Sad face thinking of “problematic states”

Oral Health Status

Biology & Genetics (5%)

Environment (>50%)

Medical Services (20%)

Lifestyle & Behaviour (25%)

Peace

Food

Shelter

Income & Education

Social security & relations

Empowerment of Women

Social Justice & Equity

Respect for Human Rights Stable eco-system & sustainable resources

Poverty

Ref: 1. Health Determinants: Lalonde 1974; McKeown 1978 2. Jakarta Declaration of Health Promotion, 1997

Factors Contributing To Oral Health Status

1. Poor oral health status

2. Low coverage of school children

Service Delivery

Resources

Universal Coverage

Policy

1

3

4

2

Service Delivery

Setting up task force

• A task force to:

• Analyze root cause of problem identified

• Prioritize issues to be solved

• Devise comprehensive, realistic and do-able strategic plan/ programme

• Determine a time-line for implementation of the strategic plan/ programme

• Monitor and evaluate the effectiveness/ implementation of the plan/ programme

Service Delivery

“Orally-fit through preventive” approach

• Outcome-based vs. output target

• Investing time today for a better tomorrow

• Paradigm shift – prevention is always better than cure

“The day is surely coming…when we will be

engaged in practicing preventive, rather than

reparative dentistry.”

G.V. Black, 1896

Service Delivery

Setting up different target/ standard for state/ district to achieve

• Moving target

• Different set of QAP/ NIA standard – according to state/ district current achievement

“Common Risk Factor Approach”

• Should be strongly emphasized in tackling root cause of disease and promoting health

Common Risk/Health Factor Approach

Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 2000; 28: 399-406.

Service Delivery

“Program Bersepadu Sekolah Sihat”

• To help to “resuscitate” and strengthen existing programme

Incentive/ Reward/ Award/ Recognition

• To encourage healthy habits among children

• To encourage community participation in promoting health and owning health

• Adopt “What’s In It For Me? (WIIFM)” Approach

Service Delivery

Innovative Ways To Recruit Target Population

• e.g. “Photo Voice” concept

• Target population to promote oral health to their own peers

Service Delivery

To apply Blue Ocean Strategies

• To reduce (factors contributing to the problem)

• To increase (standards/ oral health status)

• To eliminate (old/ existing strategies that doesn’t work/ not effective)

• To create (new concept, intervention, etc.)

1. Pooling resources through zoning

Human resources

Equipment

Expertise

2. Redistribution of DPHS according to needs

Cross border (neighbouring state and district)

3. Capitalize/ ride-on government’s policies and

priorities of the day

Program Transformasi Luar Bandar

Be an “opportunist” and politically savvy

Resources

4. Facilities

Dental clinic in every district

1Malaysia clinic concept – bringing care to door step

Increase number of mobile teams

5. Extended hours

Staggered operating hours

Making service more accessible and convenient to

customer

Resources

Universal Coverage

Strengthening collaboration with other

health personnel

Strengthening collaboration with

other agency

Empower paramedics to improve oral health in

rural communities

• Working together on CRFA

• Village/ school health team

• MINDEF, University, JKM, JHEOA, JBA, KEMAS, Teachers, MDA, NGOs

• Develop “Guidelines on Management of Acute Dental Conditions for Paramedics”

• Distributing oral health promotion materials

Universal Coverage

Empower local communities to

take care of their own oral health

Incentive for Outreach

Programme

• Community leaders, village health promoters

• Training of trainers

• Developing “Oral Health Care Manual”

• Private GDP, volunteer personnel

• e.g. tax deduction, CSR

1. Compulsory service for Dental Officers to

serve in state with problems (i.e. Sabah,

Sarawak, Kelantan, Terengganu)

2. Human resource distribution should based

on burden of disease, accessibility

3. Making healthy choice an easier choice

Advocate ‘less sugar’ policy

Subsidy rationalization programme for sugar

Making oral hygiene kit as standard item in

Kedai Rakyat 1Malaysia

Policy

4. Expand fluoride mouth rinsing initiative to

schools in area that are not covered by

water fluoridation

5. To advocate for inclusion in the Annual Work

Output Target (SKT) of paramedics on:

a. Cursory examination and oral health education

for antenatal mothers

b. Giving talks/ advice to parent/ carer of toddlers

6. SKT of Head Master to include scheduled

and regular TBD

Policy

Burkitt DP. Don't just mop the floor; turn the tap off. McCarrison Society Newsletter; 1989.

Burkitt DP. Don't just mop the floor; turn the tap off. McCarrison Society Newsletter; 1989.

The Main Determinants of Health

Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Copenhagen: WHO

Regional Office for Europe; 1992.

1. Don’t be a copy-cat but be a leaping cat

2. Combination of population and high risk

prevention strategy

3. Apply evidence based intervention

4. Evaluate intervention programme

5. Achieving balance

Poster “Visit your dentist regularly” (December 31st 1989). Health Education Authority.