República Dominicana

Transcription

1 Caribbean Oral Health Initiative Dr. José Saldaña General Director of Oral Health Public Health Ministry (PHM)-Dominican Republic San Juan, Puerto Rico November 13th 14th, 2013 República Dominicana

2 National positions Workforce in Dentistry Department of Oral Health/(MPH) Dental School Department UASD/State Presidential Adviser in Dentistry Social Security Department of Dental Services, Armed Forces (FFAA) and National Police (PN) School Directors and Dental School Departments-Private Universities / Public and Private Funds Presidency (Dominican Dental Association AOD) / Guild

3 Standards for the Presidency and Provision of Services Public Services: standards for decision making: Central: Presidency, regulation and massive promotion/prevention Regional: Management services Provincial: Decentralized exercises by the Presidency Local: Provision of services First, second and third levels of care Integrally intensive ambulatory aid services Dental services in academic centers and union sectors 1,554 Dentists and 376 assistants

4 Primary Care in Oral Health The Primary Care Units Oral health staff, develops activities related to: 1. Dental emergency assistance (pain and hemorrhage control) 1. Patient referrals at a competent level

5 Academic programs and/or oral health training: Higher Education Institutions: Graduate Schools: 5 offer Specialties and Masters 2. Only one Postgraduate School 4,850 Dental Students Two technical institutes for the training of dental assistants and laboratory technicians.

6 Dental Professional Organizations 1 Dominican Dental Association (National) 23 Provincial Associations 7 Specialized Societies 1 Dental School Directors Association Diverse Study Groups

7 Academic and Governmental Entities Governmental: MSP IDSS MINERD FFAA y PN INAVI APODOM CDEEE Academic: 13 Universities

8 Public Policies in Oral Health NATIONAL ORAL HEALTH PLAN QUISQUEYA SONRIE School Oral Health Ambulatory Dentistry Equipment Repair and Maintenance Institutional Strengthening Research Human Resources

9 Availability and Application of the Oral Health Public Policy QUISQUEYA SONRÍE National Oral Health Program MIRA Y SONRÍE DOMINICANO, QUISQUEYA APRENDE CONTIGO : Dental Assistance for adults in alphabetization plan Availability of public funds for development.

10 Political and Economic Context in Oral Health Services Dominican Republic Constitution General Health Law Social Security Law Regulations, Standards and Guidelines Financial assignments Strengthening of Infrastructure

11 Facilities and Infrastructure for Public Sector Oral Health Services Public Health Ministry with a network of establishments: primary care units. 150 second and third level specialized care centers 15 specialized hospitals 11 regional, 20 provincial and 104 municipal hospitals *Source: web MSP

12 Facilities and Infrastructure for Public Sector Oral Health Services 529 PUBLIC HEALTH CENTERS: HOSPITALS : 178 SCHOOLS : 147 UNAP :104 ONG :72 *Source: GBSB MSP

13 General Budget Relation(2012/2013) National General Budget: US$ 12 billions Health Budget: US$ 1,200 millions Oral Health Budget: US$ 404,000 thousand % of estimated designation 0.1 % of the General Budget for Health 0.03 % Health Budget corresponds to the Oral Health Plan *Source: Central Bank of the Dominican Republic

14 Oral Health Education Efforts and Marketing Practices Public: Convention and agreements between ministries and academic institutions Private: Social Responsibility Program Sonrisas Brillantes, Futuros Brillantes (Brilliant Smiles, Brilliant Futures) Joint actions.

15 Dental Emergency Care with Public Funding Expanded Basic Plan in Oral Health Care: Emergency assistance (reception, care, stabilization and referral) in all basic and specialized areas.

16 Health Prevention and its Aspects in Oral Health Estimated Population: (2012): 10,280,000 hab. Vulnerable groups: Teenage mothers Patients with special conditions Children ages 0-4 AIDS patients Sex workers Homosexuals

17 Socio-economic Indicators GINI Index, (2000) to (2010) Population below poverty: 1.80 % Population with access to sanitary services: 82.70% Unemployment rate (2012): Male> 9.94 % Female> 23.76% Illiteracy rate (2012) Country: 9.90 % (10.00% male and 9.80% female) Gross Domestic Product (GDP) for 2011 US$ 93,230,000, *Sources: National Statistics Office. ONE/PNUD

18 Risk Factors for Concurrent Diseaseas according to (ASIS)-MSP HIV: transmitted in female population, with a prevalence of 1% Nutrition: low birth weight (LBW) with 21% and acute malnutrition with 2.4 % Total for Diabetes: rate of 5.5/100,000 inhabitants Cardiovascular: arterial hypertension with 16.8 /100,000 inhabitants. *Source: Basic Health Indicators.

19 Needs for Vulnerable Groups and Availability of Services ENDESA: 43.7% of the population receive services for oral health problems (2007). National Study conducted by PHM, supported by OPS and W. K. Kellogg Foundation, (1997): 72.7% of school children (6 to 15 years of age) had dental caries; DMFT: 5 affected teeth Partial and localized studies, (Collins, Bobadilla, Fresno, 2008) 90.02% students (12 to 21 years of age) in Santo Domingo, affected by caries; DMFT: 8.52 teeth. *Source: Basic Health Indicators

20 Needs for Vulnerable Groups and Availability of Services (cont.) Graduate thesis in Stomatology (PUCMM, Santiago, 2010): 148 pregnant women (obstetric consultation of Hospital José María Cabral y Báez, Santiago): 79.1 % had swelling and bleeding of the gums *Fuente: PUCMM

21 Needs for Vulnerable Groups and Availability of Services (cont.) Graduate thesis in Stomatology (PUCMM, Santiago 2010) Hospitales Maternidad San Lorenzo de Los Mina in Santo Domingo and Infantil Arturo Grullón de Santiago: Found that 81 children born or that came for a consultation from were children with cleft lip, cleft palate and / or the combination of these. *Source: Universidad PUCMM

22 Monitoring System of Oral Health Clinical and Epidemiologic Record Systems Periodic reports for monitoring of notifiable diseases Control of Prevalent Processes, impactful and of national interest.

23 OPS Participation in Oral Health Initiatives support for salt fluoridation and aspects of service strategies. National advisory to support research and projects for the strengthening of services and teaching, until In the last 12 years, there has not been a cooperation and support program for national, regional, permanent or sustainable initiatives. Support for non-relevant sporadic consulting. Support to participate in international oral health events.

24 Oral Health Research Research Activities conducted to support the Oral Health Program Exploratory studies, partial and national prevalence studies in certain areas and groups Descriptive Epidemiological and Census studies of natural fluoride content in water used for consumption; 1978 y 1996

25 Areas of Ongoing Research Projects in Oral Health There are few epidemiological, clinical, and translational studies. Dental caries studies; local and limited EP. National, in1996, and one scheduled for Individual studies, Graduate and Postgraduate work of the clinical and epidemiological nature. Some of them translational.

26 Research to Launch Programs as Oral Health Needs Study results from the national studies of 1978, 1982, and 1996/97, have served in the development of educational and preventive programs. F/water Mouthwashes; 1978, 1982, 1984, F/salt 1996/97

27 Research Staff and Infrastructure Those responsible for the research, hired by four private universities. Two part-time teachers hired for research development at a state university. University professors hired for graduate thesis by private and state universities. Two investigators for the Ministry of Health.

28 Designated Funds for Oral Health Research There are no specific funds for Oral Health. Funds for general projects are competed for; winner awarded the funds. National Funds: FONDOCyT Local Funds: PUCMM and UNIBE Universities Private Companies

29 THANK YOU!! DR Team: Dr. José Saldaña Dr. Norberto Puello Dr. Adolfo Rodríguez Dr. James Collins Dr. Carmen Hernández Dr. Antonio Mena