Make oral care integral to universal health coverage

Against a WHO-recommended dentist to population ratio of 1:7500, our country’s ratio is 1:1027 and the spread of dental specialists in rural areas has always been a matter of concern.

Lt Gen Dr Vimal Arora | April 8, 2019


#UHC   #rural   #India   #dentists   #dental health   #oral health   #WHO   #PMJAY   #PM Modi   #SDG  


In a world that continues to witness a sharp divide between the rich and poor, and diseases continue to stare menacingly at humanity, it is only prudent that World Health Organisation declared Universal Health Coverage (UHC) as this year’s Health Day theme. UHC means that all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality, to be effective and ensuring that the use of these services does not expose the user to financial hardship. With an estimated 100 million being pushed into extreme poverty each year because of out of pocket spending on healthcare, it is time we intensified our efforts to create systems which provides cushion to the people.

 
It is heartening that India has made a giant leap in addressing this menace of financial hardships caused by ailments. The ambitious Ayushman Bharat programme could soon become a model for many countries in the world to emulate. Rightly termed as world’s largest healthcare program, the Pradhan Mantri Jan Arogya Yojana (PM-JAY) is designed to reduce the financial burden on poor and vulnerable groups arising out of catastrophic hospital episodes and ensure their access to quality health services. PM-JAY seeks to accelerate India’s progress towards achievement of and Sustainable Development Goal - 3 (SDG3) by providing financial protection to 10.74 crore poor, deprived rural families and identified occupational categories of urban workers’ families. All this translates into about 50 crore beneficiaries. PM-JAY offers a benefit of Rs. 5 lakh per family per year and covers medical and hospitalisation expenses for almost all secondary care and most of tertiary care procedures.
 
The take off to the program has been good with over 27 million e-cards having been issued. As per a National Health Agency (NHA) data, for the initial period of Ayushman programme, oral and maxillofacial surgery was among the most sought after service. This certainly indicates a growing awareness about oral health but given the enormity of the problems associated with it this may be just the tip of the iceberg.
 
The Global Burden of Disease Study 2016 estimated that oral diseases affected 3.58 billion or half of the world’s population, with dental caries in permanent teeth being the most prevalent condition assessed. WHO says that oral diseases are the most common non-communicable diseases (NCDs) and affect people throughout their lifetime – causing pain, discomfort, disfigurement and even death. Not many would be aware that severe periodontal (gum) disease, which may result in tooth loss, was estimated to be the 11th most prevalent disease globally. Oral health inequalities exist among and between different population groups around the world and through the entire life course. Needless to reiterate that oral health has bearing on overall health status of people and it is only wise that when we speak of UHC, we give special consideration to dental care.
 
The WHO also says that dental treatment is costly, averaging 5 percent of total health expenditure and 20 percent of out-of-pocket health expenditure in most high-income countries. Therefore it is critical that dental care is covered by the health insurance schemes of both state-run and private insurance companies. While the country has seen unprecedented advancements in technologies in variety of specialties including cardiology, neurology, ophthalmology and orthopedic, the same is missing in dentistry. It is important that our hospitals, especially in tier-II cities and smaller towns, get equipped with state-of-art dentistry technologies. Alternatively, we could work out a hub and spoke model where private chains with good network of clinics and technology deployment, serve as referral centres for government and private hospitals in smaller cities.
 
As we aspire to move towards UHC, it would also be critical to strengthen our human and capital infrastructure, and more so in neglected areas such as dentistry. It is imperative to create a system where dental doctors are encouraged to necessarily serve in rural areas. Despite being home to a surplus of over 1.2 lakh dentists, India’s rural deployment of dentists is very poor. Against a WHO-recommended dentist to population ratio of 1:7500, our country’s ratio is 1:10271. With less than 25 percent of Primary Health Centres having a dentist, the proposition of placing a dentist per 30,000 population is highly desirable. While as per the 10th Five Year Plan, we have managed to increase the number of dental colleges in India, the spread of dental specialists in rural areas has always been a matter of concern.
 
Among others, the WHO call to action to policy makers includes gathering better health data for effective use of resources. Having spent considerable time in the Indian Army and then in public healthcare system for more than four decades, I can safely say that dental care remains a highly neglected areas - not only by us, the people, but also by the policy makers. Its ramifications, I am afraid, are scary and as we get down to dedicate ourselves to follow the spirit of universal coverage this World Health Day, I shout out loud to all to factor in dental and oral care as integral part of the overall healthcare. Affordability and access have been two big inhibitors that have prevented better dental care coverage, and I am glad that inspired by the ideals of PM Sri Narendra Modi, we have launched a special, highly affordable (just over Re 1 a day) plan for people to take care of their oral health.
 
A good oral health system will be significant to UHC, and in turn, overall wellbeing of India. 
 
Dr Arora, a former director general of the Dental Services of the Indian Armed Forces, is chief clinical officer, Clove Dental.

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