A Policy Shift On Oral Health Care Could Do The Magic, Let’s Revisit The 1978 Alma Alta Declaration

Until September, 1978, the health sector focused mainly on the few urban dwellers which constitute 20% to the neglect of the rural dwellers who constitute 80% of the entire population in a top – bottom approach, this worrying trend led to a six(6) days International Primary Health Care Conference at Alma Alta in Union of Soviet Socialist Republics (USSR), now Russia, from the 6th to 12th September, 1978.

This Conference reaffirmed the current definition of health and actually made health a fundamental human right, the conference also gave birth to ten strong point declaration, which was termed “Alma Alta declaration” . The goal for this first International Primary Health Care Conference was “health for all by the year, 2000”

Primary Health Care (PHC) is simply defined as taking the health care to the doorstep of the individual. Countries are gradually shifting from the top – bottom approach to the bottom – top approach, Ghana really came into the real international picture of PHC and became a model for study after successful implementation of Community – based Health Planning and Services (CHPS) in the year 1999 after 5years of successful piloting of the program by Navrongo Health Research Center, the CHPS started initially as Community – based Family planning Program (CFP).

This initiative coupled with others saw a dramatic improvement in immunization coverage in Ghana, from 47% in 1988 to 79% in 2008 (% of children 12 to 23months fully vaccinated), the overall improvement of health care accessibility in Ghana now is also a major landmark worth celebrating as a country though it falls short of the goal, health for all by the year 2000 as stated in the Alma Alta declaration.

The multi million questions that we should be asking ourselves when it comes to Oral Health are; “has oral health care been brought to the doorstep of individuals? ” the answer is obviously hell no! Was oral health excluded from the Alma Alta declaration? The definition of health encompasses all aspect of health! The other question is when are our policy makers going to reorient our health sector to make oral health care accessible to the ordinary people who can’t afford to travel long distance to seek for oral health informations? The question goes on and on without ending.

The excuse that is normally heard is the scarcity of dentists, another question is, did the country train more doctors (General Practisioners) and Public Health Nurses before creating health centers and CHPS Compounds? The issue boils down to the priorities of our nation and the vision of our health managers.

I would be the first person to shout on top of the roof about the scarcity of dentists and and advocate for more incentives for the few dentists taking into consideration the workload and the manner in which they over stretch themselves in the name of service to God and country, however Physician Assistants – Dental are trained to subtly supplement for the deficiency of dentists and serve as agents of referral, Registered Dental Surgery Assistants (RDSA) are also trained to assist both Dentists and Physician Assistants but specifically dentist since the physician assistants work to also assist dentist.

My difficulty is how the full potentials and energy of RDSAs are left untapped to the benefit of the society and the achievement of the noble “Alma Alta declaration “, RDSAs are only made to sit at the dental units (operatory) and give direct assistants no matter their number in a particular dental units.

Meanwhile if there is a favorable policy shift, RDSAs could be posted to sub districts to take charge of oral health care and indirectly assist dentist by focusing on oral health promotion such health talks, basic oral examinations and prompt referral of cases and if possible enhance their ability to undertake minor treatments, almost all the staff Manning the various sub districts are ignorant when it comes to oral health conditions and information regarding oral health and therefore make the plight of patients with oral health conditions very worse.

My humble opinion is that, the current health sector should be reoriented to include oral health service at the sub district level so that more RDSAs could be trained and empowered to take charge of these offices with the primary aim of taking oral health to the doorstep of the ordinary people through oral health education, community durbars, perform basic oral health examinations, and above all promptly refer patients with oral health conditions to dentists for early treatment and if possible strengthened to undertake basic treatment.

If physician assistants – medical, Registered General Nurses, Midwives, Community Health Nurses and Health Assistants Clinical undertake health promotion, basic examinations, minor ailment treatment and referral to assist doctors(General Practisioners) in their various sub district and CHPS Compounds then it wouldn’t be out of place for RDSAs to do same at sub district level to assist their dentists who are very few and over stretched. God bless our dentists, God bless RDSA, God bless OHSAG, God bless OHPAG and God bless our motherland, Ghana.

…….Shaibu Issifu (Jnr Prof) ……
General Secretary – OHSAG
College of Health, Kintampo

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