WORKING PAPER
A CHILD ORAL HEALTH PROMOTION PROJECT Cambodia - Pilot November, 2017
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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 preventive dentistry, 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. Corporations provide materials and funding as part of their commitment to Corporate Social Responsibility.
II. INFORMATION ON BIKE FOR CAMBODIA 1. Primary Contacts: Fredrik Olsson Designation: Regional Manager Sweden Tel.: +46 76 7621122 Email: fredrikolss@gmail.com Horn Seangphally Designation: Operational Manager Cambodia Tel.: +855 17 661854 Email: h_seangphally@yahoo.com 2. Goals and Vision: Increase the quality of education and health services to children in Cambodia. 3. Main Working Areas: Schools in rural Cambodian communities. 4. Organizational Structure: Bike for Cambodia is made up of 3 organizations located in Sweden, Cambodia and UK. Registered in Sweden, No. 802452-‐6249 Registered in the UK, No. 1149440 5. Institutional Infrastructure and Capacity: A Board governs each of the 3 organizations. Partners in Sweden include Kunskapsakademin (elementary school in Sundsvall) and Narkoskliniken (dental clinic in Stockholm); in Cambodia include several elementary schools; in UK include Festival Repulic and Land & Sky Campsite.
III.
INFORMATION ON INTERNATIONAL ASSOCIATION OF DENTAL STUDENTS 1. Primary Contact: Ms Deema Raslan Designation: Volunteer Programs Coordinator email: voluntary@iads-‐web.org
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2. Goals and Vision: The international association of dental students was founded in Denmark 1951 and currently represents more than 200,000 dental students and graduates in more than 60 countries worldwide. IADS mission is to serve and fulfil the educational development needed to form passionate dental student and leaders. IADS strives to involve students with people in need while tasting extracurricular activity such as voluntary participation in 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. Cambodia faces numerous challenges. Important sociopolitical issues include widespread poverty, pervasive corruption, lack of political freedoms, low human development, environmental destruction and a high rate of hunger. While per capita income remains low compared to most neighbouring countries, Cambodia has one of the fastest growing economies in Asia with growth averaging 6 percent over the last decade. Agriculture is the traditional mainstay of the Cambodian economy, with rice the principal commodity. The Cambodian population is known to have a high burden of dental caries. Since 1994, studies have highlighted the high prevalence and severity of early childhood caries and have linked this with certain risk behaviors: changes in dietary habits, and; the lack of access to oral hygiene aids (one report stated that as many as one in five 12 years old from rural Cambodia had never brushed their teeth). Of the 450 dentists in Cambodia, most are not in the rural areas where most of the population lives. The most recent publication (Chher T, et al. Int Oral Health 2016) reported the results of the 2011 National Oral Health Survey which was conducted to assess the dental caries, sequelae, and selected risk indicators in Cambodia. The prevalence of dental caries was 93% at age 6 years, and 80% at age 12-‐13, and 35-‐44 years. At age 6 years, the mean dmft was 9.0; at age 12-‐13 years the mean DMFT was 3.8; at age 35-‐44 years the mean DMFT was 5.6. There was a high frequency of cariogenic foods consumption by children and adolescents, and prolonged nocturnal breastfeeding was common. Around 62% of children aged 6 years had not started tooth brushing yet. The most common dental problems, such as dental caries which is pandemic, 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 disadvantaged youth of vulnerable communities such as in the Kampong Cham and Tbong Kmoum districts of Cambodia, 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 Cambodia, 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. This proposal envisages a model based on the PLANNING-‐IMPLEMENTATION-‐EVALUATION cycle for oral health programs in developing countries.
F. Project target groups/beneficiaries: o Primary: § Children – Pilot aims to reach 685 kids § Government o Secondary: § Schools § General population 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:
Prekjik Village, Tonlebet Commun, Tbong Kmoum district. School: Prekjik Primary School Total potential reach: 685 th nd Project time frame: November 9 – 22
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 excursion Bike for Cambodia 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 excursion 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. None are recommended. -‐ Visa. Not necessary if from a visa exempt country. -‐ Flights -‐ Extras such as shopping, leisure activities etc Excursions 1. Sihanoukville also known as 'Kampong Som', is a coastal city in Cambodia and the capital city of Sihanoukville Province, located at the tip of an elevated peninsula in the country's south-‐west at the Gulf of Thailand. The city is flanked by an almost uninterrupted string of beaches along its entire coastline and coastal marshlands bordering the Ream National Park in the East. The city has one navigatable river, the mangrove lined Ou Trojak Jet running from Otres pagoda to the sea at Otres. There are a number of thinly inhabited islands nearby.
2. Siem Reap is the capital city of Siem Reap Province in northwestern Cambodia. It is a popular resort town and a gateway to the Angkor region. Siem Reap has colonial and Chinese-‐style architecture in the Old French Quarter, and around the Old Market. In the city, there are museums, traditional Apsara dance performances, a Cambodian cultural village, souvenir and handycraft shops, silk farms, rice-‐paddies in the countryside, fishing villages and a bird sanctuary near the Tonle Sap Lake. Siem Reap is close to the Angkor temples, the most popular tourist attraction in Cambodia. K. 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.