WORKING PAPER
MZANSI SMILES
AN ORAL HEALTH PROMOTION PROJECT for the children of the Ndebele Kingdom in Nkangala Region, Mpumalanga Province, South Africa
Pilot February 16th – March 4th, 2018
by invitation of Ndebele Kingdom Princess Agnus Mabena in association with
I.
INFORMATION ON HUMBLE SMILE FOUNDATION 1. Primary Contact: Dr Darren Weiss Qualification: B.D.Sc.(Melb.) Designation: President, Humble Smile Foundation Tel.: +972-‐522675410 Email: darren@humblesmile.org 2. Goals and Vision: The prevention of suffering caused by oral disease by promoting effective oral health initiatives where needs are great. 3. Main Working Areas: Schools in developing countries. 4. Organizational Structure: Board of Directors –scientific and policy governance; fund management Community Executive Committees – mission management Registered charity in Sweden No. 802500-‐7785. 5. Institutional Infrastructure and Capacity: President is a dentist and oral health promotion consultant for companies and organizations. Board with its executive and advisory committees, comprises professionals and academics in community, clinical and preventivedentistry, international health and child welfare. International leaders are Humble Smile Ambassadors. Organizations on global health research and humanitarian assistance are partners. Academic partners include dental schools, professional (dental and dental hygiene) and student associations. NGOs locally provide the on-‐site platforms and access to schools. Corporationsprovide materials and funding as part of their commitment to Corporate Social Responsibility.
II. INFORMATION ON NDEBELE KINGDOM REPRESENTATIVES 1. Primary Contacts: Romay Harding Designation: Regional Projects Coordinator Tel.:+27 72 108 8800 Email:romayharding@gmail.com Princess Agnes Mabena (Eldest sister of King Makhosonke II) Designation: Community Leader appointed by Dept. of Transversal and Rural Development . Chairman of Woman’s NGO/NPO INKONJANI WOMENS NETWORK. Mamsy Masilela Designation: Health Director Unjani Clinic Kwaggafontein Tel.:+27 72 203 7049 Email: hlophemamsy@gmail.com
III.
INFORMATION ON INTERNATIONAL ASSOCIATION OF DENTAL STUDENTS 1. Primary Contact: MrBjorn Bierlich Designation: Volunteer Programs Coordinator Tel.: +49 176 9263 3401 email: voluntary@iads-‐web.org
2. Goals and Vision: The international association of dental students was founded in Denmark 1951 and currently representsmore than 200,000 dental students and graduates in more than 60 countries worldwide. IADSmissionistoserve and fulfil the
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V.
educational development neededto formpassionate dental student andleaders.IADS strives to involvestudents withpeople in need while tasting extracurricular activity such as voluntary participationin outreach projects. INFORMATION ON ALLAINCE FOR ORAL HEALTH ACROSS BORDERS 1. Primary Contact: Prof. Amid Ismail Desigantion: Chair email:ismailai@temple.edu 2. Goals and Vision: The Alliance is a membership organization that serves as a change agent to nurture respect, understanding, and cooperation amongst the global oral health community, through initiatives focused on promoting oral health that can bridge the valleys that exist among people that are based upon religions, origins, cultures, economic disparities and political positions. CONTEXT AND BACKGROUND
Oral health is fundamental to general health and well-‐being. Poor oral health affects quality of life as a result of pain or discomfort, tooth loss, impaired oral functioning, disfigurement, missing school time, loss of work hours and death in the case of oral cancer and noma. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. This, together with insufficient emphasis on primary prevention of oral diseases, poses a considerable challenge for several countries, particularly developing countries and countries with economies and health systems in transition. The World Bank classifies South Africa as an upper-‐middle-‐income economy, and a newly industrialised country. Its economy is the second-‐largest in Africa, and the 34th-‐largest in the world. It has the seventh-‐highest per capita income in Africa. However, poverty and inequality remain widespread, with about a quarter of the population unemployed and living on less than US$1.25 a day, and South Africa is ranked in the top 10 countries in the world for income inequality. Life expectancy in 2009 was 71 years for a white South African and 48 years for a black South African. According to the 2015 UNAIDS Report, South Africa has an estimated 7 million people living with HIV – more than any other country in the world. Most AIDS deaths are experienced by economically active individuals, contributing to the estimated 1,200,000 orphans who in many cases depend on the state for care and financial support. While 16% of the total population of the country are covered by third party insurance and make use of the private sector for their health services, 84% of the population depend on the public healthcare system, which is beset with chronic human resource shortages and limited resources. The oral health system is also divided along similar private/public lines. Oral health services are provided by approximately 3400 dentists, plus dental therapists and oral hygienists. More than 80% of this oral health workforce works in the private sector. Caries has been identified as the most widespread condition affecting children in South Africa. The National Children’s Oral Health Survey (2003) indicates prevalence of over 60%in the 6-‐year-‐old group, while 80% of those carious lesions go untreated. The inevitable dental pain and discomfort result in the loss of school days and dental caries has become a major public health concern because of the burden it places on public health services. Emergency relief of pain is the most frequent clinical procedure performed at a primary oral healthcare-‐ rendering service facility. The scientific literature suggests that intervention strategies (such as school-‐based programs) currently employed are standardised and not evidence-‐based for diverse populations. These interventions are therefore not producing the desired outcomes resulting in the failure of the current National Oral Health plans in South Africa. Consequently, the prevalence of caries in children has not been adequately addressed through policy and service delivery. The most common dental problems, such as dental caries, can be prevented by simple and inexpensive methods. Dental health is based on oral hygiene, nutrition, fluoride intake and dental service utilization; whereas bad dental health in adults is usually the result of the absence of these influences during childhood. Dental health promotion aims to create an environment favorable to the adoption of these healthy behaviors. The use of school structure is particularly beneficial as activities can be integrated into the curricula, and it provides quality personnel to ensure proper implementation. The implementation of dental health promotion generally doesn't result from a national initiative in developing countries, largely due to the lack of integration of dental health in activities of education and health promotion in general. There is a great window of opportunity for promoting dental health among the Ndebele youth such as in KwaMhlanga, in the municipality of Thembisile, in South Africa, through self-‐ care and community participation oriented programs. VI. PROJECT CONCEPT A. Overall Objective:
o To improve oral health integration in BHC and education systems in KwaMhlanga, following WHO recommendations. B. Project Purpose: o To reduce morbidity due to caries among vulnerable population in target region. C. Outputs: o Sugar and acid intake habits are improved among children o Plaque control measures are increased o The ratio of favourable:unfavourable host factors is increased D. Output-‐wise major activities: o Sugar and acid intake habits are improved among children § Obtain authorisation to work in schools § Work with school directors and teachers on appropriate food intake (where necessary) § Prepare a training module and schedule for the school kids § Advocate to MoH and MoE for policies and protocols implementation § Meet local community leaders to sensitize and explain oral health o Plaque control measures increased among children in schools § Introduce oral health habits in school routine § Sensitize local leaders and parents § Toothbrushes or other culturally accepted accessories distribution (1 year supply) to the school students, § Discuss with government opportunities to reduce taxes on those accessories § Find potential donors for the accessories § Train school professionals on the subject § Create brushing stations o The ratio of favourable:unfavourable host factors is increased § Introduce fluoride based toothpaste into the school routine § Sensitize the community regarding fluoride intake benefits § Sensitize the community regarding sugarless chewing gums benefits § 1 year supply distribution for the school kids § Advocate regarding fluoridation § Train school professionals § Apply Silver Diamine Fluoride to cavities § Apply fissure sealants
E. Implementation strategy: A capacity development model whereby the IADS field team educates local school staff to promote specific behavior-‐ based preventive oral health initiatives, and advocates the integration of oral health in upstream policies. The principle recommended dental health measures are: 1/ topical fluoridation; 2/ modification of the amount of sugar in the diet, and; 3/ implementation of monitored dental hygiene activities in schools. Supporting school health in this way aims at broad exposure to the host population, while maximizing long-‐term benefit to the host population, and minimizing cost and any potential dangers to the local infrastructure. Participation in an annual community event for the grandmothers, who are in most cases the caretakers (known as “Gogos”), including oral hygiene and nutritional instruction. This proposal envisages a model based on the PLANNING-‐IMPLEMENTATION-‐EVALUATIONcycle for oral health programs in developing countries. F. Project target groups/beneficiaries: o Primary:
§ Children – Pilot aims to reach 800 – 1000 kids o Secondary: § Schools § General population § Governmnet G. Indicators and Success (Monitoring and Evaluation): th WHO Oral Health Surveys, Basic methods, 5 edition, Annex 8. H. Secondary Benefits (not monitored): o Children: § empowerment to make choices for their health and autonomy. § hand-‐washing hygiene and sanitation o Profession: dentistry ultimately benefits from dentists that are preventive minded, disease oriented and communally engaged. o Peace: relationships developed and sustained amongst dental student volunteers from around the world, living and collaborating together on challenging health issues, promotes understanding and co-‐existence in the world.
I. Location of the project site:
Ndebele Kingdom in Nkangala Region Mpumalanga Province, South Africa. Schools: Sizabantwana Primary Mbhongo Primary Loding Primary Mgibe Primary Ndayi Primary Total potential reach: >1000 th th Project time frame: February 16 – March 4
J. Operational Roles and Responsibilities: Humble Smile will be responsible for -‐ Training the field team -‐ Providing oral care products -‐ Providing educational resources -‐ Advocating the integration of oral health in upstream policies -‐ Monitoring, evaluation and reporting -‐ Funding of operations including weekend excursions Ndebele Kingdom Reps will be responsible for logistics(not funding) of: -‐ Gaining access to schools -‐ Authorization from local government / oral health / education depts. -‐ Providing local support personnel incl. guides, translators, drivers, cooks -‐ Food -‐ Accommodation -‐ Transport -‐ Letter of invite for volunteers in non-‐visa exempt countries -‐ Organizing weekend excursions IADS -‐ promotion of project amongst members -‐ enrolling student volunteers incl. copy of passports -‐ providing the volunteers with information Alliance for Oral Health Across Borders -‐ Promotion of project amongst dental school members -‐ Generate content for one evening program focusing on the interaction between dental students and discussion on Oral Health
Diplomacy. -‐ Formation of an Alliance Student Chapter as an outcome, to nurture relationships formed and future leadership. Volunteers -‐ Health insurance -‐ Vaccinations (consult with travel clinic) -‐ Visa -‐ Flights -‐ Extras such as shopping, leisure activities, beer etc K. Excursions: 1. The First Fruits UKULUMA Festival, February 17 We will be fortunate to arrive in time for the traditional harvest celebration -‐ Omit Zulu th
2. Dinokeng Game Reserve other Nature Reserves as well as Cullinan which was the richest Diamond mine in its day and is now an amazing historical village to visit. February 24-‐25th
3. Festival of Kings KOMJEKEJEKE, Wahlmasthal, March 3
rd
We will be even more fortunate to end our project withthis truly African experience, attended by kings and chiefs from all over southern Africa. See a write up on last year’s eventhttp://www.sowetanlive.co.za/news/2016/03/04/amandebele-‐nation-‐to-‐ commemorate-‐late-‐ndebele-‐king-‐silamba
L. Sustainability: In addition to training the local non-‐dental personnel, interventions must aim to promote and facilitate long-‐term sustainable improvements, such as tackling upstream factors, and the environment that cause poor oral health and create inequities. It is clear that actions from the health departments alone have limited impact on the wider determinants of health inequities. Healthy public policies and legislation are important upstream measures to promote oral health, such as legislation to support the implementation of fluoridation programs (water, milk, salt and toothpaste), and healthy diet policy to create a supportive environment that is conducive to oral health. In particular, water fluoridation is one of the most cost-‐effective public health measures to improve dental health and reduce
inequalities. Also, removal of taxes for oral health products is fundamental to avoid health inequities. Capacity building, training and empowering the non-‐dental school staff, is the key to continuity.
PARTNERS