Future of health workforce education for addressing NCDs in the global health context - WHO perspectives

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1 18/10/2018 1

2 Future of health workforce education for addressing NCDs in the global health context - WHO perspectives Dr Benoit VARENNE, DDS, MPH, PhD Dental Officer, WHO HQ Geneva 23 rd CONGRESS EADPH, October 2018, Palma De Mallorca, Spain 2

3 PRESENTATION OUTLINE 1. Key facts, challenges & emerging issues 2. Global health opportunities for changes 3. Mapping mainstream strategies 4. Key messages 3

4 PRESENTATION OUTLINE 1. Key facts, challenges & emerging issues 2. Global health opportunities for changes 3. Mapping mainstream strategies 4. Key messages 4

5 A universal truth: no health without a workforce Health workers are the backbone of strong, resilient health systems Improving health service coverage and realizing the highest attainable standard of health is dependent on health workers availability, accessibility, acceptability and quality Universal Health Coverage is only possible with adequate investment in the health workforce Health workforce shortages are increasing the inequities in access to health services, causing preventable illness, disability and death, and threatening public health, economic growth and development 5

6 The health economy is a major & growing source of employment 6

7 Overview of the main drivers of the health labour market 7 Ref. WHO. Global strategy on human resources for health:worfkforce 2030

8 Key facts, challenges & emerging issues Oral diseases as major NCDs continue to be a serious burden with a growing threat of co and multi morbidity 8

9 Oral disease burden - GBD study 2016* 3.5 billion people (nearly half of the world population) suffer from disability from oral conditions Untreated Dental caries in permanent teeth, the most prevalent condition, affects more than 2.3 billion people worldwide 9 *Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, : a systematic analysis for the Global Burden of Disease Study Lancet 2016

10 Key facts, challenges & emerging issues Oral diseases as major NCDs continue to be a serious burden with a growing threat of co and multi morbidity Unequal distribution, shortage of oral health professionals and lack of appropriate facilities means that access to essential oral health services is often low 10

11 Density of Dentistry personnel (total number per 1,000 pop)* *Latest available year 11 Ref: WHO Global Health Observatory

12 Density of Dentists per 10,000 population (average)* 0.0, 1.8 (43) *last 5 years (2013 to 2017) No record in 82 Member States last 5 years 12 Ref: WHO Global Health Observatory

13 Key facts, challenges & emerging issues Oral diseases as major NCDs continue to be a serious burden with a growing threat of co and multi morbidity Unequal distribution, shortage of oral health professionals and lack of appropriate facilities means that access to essential oral health services is often low Oral health care demands are beyond the capacities of the health care systems in most LMICs and beyond, exerting an additional burden on the health-care system This results in a high proportion of oral diseases being untreated and leads to significant unmet patient needs 13

14 Key facts, challenges & emerging issues ORH workforce and education models are relying on dentistcentred health system Incentive payment mechanisms to providers of healthcare services towards restorative treatment Vertical programming and managing characterized by isolated disease approaches rather than integrated preventive strategies has remained the standard Socio-economic inequalities and social gradients exist in oral health globally 14 Progress in addressing the burden of oral diseases in an equitable and integrated manner remains slower than expected

15 PRESENTATION OUTLINE 1. Key facts, challenges & emerging issues 2. Global health opportunities for changes 3. Mapping mainstream strategies 4. Conclusion 15

16 A Presentation definition of Global outline Health Global health is an area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. Global health emphasises transnational health issues, determinants, and solutions; involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population based prevention with individual-level clinical care. Jeff rey P Koplan and al. Lancet,

17 The reality of Global Health!

18 PRESENTATION OUTLINE 1. Key facts, challenges & emerging issues 2. Global health opportunities for changes 3. Mapping winning strategies 4. Conclusion 18

19 Agenda for Sustainable Development Commits governments to develop national responses: Target 3.4: By 2030, reduce by one third premature mortality from NCDs Target 3.5: Strengthen responses to reduce the harmful use of alcohol Target 3.8: Achieve universal health coverage Target 3.a: Strengthen the implementation of the WHO Framework Convention on Tobacco Control Target 3.b: Support research and development of vaccines and medicines for NCDs that primarily affect developing countries Target 3.b: Provide access to affordable essential medicines and vaccines for NCDs Target 3.c: Increase health financing and health workforce in developing countries

20 20

21 10/18/

22 Universal Health Coverage (UHC) WHO defines UHC as all individuals and communities receive the health services they need without suffering financial hardship. Three areas are critical to achieving UHC: 1) Integrated essential oral health services; 2) Oral health workforce geared towards population health needs; 3) Financial protection for oral health care. 18/10/

23 UN Political Declaration on NCDs (New York, September 2011)...Article Recognize that renal, oral and eye diseases pose a major health burden for many countries and that these diseases share common risk factors and can benefit from common responses to noncommunicable diseases;

24 UN Political Declaration on NCDs (New York, September 2011) 24

25 Political Declaration on NCDs 25

26 Global NCD Agenda 26

27 Minamata Convention on Mercury: Phase Down Use of Dental Amalgam To protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds 27

28 28 Highlights of the Convention Measures to be taken by a Party to phase down the use of dental amalgam shall include two or more of the measures from the following list: i. Setting national objectives aiming at dental caries prevention & health promotion ii. Setting national objectives aiming at minimizing its use iii. Promoting the use of cost-effective and clinically effective mercury-free alternatives iv. Promoting research & development of quality mercury-free materials v. Encouraging professional organizations and dental schools to educate & train dental professionals and students on the use of mercury-free dental restoration alternatives & on promoting best management practices vi. Discouraging insurance policies, & programmes that favor dental amalgam use vii. Encouraging insurance policies & programmes that favor the use of quality alternatives to dental amalgam viii. Restricting the use of dental amalgam to its encapsulated form ix. Promoting the use of best environmental practices in dental facilities

29 IMPLEMENTING PHASE DOWN OF DENTAL AMALGAM A MULTI-PRONGED AND MULTISECTORAL APPROACH - Situation assessment of trade, regulation & use of dental amalgam & alternative - Documenting good practices and demonstrating the feasibility of early implementation - Adaptation of third-party payment systems for dental care - Implementing environmentally sound management of waste - Research & development of alternatives - Revising curricula of dental professional education Stakeholder groups - Raising public & dental professional awareness Population Industry Professional Policy makers 29

30 PRESENTATION OUTLINE 1. Key facts, challenges & emerging issues 2. Global health opportunities for changes 3. Mapping mainstream strategies 4. Key messages 30

31 The Global Strategy on Human Resource for Health (2016) Accelerate progress towards UHC and the UN SDGs by ensuring equitable access to health workers within strengthened health systems Objectives: 1. Optimize the existing workforce in pursuit of the Sustainable Development Goals and UHC (e.g. education, employment, retention) 2. Anticipate future workforce requirements by 2030 and plan the necessary changes (e.g. a fit for purpose, needs-based workforce) 3. Strengthen individual and institutional capacity to manage HRH policy, planning and implementation (e.g. migration and regulation) 4. Strengthen the data, evidence and knowledge for cost-effective policy decisions (e.g. National Health Workforce Accounts) 31

32 One key principle of the Global Strategy on Human Resource for health (2016): People-centred health services Putting the comprehensive needs of people and communities, not only diseases, at the centre of health systems, and empowering people to have a more active role in their own health 32 Reference

33 Another principle: Public policy levers to shape health labour markets for achieving UHC 33 Reference: WHO. National health workforce accounts: a handbook.

34 Framework for Action on Interprofessional Education & Collaborative Practice Collaborative practice occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, and communities to deliver the highest quality of care across settings Interprofessional education occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes 34 Ref: WHO. Framework for Action on Interprofessional Education and Collaborative Practice (2010)

35 Framework for Action on Interprofessional Education & Collaborative Practice 35 Ref: WHO. Framework for Action on Interprofessional Education and Collaborative Practice (2010)

36 Existence of standards for inter professional education & collaborative practice 1. Existence of standards for education and existence of accreditation system based on the standard 2. Existence of standards for inter professional education 3. Existence of systems for inter professional practice and continuing professional development 4. Improve skill mix composition key steps to move forward dental education 36

37 Existence of national standards for NCDs and its risk factors education and accreditation system For example, nutrition.. There is a need for dental educational bodies to define the core content of the dental curriculum with respect to nutrition. This should include the evidence base on the impact of dietary sugars on both general and dental health, information on current dietary guidelines for health, an understanding of nutrition labelling, and an knowledge base in behavioural change theories to support dietary modification in individuals seen in dental practice. 37

38 Another example: Tobacco cessation Role of the Oral Health Professionals Ref: 2018 global progress report on implementation of the WHO Framework Convention on Tobacco Control 38

39 Role of the Oral Health Professionals Slightly over half of all Parties declared having integrated tobacco dependence and cessation in the curricula of various of medical students and it was even less common in nursing, dentistry and pharmaceutics. Better inclusion of the methodology in the curricula would reduce the need for later extensive and more costly training of health workers. Ref: 2018 global progress report on implementation of the WHO Framework Convention on Tobacco Control 39

40 Reforming health service delivery and organization 1. Prioritizing health promotion & disease prevention 2. Optimizing scopes of practice 3. building stronger linkages between health and social sectors 4.Empowering people and communities 40

41 PRESENTATION OUTLINE 1. Key facts, challenges & emerging issues 2. Global health opportunities for changes 3. Mapping mainstream strategies 4. Key messages 41

42 Key Take Home Messages Demographic and epidemiological transitions are putting (oral) health systems around the world under huge strain There is a growing demand for integrated, people-centred, community-based health services and personalized longterm care SDG2030 Agenda including UHC, Minamata Convention and prevention & control of NCDs is an ideal framework to built the future of dental education and reorient oral health sector Interprofessional collaboration in education and practice a necessary step in mitigating the global ORH workforce crisis 42

43 Key Take Home Messages (2) Radical reforms are needed in the oral health sector towards (1) Prioritizing oral health professionals with strong competencies in health promotion and disease prevention (2) Developing multidisciplinary and complementary teams of (oral) health workers (3) Building stronger linkages between health and social sectors in order to meet the health and social care needs of an older population and people living with chronic conditions and disabilities (4) Empowering people and communities to play a greater role in designing health systems and to participate in their own health care 43

44 44 Further reading

45 Oral Health is much more than healthy teeth! Thank you! 45

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