CONCEPT PAPER
AN ORAL HEALTH PROMOTION PROJECT for the children of South Africa Emadlelwini Primay School, Soweto Bethany Home, Johannesburg
Pilot -Phase II
April, 2019
a collaboration between
This Concept/Working Paper is for transparent alignment of all Gogos Give Smiles Stakeholders
I. INFORMATION ON HUMBLE SMILE FOUNDATION
1. Primary Contacts:
Romay Harding Designation: Project Manager Tel.: +27 72 108 8800 Email: romay@humblesmile.org Dr Darren Weiss Qualification: B.D.Sc.(Melb.) Designation: Executive Director 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: ED/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, global health and child welfare. Office provides services in Operations & Development Coordination and Communication International leaders are Humble Smile Ambassadors. Partners: Organizations - global health research, humanitarian assistance, professional associations; Academia - dental schools, student associations; Non-Profit Orgs - on-site platforms and access to schools; Corporations – in-kind contributions and funding (Corporate Social Responsibility).
II. INFORMATION ON RIVERS FOUNDATION 1. Primary Contact: Nuska Zwane Designation: Managing Director Tel.: +27 87 941 4090, +27 82 927 5351 nuska.zwane@riversfoundation.org.za 2. Goals and Vision: The Rivers Foundation was established in 2006 with the specific aim of addressing the unique challenges faced by the children, youth, unemployed and unskilled individuals in South African communities. All donations received are used to help the beneficiaries – nothing goes towards operational costs. The Rivers Foundation exists to be a helping hand to disadvantaged families and strives to strengthen communities through feeding schemes, coaching and mentoring, skills training and enterprise development.
3. Main Working Areas: Guateng Kwa Zulu Natal Eastern Cape 4. Organizational Structure: Regional Directors -Mr AG Olivier, Mr KM Naicker, Mrs WE Olivier, Mr MW Springett, Mr SR Lewarne, Mrs TM Zwane Facilitators -Approx. 200 - most of whom are volunteers from Rivers Church 5. Institutional Infrastructure and Capacity: Admim Headquarters is situated at Unit 13 Olympia Gardens, Cnr Olympia and Southway roads, Kelvin, Gauteng, South Africa, that caters for 10 staff, Gala clothing, teen girls toiletries, feeding area and a sorting donation room. Skills Training Quarters is adjacent to Admin Quarters, catering for the following skills: Sewing, IT, upholstery, Basic Financial Literacy training, beading and soft skills (self-development programs – SHINE & Strength, telephone skills etc).
III.
INFORMATION ON INTERNATIONAL ASSOCIATION OF DENTAL STUDENTS 1. Primary Contact: Mr Marc Tokarski Designation: Volunteer Programs Coordinator Tel.: +49 162 1801460 email: voluntary@iads-web.org
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.
IV. 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. In the unplanned settlements around Soweto there is a surge in the demand for effective and efficient health services and innovations as a result of emerging socio-economic dynamics resulting in rural-urban migration. There is a great window of opportunity for promoting dental health among these disadvantaged youth of Gauteng, through self-care and community participation-oriented programs. V. PILOT PROJECT - PHASE I – COMPLETED A. Overall Objective: o To improve oral health integration in BHC and education systems in KwaMhlanga, following WHO recommendations. (Represented in a MoU between King Makhosonke II and Humble Smile Foundation – Appendix I). 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 (such as fluoride)
D. Implementation: Facilitation Locally, the project patron, Princess Agnes, identified and arranged meetings with schools and key personnel. The field team flew in from 10 countries, consisting of dentists, dental students, a dental hygienist, public health and project management professionals.
Investigation - Two days were spent visiting homes and 4 schools in the Kingdom. The team was joined on these visits by representatives of the MoE (Ms Ntombi) and the Kingdom (Prince Freddie). - At each school information was gathered on the school infrastructure and school body. Each principal was interviewed. - 68 school students were interviewed with a WHO survey and brief clinical examination, to learn of their circumstances and needs. Results - Good oral health. Most of the children caries free. - Fluorosis evident in almost every child. - Healthy lunches at school as part of the National School Nutrition Project - The children are eating and drinking foods and drinks with added sugar on a daily basis. - Vendors sell unhealthy foods and drinks at the school - The School Governing Bodies are comprised of caregivers, 80% of whom are Gogos (grandmothers). - The SGBs do not include health professional consultations. - The children brush their teeth at home, and receive theoretical oral hygiene instruction under the Life Skills Teachers program. - Most of the children are cared for at home by the Gogos (about 80%). - The children do not have any dentistry, including check-ups. - Compared to a school we visited in Pretoria (Onderstepoort), where the children are examined and treated by a dental school, the Ndebele schools are at a disadvantage. - Principals, teachers and adults believe the childrens’ oral health status is poor due to “tooth staining”, poverty and “neglect” (not seeing dentists). - Highly cooperative schools. Model In order to motivate and train the Gogos (particularly those on the SGB) to promote supervised brushing, healthy tuck-shop products and traditional foods, cooking and herbal remedies - a 3-day (per school) model was designed and tested at one of the schools (Loding Primary). - Day I: Fact-finding. School infrastructure; staff; interview with principal; WHO survey of children; clinical exams. - Day II: Workshop. Building relations, educating and empowering the SGB members and community to promote oral health in each school. - Day III: Field day. Setting-up toothbrushing stations; preventive oral health learning activities. Proof of Concept - All days had high engagement of both children and Gogos. - In evaluations following the SGB program (Appendix II), 100% of the Gogos indicated: The workshop prepared me for helping in the school the next day; The in-school program was successful in introducing new habits in the school routine; I can support the school to maintain tooth brushing in the schools. - In evaluations following the SGB program, 92% of the Gogos commented: “Come back” - One-year follow-up with comparison to baseline evaluations is needed to prove the concept. Recommendations The project was renamed Gogos Give Smiles (previously Mzansi Smiles). The report to the King (Appendix III) recommended solidifying the Proof of Concept in another community prior to scaling up the project. This will require engagement of: - Professional and academic bodies
- Researchers - Media – local and global - Corporate sponsors -NGOs - local and global - Authorities - MoE and MoH - Ambassadors - Constance Mabena who is chief of the “Veza Ukhono Club” and living proof of concept - Promotional agreement with Veza Ukhono Club (Appendix IV)
E. Project target groups/beneficiaries: o Primary: § Children – pilot reached over 1000 kids with tooth brushing and nutritional activities. o Secondary: § Schools § General population § Authorities F. Indicators and Success (Monitoring and Evaluation): WHO Oral Health Surveys, Basic methods, 5th edition, Annex 8. (Appendix V) G. Secondary Benefits (not monitored): o Children: empowerment to make choices for their health and autonomy. o Gogos: collaboration helping them to improve the quality of life for themselves, their families and their communities. o Profession: dentistry ultimately benefits from dentists that are preventive minded, disease oriented and communally engaged. o Peace: relationships developed and sustained amongst volunteers from around the world, living and collaborating on challenging health issues, promotes understanding and co-existence in the world. H. Location of the project site: Ndebele Kingdom, in Nkangala Region Mpumalanga Province, South Africa. Schools:
Sizabantwana Primary Mbhongo Primary Loding Primary Ndayi Primary
I. Project time frame: February 2018 J. Operational Roles and Responsibilities: HUMBLE SMILE - Training the field team - Providing oral care products - Providing educational resources
- Advocating the integration of oral health in upstream policies - Monitoring, evaluation and reporting - Food - Accommodation - Transport - Funding of above operations including weekend excursions for the field team. NDEBELE REPRESENTATIVES: - Identifying schools - Gaining access to schools - Authorization from local government / oral health / education depts - Providing necessary local facilitators - Letter of invite for volunteers in non-visa exempt countries IADS - promotion of project amongst members - enrolling student volunteers incl. copy of passports - providing the volunteers with information VOLUNTEERS - Health insurance - Vaccinations (consult with travel clinic) - Visa - Flights - Extras such as shopping, leisure activities, beer etc
K. Events: Festival of Kings, Wahlmasthal. The team was honored to be the King’s guest at the annual Komjekejeke Festival.
VI. PILOT PHASE II – GOGOS GIVE SMILES A. Overall Objective: To improve oral health integration in education systems in informal settlements of Soweto, Gauteng. 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 (such as fluoride) D. Implementation: As per Phase I model above. Each cycle, repeated at 6 month intervals, is 5 days in duration, repeated twice per project: Day 1 Assessment of previous community Day 2 Assessment of current community Day 3 Preparation Day 4 Gogo workshop
Day 5 Field/ School Day 6-10 repetition of days 1-5 E. Project target groups/beneficiaries: o Primary: § Children – 900 – 1300 children with tooth brushing and nutritional activities. o Secondary: § Schools – empowering SGBs to enact policies reflecting best health practices § Gogos: - development of a dynamic and growing collaboration to help them to improve the quality of life for themselves, their families and their communities. § Government – MoE and MoH policy development
F. Indicators and Success (Monitoring and Evaluation): o Programmatic Research work in process G. Secondary Benefits (not monitored): o Children: empowerment to make choices for their health and autonomy. o Schools: - staff education about oral health - strengthen connection with Gogos o Community – healthier homes - stronger Gogo organisations o Rivers – demonstrating care for communities - promotion of the communities internationally - introduction of new partner organizations, corporate sponsors and projects into the communities o Profession: - data collection and research on an innovative model for school-based oral health promotion. - formative development of dental professionals who are more preventive minded, disease oriented and communally engaged. o Diplomacy: relationships developed and sustained amongst volunteers from around the world, living and collaborating together on challenging health issues, promotes understanding and co-existence in the world.
H. Location of the schools and community sites:
Province: Area: Closest city:
GAUTENG SOWETO JOHANNESBURG
ADDRESS
SCHOOL/ HOME/ SHELTER
GRADES
994 Funekile Street Dlamini Soweto
Emadlelwini Primary School
1 to 7
NUMBER OF LEARNERS 850
56 Millbourn Rd Bertrams Johannesburg
Bethany Home www.bethany home.co.za
Ages 1 to 14
30 to 40 children
I.
PRINCIPAL CONTACT DETAILS
GOGO CLUB
Mr Kubheka +2772 270 5028 Email: ndlekakubheka8@ gmail.com Bridget Edwards +2711 614 3245 Email: benthanyhome.edw ards@gmail.com
Siyabanakekela Social Club
Project time frame: 12 to 15 days allowing for 2 working weeks
Mothers participate
CHIEF GOGO - CONTACT DETAILS Edith Gcilitshana +2776 574 9538 -
J. Operational Roles and Responsibilities: (IADS and VOLUNTEERS as per Phase I) HUMBLE SMILE - appointment of scientific officer - development and application of dedicated scientific methodology - mapping of provinces, Gogo organizations and schools - working paper with target communities and dates - appointments of project Manager, Ambassadors and Partners - engagement of sponsors and supporters in SA and globally - engagement of professional, academic, corporate, organizational and media partners both within and without SA - promotion via media and professional channels - training the field team - provision of oral care products - provision of educational resources - advocating the integration of oral health in upstream policies - monitoring, evaluation and reporting - food - accommodation - transportation - funding of above operations including weekend excursions for the field team - provision of funds for extraordinary facilitation expenses and Gogo resources RIVERS FOUNDATION - Identifying a community with schools and Gogo clubs - Assistance with mapping of schools and Gogo clubs - Gaining access to schools - Assistance with gaining authorization from local government / health dept/ education depts - Participation in promotional and media activities - Providing necessary local facilitators - Letter of invite for volunteers in non-visa exempt countries - Ensuring the Attendance of Gogos at workshop and field day at the schools - Ensuring Gogos provide and maintain tooth brush holders for the schools - Monthly monitoring and reporting by the Gogos according to the form in Appendix VI - Assistance with monitoring and evaluation
VII. PARTNERS