Catalyst for Care: Community Oral Health Program in Tanzania
Kelly Antosh
This issue originally appeared in the Spring 2024 issue of FOCUS.
It is not uncommon for dental professionals to get involved with mobile clinical treatment teams that travel to underprivileged communities to provide low-cost or free dental procedures primarily for dental caries. What is less common are programs that focus on prevention rather than on treatment. This requires a more long-term approach and it is notably more challenging to measure the outcomes. Yet, prevention has more impact on oral health when geography, physical access to a dentist, and lack of financial resources put treatment out of reach for much of the global population.
Since 2017, the Provision Charitable Foundation (PCF) has been developing an oral health promotion and disease prevention program that has been showing favourable results in Ifakara, a town of approximately 100,000 people in South Central Tanzania. After collecting decayed, missing, and filled teeth (DMFT) data from several schools in the Ifakara area of Tanzania in 2017, it was clear that decay was a problem in both primary and secondary dentitions among children. Additionally, a majority of the children surveyed also reported soda/pop as their primary daily beverage. This assessment information led the oral health team to give birth to a Community Oral Health Program led by local Community Health Workers.
Tanzania already trains Community Health Workers in a 1-year program. According to Tanzania’s Policy Guideline for Community Based Health and Social Welfare Services from 2020,
[A] community health worker (CHW) is defined as female or male individual who on a voluntary basis are nominated by their communities and trained according to the approved national training package to address health and social welfare issues of individuals and communities in their respective localities. CHWs work in close relationship with health facilities and local community leaders. A CHW acts as a catalyst to enable people to take control and responsibility for their own efforts and achievement in their health and social well-being.
The World Health Organization (WHO) published Promoting Oral Health in Africa in 2016 and stated:
Since oral health professionals are relatively scarce in the Region, additional oral health training for non-oral health professionals such as doctors, nurses, clinical officers, and other health care workers, can help to address some of the unmet needs related to the prevention and control of oral diseases and the provision of a public dental service.
In 2020, the WHO published the Global Oral Health Status Report and recommended that “To achieve UHC (Universal Health Care) for oral health. […] Efforts should focus on the development of ‘innovative workforce models’.”
Thus, the oral health team at PCF felt that our strategy was clear — we needed to provide oral health training for CHWs and to
equip them to become the primary prevention teachers in their own community for the promotion of good oral health. In 2017, an oral health curriculum was first delivered to 16 CHWs over 5 days. The curriculum covered topics such as oral and dental anatomy, caries, periodontal diseases, common oral pathologies, systemic links to oral conditions, prevention methods (oral self-care, diet, fluoride, intra and extra oral self-exams), and signs and causes of dental pain. It also included experience in the field providing education in a variety of settings. 6 CHWs completed the training successfully and in 2022, 10 more CHWs successfully completed the program. This was step number one.
In 2021, PCF, in partnership with Ifakara’s St. Francis University College of Health and Allied Sciences (SFUCHAS), hired 3 CDWs (Community Dental Workers) and equipped them with bicycles, phones, uniforms, and educational materials. They were granted permission by the Regional and District health authorities to attend schools and Reproductive Child Health Clinics. These CDWs gradually became recognized as the ambassadors for oral health in Ifakara.
In early 2022, a social scientist at SFUCHAS did the first program evaluation by interviewing the CDWs and a sample of community members (all mothers) to evaluate the impact of the program after almost one year. This evaluation was of course critical and helped the team to make adjustments so that the program could continue to progress and grow. Qualitative comments from mothers included the following:
- I learned that I should stop giving my children sugar foods like sweets and biscuits regularly because they can cause tooth decay.
- We did not know how to brush our teeth properly, so we were trained how to do it. The experts trained us to start upward, downwards, on the sides and then you finalize with the tongue.
- We learned about the stages that a tooth can go through to its decay. There are three stages whereby in the first stage you will observe some dot mark on your tooth and if you were trained it would be easier to take measures earlier before going to dental clinics where you cannot be helped rather taking out your tooth.
The CDWs were also interviewed and identified ongoing challenges such as biking during the rainy season, dealing with community members who already had very serious dental problems and needed treatment, and an inability to meet community requests for brushes and toothpaste.
Since 2022, PCF has added 5 CDWs to the team. They are now 5 men and 3 women on the team, which allows them to cover more areas. We were able to secure support and partnership to help them with their work on the ground. PCF has secured the support of Colgate-Palmolive – Bright Smiles, Bright Futures in Tanzania. They are supplying the CDWs quarterly with thousands of brushes, toothpaste, and educational materials in Swahili. PCF is also collaborating with the Tanzanian Dental Association. Dalhousie University’s Faculty of Dentistry has been involved in supporting the program through collaborative planning discussions and ongoing qualitative research to further evaluate program outcomes and secure funding for program growth.
Personally, as the PCF lead of this Community Oral Health Program, I cannot be more pleased and proud of the program and its preventive approach, but most especially of the 8 CDWs who not only work hard at their jobs, but who believe so strongly in the message they are carrying to their own communities. They understand the long-term ramifications of ongoing dental disease and the immense value of being part of the solution. Many of the CDWs are Christians themselves and give glory to God for this work and being able to provide for their families. It is wonderful to work in partnership with our brothers and sisters in Tanzania.
PCF and our amazing CDWs will continue to forge ahead. There is more growth to come and our dream is to expand the number of CDWs to deliver education and support beyond Ifakara. For more information about this Community Oral Health Program and ways of becoming involved, please contact Kelly Antosh at kdmabey@gmail.com. You can visit Provision Charitable Foundation at www.provisioncharitablefoundation.org.