Mid year population estimate for 2010 was 1,317,714 Population increased by 10.3% between 1990 and 2010 Shift in the gradient from younger to older

Transcription

1

2 Mid year population estimate for 2010 was 1,317,714 Population increased by 10.3% between 1990 and 2010 Shift in the gradient from younger to older groups between 1990 and 2010 reflecting changes in fertility and mortality Male: Female ratio of 1

3 The economy continues to be heavily dependent on the energy sector (oil and natural gas) initiatives to diversify the economy by increasing the role of other important sectors, such as agriculture, manufacturing, and tourism. Estimated Employment distribution in 2007 services sector employed 62.9% of the workforce the construction and utilities sector employed 20.4%; the manufacturing, mining, and quarrying sector employed 12.8%; and the agriculture sector employed 3.8%

4 Unemployment rated decreased from 5.4% in the first quarter of 2012 to 4.9% in the second quarter of 2012 (Central Bank) Survey of Living Conditions(2005) reported that 16.7% of the population was poor and 1.2% was indigent. This survey found that there was a tendency for poorer households (31%) to be headed by women.

5 The Government provides free education at the primary, secondary, and tertiary levels. The 2009 literacy rate for adults was 99% enrolment have been high, with levels above 97% reported for the primary level, and levels above 75% for the secondary level. The female to male ratio: at the primary level and 1.06 at the secondary level (2009) At the university level, females outnumber males.

6 Gender Inequality Index of inequalities exist in relation to reproductive health, empowerment and labour market Women s average income as a percentage of men s in 2000 was lower in all occupational categories Males have lower participation in the education system, participate more in high risk behaviours (e.g., early sexual activity, use of drugs and alcohol), and are more likely to be affected by violence and accidents.

7 Expectant Mothers Infants and young children Elderly People living below the poverty line Special needs

8 6 DMFT OF 12 YEAR OLDS IN 1989 AND DMFT

9 2004 National oral health survey found a relatively high caries prevalence and severity among 6-8yr olds Dmft score of 2.54 with only 38% caries free High d component Paucity of data for children between 11/2 and 5 yrs

10 adult national health survey has never been conducted Very few studies conducted Camejo (1999) found that 15% of elderly needed to replace their dentures

11 More recent study on the elderly in Trinidad by Rawlins et al. (2008) High % of population with dentures: 47% for males and 62% of females 20% of males and 28% females were edentulous majority wore their dentures regularly, 90% for the males and 88% for the females majority (64%) reported that no negative impact of their oral health on eating their meals regularly

12 National census of Trinidad and Tobago(2000) found that 45,496 persons living with disabilities No national oral health survey ever conducted among the special needs population Data available from a 2004 study by Naidu et al. on 410 special Olympic athletes High prevalence of untreated molar decay(43.7%) and gingival signs(34.6%) 27.6% had urgent treatment need

13 For the period , oral cancer accounted for 1.3% of all cancer cases and 1.4% of cancer related deaths Male to female ratio of 3:1 Data on patient demographics, five year survival rates and quality of life among oral cancer patients lacking

14 Accounts for the majority of oral health services Funded primarily through direct payment or insurance coverage 338 dentists with a dentist to population ratio of 1/3846 No official register for dental assistants Very few dental nurses

15 Five Regional Health Authorities, (RHAs), which are responsible for service delivery Annual service(asa) agreement between the RHA and the MOH which details services that the RHAs are expected to deliver which includes procurement of dental equipment and supplies, maintenance of dental surgeries and provision of dental reports At the local level, the oral health staff- (dentists, dental nurses and dental assistants,) provides oral health promotion and oral disease prevention as well as curative and rehabilitative services to meet the oral health needs of the population.

16 Primary and Secondary levels of oral health care are offered at 47 dental units operating in the 110 health centers throughout Trinidad and Tobago Tertiary oral health services (specifically maxillofacial surgical services) are offered at three of the national s hospitals Public sector dental workforce currently comprised of 49 nurses, 46 assistants,25 dentists and 2 oral maxillofacial surgeons

17 Data on private dental care provision non existent Public services limited to provision of care for children up to the age of 18 and emergency/palliative care to adults No programme that attends to the routine treatment and preventive needs of the elderly Treatment of special needs also limited with most being referred to OMFS departments of various hospitals No formal coordination between MOH and any other agency with respect to the education of caretakers of people with special needs

18 Children under 12yrs Data available for periods and Fluctuation in attendance Predominantly prophylaxis, followed by Fluoride,extractions and fillings Fissure sealants not provided Adolescents and adults Predominantly extractions

19 Strategies and mechanisms for delivery of oral health care at the national level are discussed in the National Oral Health Plan. the Plan identifies eleven (11) different action areas as follows: 1. Oral health promotion and disease prevent 2. Decentralization and Integration of oral health services 3. Integration of Oral Health Care into Primary Health Care 4. Oral Health of Children 5. Oral health of the Elderly Action Area 6. Oral health of Persons with Special Need 7. Human resource development 8. Oral health information systems 9. Research 10. Quality Management 11. Water fluoridation

20 As part of the Annual Services Agreement, each RHA is given a sum of money that they allocate to various projects and programmes. Determination of the exact % of an RHAs budget to oral health is presently difficult, however, Cost Centers are being developed by the RHAs to track costs incurred in the provision of oral health and various other programmes

21 At present the Information Communication and Technology Department of the Ministry of Health are working on verifying clinical and technical requirements so that the necessary and appropriate solutions can be procured for a health information system. Work is also presently being undertaken to develop the appropriate standards and establish the legal framework for this system

22 Programmes DDS(UWI) BSc Dental Hygiene and therapy (UWI) Certificate Dental surgery assistant (UWI) Professional bodies Dental Council Dental Association

23 UWI, Ministry of health, Rotary Club, PAHO Oral health Plan/Policy Dental Outreach in primary schools Continuing education for dental nurses ART training CARPHA Staff of UWI have presented various pieces of in CARPHA s annual scientific meetings. Topics ranged form school based health education, to smoking cessation dental settings and dental anxiety in children

24 Oral health of children and people with special needs Oral health promotion Management of tooth wear and restorative dental care in adults Dental materials Dental education Oral and maxillo-facial pathology

25 major gaps exist in relation to data and policy and programming Lack of data for adults and special needs, children between the ages1-5 and oral cancer staging The national Oral Health policy and plan have been developed to fill these gaps by addressing several key areas: integration of oral health into primary health, decentralization of dental services, human resource development and improving oral health services including the development of national health information and surveillances systems

26 Draft national Oral Health Plan for Trinidad and Tobago 2010 (Ministry of health) Oral Health Policy Document for Trinidad and Tobago 2010(Ministry of Health) Naidu R, Percival T, Ramroop V, Prabhu S and Perlman S (2006) The oral health Status of Special Olympic Athletes in Trinidad and Tobago. Journal of Disability and Oral health Naidu R, Prevatt I, Simeon D.( 2006). The oral health and treatment needs of schoolchildren in Trinidad and Tobago: findings of a national survey. Int J Paediatric Dent 6:412-8 PAHO/WHO country cooperation strategy,trinidad and Tobago