Nikhil Dev Wazir
The IMF (International Monetary Fund) and economist at world bank have suggested that within few years India’s economy might be growing more quickly than china as it has 11.5 % of world’s population and 44% of them being young and in productive age. India’s economy is robust but India lacks behind in terms of education, standard of living, and in particularly health. Over decades health in India is gaining less importance and oral health the least. Oral diseases remain a public health problem for developed countries and a burden for developing countries like India especially among the rural population .India has around 69% rural population. Prevalence of oral diseases is very high in India with dental caries ( 50%, 52.5%, 61.4%,79.2%, and 84.7% in 5 yrs, 12yrs, 15 yrs, 35-45 yrs, and 65-75 yrs old , respectively) and periodontal disease (55% 89.2%79.4%in 12 yrs, 35-44yrs,65-74 yrs old respectively) as 2 most common Oral diseases. Oral health is an integral part of general health and there is well documented that there is an association of oral diseases with various systemic diseases like diabetes, cardiovascular disorders, pregnancy and its impact on quality of life. The reported facts about various oral health diseases are alarming and reflecting the state of oral health in our country.
Oral disease patterns are changing in India as the nation is witnessing a major shift in dietary habits of its citizens due to changing lifestyles. The lack of well organised Oral health care delivery system due to absence of Oral health policy which could be main reason for increase in oral diseases load on its citizens. Although the blue print of the National oral health policy was drafted at developing an efficient oral health care delivery mechanism to address the oral health needs, still remains as a draft since last 20 yrs due to poorly motivated policy makers, despite hike in oral disease load in India .The reason given then was there was scarcity of qualified dental man power, but this doesn’t hold true today as dental surgeons are in surplus.
National oral health policy
It was formulated way back in 1984,, National workshops were organised in then Bombay now Mumbai on Oral heath targets for India. In 1986 Indian dental association conscripted oral health policy. Two national workshops organised in Delhi (1991) and Mysore (1994) gave Dental council of India various inputs to develop National policy on oral health. Also in the same year 1994, WHO gave importance to dental health worldwide by selecting a theme”oral health for healthy life”, at the same time core committee appointed by ministry of health and family welfare, GoI accepted in principle, National oral health policy as a component of National health policy and moved 10 points resolution in its 4rth, conference in year 1995. After 3 yrs , National Oral Health Care Programme (NOHCP), a project of Directorate General of Health Services (DGHS) and Ministry of Health and family welfare was initiated and launched on pilot basis and Dept of Oral and Maxillofacial surgery (AIIMS ) was given charge to execute the pilot project in 5 states ( Delhi, Punjab, Maharashtra, Kerala and North eastern states )in the process of achieving goals of National oral health policy .One single districts from each state was selected to trial the strategies of NOHCP. The strategies included oral health education with information, education and communication materials by involving health workers, school children, teachers and mass media, formulation of basic package on rural health care, dental man power and infrastructure development, mobile dental clinic services for rural people, public health and research monitoring.
Scenario of dentist in J&K
· Oral health care programme is launched recently in two districts , udhampur and Anantnag-a good beginning.
· There has been no creation of new posts and recruitment for the past 8 yrs at graduate level (BDS). The Govt. should have special quota of posts for dental surgeons under recently framed New Recruitment Policy.
· The Health Ministry should create posts of Dental Surgeon in National Health Mission (NHM) for Oral Health Mission programme and remove pay anomaly of Dental Surgeons who are already working under NHM.
· There are only 500 plus sanctioned posts of dental surgeons for a huge 1.25 crore (1: 25000 )population of J&K which simply flaws the WHO Oral Health guidelines of dentist : population ratio in developing country
· There are more than 2500 unemployed dental surgeons in the state and the number is increasing every year.
· Dental surgeons are virtually nonexistent in NRHM scheme of central Government. Just one post per district. The Government must work in coordination with Central Government about this matter.
· There should be a minimum of six dental Surgeons in a district hospitals and 3in sub district hospital respectively and 2 dental surgeons in every P.H.C, C.H.C. and School Health Program.
· After reorganization of Districts and up gradation of Allopathic Dispensaries in to PHCs – the Govt. should notify posts and create more posts in the corresponding PHC.
· Govt should create dental surgeon posts in all newly constructed NTPHC’s wherein Medical officer Posts have been already created.
· The Oral Health of Patients in Rural Areas is severely compromised because of lack of accessibility and unavailability of Dental surgeons. The Govt. Should open ‘Rural Clinics’ and ‘Dental units’ in remote areas and appoint Dentists- to deliver Health care and to Serve Rural people
· The Govt. Of J&K must frame Policy in the pattern of other States- to notify PSC posts every year so that the Graduates have more opportunities for employment.
· The Govt. Should open post graduation courses in all depts. in Institute of Dental Sciences Sehora and Govt. Dental College Amphalla Jammu (GDC Srinagar has a post graduate programme running already) on fast track basis so that a highly skilled dedicated dental man power is created to serve our state. This will further help to reduce the frustration and unemployment which dentists are facing today in J&K.
What needs to be done?
· To equalize uneven distribution of dentist between urban and rural areas, the Govt has to take adequate measures to promote dentist wishing to practice in rural areas by providing jobs at every level of rural health care network like NHRM. As there is no posts for dental surgeons in NHRM. Is dental health not of importance for our rural India.
· The Govt should provide incentives to those establishing practices in rural areas by providing space, infrastructures and amenities at subsidized rates.
· Since the frequency of people visiting the rural dental clinic is less due to poor health education, a dental education programme has to be initiated.
· Private companies or Govt. Or a combination of both should start Dental insurance to cover for dental health care needs for urban and rural population. Such insurances are already functional in countries like USA, UK.
· School dental health services should be mandatory for schools to comply with. And needs to be monitored.
· Central bureau of health intelligence to be initiated for our state.
· Creation of new posts and increase in the number of dental surgeons for every PHC , district hospital and Govt dental colleges
· Dental Institutions should have specific funds allotted for community primary prevention procedures.
· Having a full fledged Directorate of Dentistry dedicated for dental health across our state.
The need for implementation of a drafted oral health policy with some modifications that suits rapidly changing oral health systems of our Jammu and Kashmir is inevitable. The govt. needs to set up a committee by involving dental professionals to plan to reduce the oral disease burden in a more practical approach.
(The author is Prof & Head Dept of Conservative and Endodontics Institute of Dental Sciences, Sehora Jammu)
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