National Oral Health Care Programme
National Oral Health Care Programme a project of DGHS and Ministry of Health & Family Welfare was initiated in 1998 with aim of providing oral health care in the country through organized primary prevention and strengthening of Oral health setup as per the recommendations made in National Oral Health Policy. Later on the Department of Dental Surgery, All India Institute of Medical Sciences was chosen as the nodal agency to implement it.
Oral Health Policy was drafted with the help of Indian Dental Association and was accepted in principle as a part of National Health Policy during the Fourth Conference of Central Council of Health & Family Welfare in the year 1995.
6.1 National Oral Health Policy
Fourth Conference of Central Council of Health & Family Welfare in October 1995, New Delhi resolved that:
1. There is an urgent need for an Oral health Policy for the nation as an integral part of the National Oral Health Care Programme Health Policy.
2. Special, well coordinated, National Oral Health Care Programme be launched to provide Oral Health Care, both in the rural as well as urban areas due to deteriorating oral health conditions in the country as revealed by various epidemiological studies. Dentists/population ratio in the rural areas is only 1:300,000 whereas 80% of the children and 60% of the adults suffer from dental caries, more than 90% of adult community after the age of 30 years suffer from periodontal diseases which also have its inception in childhood. In addition, 35% of all body cancers are oral cancers. Large segment of the adult population is toothless due to the crippling nature of the dental diseases and about 35% of the children suffer from mal-aligned teeth and jaws affecting proper function. In view of the above facts, it is important to launch preventive, curative and educational oral health care programmes integrated into the existing system utilizing the existing health and educational infrastructure in the rural, urban and deprived areas.
3. A post of full time Dental Advisor at appropriate level in the Dte. G.H.S. should be created as a first step towards strengthening the technical wing of the Dte.GHS in this regard.
4. Studies have revealed that dental diseases have been increasing both in prevalence and severity over the last few decades. There is, therefore, an urgent need to prevent the rising dental diseases in India. The method used for primary prevention of dental diseases aims at achieving primary prevention of periodontal diseases and oral cancers.
5. The Council, therefore, resolves that preventive and promotive Oral Health Services be introduced from the village level onwards and accordingly a pilot project on Oral Health Care may be launched by the Ministry of Health & Family Welfare during 1995-96 in five districts, one in each in five states.
6. The Council further resolves that legislative measures be adopted to ensure a statutory warning on the wrappers and advertisement of sweets, chocolate and other retentive sugar eatables ‘TOO MUCH EATING SWEETS MAY LEAD TO DECAY OF TOOTH’. Similar measures are also called for tobacco and Pan Masala related products.
7. The Council recommends that a National Oral Health Care Programme Training Centre be established or the existing centres be strengthened for training of various categories of Oral Health Care Personnel.
8. The Council also resolves that all District Hospitals and Community Health Centres have dental clinics. All Dental Colleges should have courses on Dental Hygienists and Dental Technicians.
9. The Council further resolves that the Pilot Project may be extended to all the States at the rate of one District in every State.
10. The Council resolves that there is an urgent need to have a National Oral Health Care Programme Institute for Dental Research to guide oral health research appropriate to the needs of the country.
(* - Ref, agenda item No. XX, Proceedings and Resolutions, Fourth Conference of Central Council of Health & Family Welfare, October 11-13, 1995, New Delhi)
As per the resolution no. 5, Govt. of India, Ministry of Health and Family Welfare has declared AIIMS as a nodal agency to implement pilot project on Oral Health in the country since the year 1999. The main objectives of this programme are to improve the oral health of the masses and to prevent/ reduce the burden of oral disease in the country. Towards this objective, the Nodal Agency has developed an accessible, low-cost, sustainable, primary preventive programme using existing primary health care infrastructure and resources.
The programme has 3 basic components
(1) To provide oral health education to masses through a network of Dental Surgeons, Health Care Workers, Anganwadi Workers and Schoolteachers
(2) To produce Information, Education and Communication material (IEC) to train the Health Workers and for conveying oral health messages to the people through mass media and,
(3) To formulate guidelines to strengthen oral health set-up at District level, Community Health Centers and Primary Health Centers.
For the purpose of Implementation, the Programme is divided into three phases.
1. Developing the Implementation Strategies
During 1999-2000, four regional and two National Workshops were organized to sensitize the dental personnel in various parts of the country. The outcome of these workshops has been compiled in the form of Implementation Strategies.
2. Training and Re-orientation of Dental Surgeons
In order to train the Health Workers at various levels and the Schoolteachers, the Dental Surgeons from various Govt. Hospitals, Training and Re-orientation Programmes are being conducted in pilot states. So that the Dental Surgeons can act as Master Trainers for the National Oral Health Care Programme. Till now 11, workshops for the master trainers have been conducted for Delhi, Assam, Meghalaya, Maharashtra, Punjab, Arunachal Pradesh, Manipur and Tripura states and Indian Railways.
3. Training of Health Workers
As a part of background material for training of health workers, an educative video film on oral health “Kripaya Muskuraiye” and pictorial training manual on oral health for health workers have been produced. Till now 13 training programmes in the Delhi, Meghalaya, Punjab, Maharashtra, Arunachal Pradesh, Manipur and Tripura have been conducted for the health workers and Schoolteachers.
Apart from these, symposiums are conducted in various professional workshops and conferences to involve more and more Dental Professionals in the National Oral Health Care Programme. Till now, five symposia have been conducted in Delhi, Bhubaneshwar, Allahabad, Kochi and Vijaywada.
The nodal agency conducts Free Oral health Camps for the lower socio-economic population at various places. Till now, about 43 oral health camps and awareness programmes have been organized under the aegis of National Oral Health Care Programme.
4. IEC Material Publication and Distribution
Following IEC aids have been produced as a part of this programme and are distributed to various Govt. Organization, State Health Education Bureau, Dental Colleges, IDA Branches and NGO’s for Oral Health Awareness programmes.
1. National Oral Health Care Programme: Implementation Strategies – 2001
2. Training Manual on Oral Health for Health Workers – in Hindi and English in the year 2001
3. Educative video film on Oral Health entitled “Kripaya Muskuraiye” – in Hindi and English in the year 2002
4. Single Sheet colored Oral Health Information for Health Workers in Hindi for their Ready Reference in the year 2002
5. Training Manual on Oral Health for Schoolteachers – in Hindi and English in the year 2003
6. Posters on Oral Health “Dant fit to Life Hit” series of four posters in English and Hindi in 2003.
7. Educative Poster Series of five posters for schoolchildren “Swastha Muskan Aapka Vardan” in Hindi and English in 2004.
6.2 Barriers in Oral Health Promotion in the Country
During the implementation of the National Oral Health Care Programme in the pilot phase, it was perceived that most of the times our policymakers give oral health last priority. They are inadequately informed about burden of oro-dental problems and its connection with the systemic health and possibly minimal threat to human life due to oro-dental problems makes step motherly treatment for dental public health programmes. One of the major disadvantages is that in India, health is a state subject and most of the states in the country are suffering from financial burden even for subsistence rather than providing quality health care. Mostly the health care is looked after by the private sector and individual practices including non-formal medical facilities. However, the treatment cost for oral diseases is enormously expensive and it has not been possible for any Govt. setup to provide dental services to all. Moreover, our country lacks experts in dental public health. The curriculum for graduation is outmoded with very little importance to prevention. The dental graduates are unable to perceive the importance of learning prevention of oro-dental problems for the community and they are not aware of their responsibilities towards the society. The internship programme is also underutilized by the dental colleges for services to the grass root level and dental health needs of our geriatric population are overlooked. We do not have organized school oral health education programmes so that children may learn right oral health practices from the beginning. Over and above fastest growing population, rapid westernization and lack of resources are increasing the burden of oral diseases in our country. Tobacco abuse is further causing menace for not only the poor and disadvantaged but also civilized population. Early initiation of tobacco habits in children is causing havoc in terms of morbidity and mortality of our younger generations.