Sad face thinking of problematic states

Factors Contributing To Oral Health Status Medical Services (20%) Biology & Genetics (5%) Lifestyle & Behaviour (25%) Oral Health Status Peace Food Shelter Income & Education Environment (>50%) Stable eco-system & sustainable resources Ref: 1. Health Determinants: Lalonde 1974; McKeown 1978 2. Jakarta Declaration of Health Promotion, 1997 Poverty Social security & relations Empowerment of Women Social Justice & Equity Respect for Human Rights

1. Poor oral health status 2. Low coverage of school children

1 2 3 4 Service Delivery Resources Universal Coverage Policy

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.)

Resources 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

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

Policy 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

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 31 st 1989). Health Education Authority.