
ue.
(i)
Sim
pli
fied
rev
ised
o
ral
hea
lth
su
rvey
m
eth
od
.(i
i)E
ffec
tive
nes
s o
f co
mm
un
ity
ora
l h
ealt
h e
du
cati
on
.(i
ii)
Pro
cess
eva
luat
ion
.(i
v) Q
ual
ity
of
care
as
sess
men
t.(v
) R
esea
rch
ef
fect
iven
ess
of
trad
itio
nal
met
ho
ds
of
ora
l h
ealt
h
pro
mo
tio
n a
nd
p
rote
ctio
n.
(i)
Tra
in a
uth
ori
ty
mem
ber
s o
f th
e co
mm
un
ity
su
ch a
s te
ach
ers,
MC
H a
ids,
n
urs
es, P
HC
wo
rker
s in
ora
l h
ealt
h m
atte
rs
as p
art
of
gen
eral
h
ealt
h e
du
cati
on
.(i
i)
Tra
in a
pp
rop
riat
e h
ealt
h w
ork
ers
in
scre
enin
g an
d
extr
acti
on
du
rin
g th
eir
pre
-pro
fess
ion
al
cou
rses
.(i
ii)
Tra
in d
istr
ict
ora
l h
ealt
h w
ork
ers
in
AR
T t
ech
niq
ue.
(i)
Dev
elo
p a
pp
rop
riat
e ed
uca
tio
n
pro
gram
mes
.(i
i)
In a
reas
wh
ere
flu
oro
sis
is e
nd
emic
, id
enti
fy a
lter
nat
ive
wat
er s
up
ply
(an
d
oth
er f
luo
rid
e so
urc
es).
(i)
De-
flu
ori
dat
ion
of
avai
lab
le d
rin
kin
g w
ater
in
sm
all
com
mu
nit
ies.
(ii)
A
pp
rop
riat
e re
sto
rati
on
of
affe
cted
an
teri
or
teet
h.
(i)
Into
de-
flu
ori
dat
ion
te
chn
olo
gy.
(ii)
F
luo
rid
e ex
po
sure
(i
ii)
Flu
ori
de
map
pin
g(i
v) S
ou
rces
of
flu
ori
de
(v)
Uti
liza
tio
n o
f fl
uo
rid
e
(i)
Tra
in t
he
com
mu
nit
y
and
hea
lth
per
son
nel
o
n i
den
tifi
cati
on
of
den
tal
and
sk
elet
al
flu
oro
sis
and
ref
erra
l fo
r ap
pro
pri
ate
man
agem
ent
of
case
s.
-
Oral Health
33
An
nex
3S
UR
VE
ILL
AN
CE
PR
EV
EN
TIO
N E
T
PR
OM
OT
ION
PR
ISE
EN
CH
AR
GE
D
ES
MA
LA
DIE
SR
EC
HE
RC
HE
RE
NF
OR
CE
ME
NT
DE
S
CA
PA
CIT
ES
/FO
RM
AT
ION
Ed
entu
lism
Per
iod
on
tal
Dis
ease
s
Har
mfu
l P
ract
ices
Ben
ign
Tu
mo
urs
Co
ng
enit
al
Mal
form
atio
ns
Dea
l w
ith
as
for
tra
um
a ab
ove
.
Dea
l w
ith
as
for
ora
l ca
nce
r ab
ove
dep
end
ing
on
nat
ure
of
the
tum
ou
r.
Dea
l w
ith
as
for
des
tru
ctiv
e fa
cial
co
nd
itio
ns
such
as
no
ma
and
oth
er c
on
dit
ion
s re
qu
irin
g re
con
stru
ctiv
e su
rger
y.
(i)
Rec
ord
s b
ased
su
rvei
llan
ce a
s fo
r o
ral
can
cer
(i)
Uti
lize
exi
stin
g d
ata
and
rec
ord
sy
stem
s to
mo
nit
or
thes
e co
nd
itio
ns.
(i)
Dev
elo
p e
ffec
tive
o
ral
hea
lth
ed
uca
tio
n a
nd
p
rom
oti
on
m
ater
ials
wit
h
stro
ng
mes
sage
s o
n
mo
uth
cle
anin
g.(i
i)
Pro
mo
te u
se o
f ef
fect
ive
trad
itio
nal
m
eth
od
s o
f o
ral
care
(Se
e ca
ries
ab
ove
)(i
ii)
Inte
grat
e o
ral
hy
gien
e p
ract
ices
w
ith
en
viro
nm
enta
l h
ygi
ene
pro
mo
tio
n
effo
rts
by
lo
cal
hea
lth
wo
rker
s.
(i)
Ref
erra
l to
th
e n
ext
leve
l o
f ca
re.
(ii)
E
mer
gen
cy t
reat
men
t fo
r p
ain
rel
ief.
(iii
) Se
lect
ed u
se o
f sc
alin
g an
d o
ther
fo
rms
of
trea
tmen
t ai
med
at
pre
ven
tin
g p
laq
ue
rete
nti
on
.(i
v) C
om
ple
x tr
eatm
ent
such
as
per
iod
on
tal
surg
ery.
(i)
Eff
ecti
ven
ess
of
com
mu
nit
y o
ral
hea
lth
ed
uca
tio
n.
(ii)
A
etio
logi
cal
and
ris
k
fact
or
rese
arch
.(i
ii)
Th
e in
tera
ctio
n
bet
wee
n s
yst
emic
an
d
oth
er c
on
dit
ion
s re
late
d t
o p
erio
do
nta
l d
isea
ses.
(iv)
Fac
tors
th
at c
ause
p
rogr
essi
on
of
gin
givi
tis
to
per
iod
on
titi
s an
d
AN
UG
to
no
ma.
(v)
Tra
dit
ion
al m
eth
od
s o
f p
reve
nti
on
an
d s
elf
care
.
(i)
Tra
in P
HC
wo
rker
s an
d
sch
oo
l te
ach
ers
on
ora
l h
ealt
h
edu
cati
on
an
d p
rom
oti
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