Student Number : 9001367H - MPh research report - School of Public Health and Oral Health Sciences - Faculty of Health Sciences / Introduction: Compulsory Community Service (CS) for health professionals has been introduced in South Africa since 1997. Some of the aims for its introduction were to: 1) address the maldistribution of health service providers, 2) prevent qualified health professionals from emigrating and 3) improve clinical skills and knowledge of newly qualified medical graduates. The Oral Hygiene (OH) and Dental Therapy (DT) professions have as yet not been included in the performance of CS. However the Department of Health (DOH) is planning to introduce CS for these groups of health professionals in the near future. The role of the oral hygienist and dental therapist in South Africa (SA) cannot be over emphasized. Given the high caries levels, low oral hygiene education levels, large unmet oral health needs and the preventative approach of the DOH at all levels, the oral hygienist and dental therapist can provide invaluable human and technical resources that are currently required to address these concerns. Aims: To assess the attitudes of OH and DT students registered during 2004 at the five dental schools in South Africa regarding the introduction of CS. Objectives: 1) To obtain the demographic data of the OH and DT students, 2) to determine whether their current training programme prepares these students for CS, 3) to identify the provinces in which the OH and DT students would prefer to be placed for CS and 5) to identify the different types of professional activities that the OH and DT students would like to perform whilst completing CS. Methods: A self administered questionnaire was jointly developed between the Kwa- Zulu Natal Department of Health and the Division of Public Oral Health at the University of Witwatersrand, Johannesburg. The questionnaire was sent to all OH and DT students who were registered at each of the five dental schools in SA during 2004. Results: There were a total of 163 students (68%) who responded to the questionnaire. Of the respondents, 109 (70%) were OH students and 54 (64%) were DT students. There were 132 (81%) females and 31 (19%) males. The average age of the student’s was 21 years (17-37; mode 19; median 20 and SD 3.2). There were 59 (36%) Whites, 53 (33%) Black, 31(19%) Asian and 18 (11%) Coloured students. The majority of OH students (63%) were against the introduction of CS. There was a significant number (p<0.05) of White students who were registered for the OH degree that did not want to perform CS. A significant number of respondents (p<0.05) felt that they were adequately trained to perform all the necessary duties that may be required of them during their CS. Most of the respondents chose Kwa-Zulu Natal (26%), Western Cape (26%) and Gauteng (22%) provinces respectively as their first choice province for carrying out their CS. The majority of students (p<0.05) chose their resident province as their first choice province in which they would prefer to perform their CS. Students indicated a preference to perform oral health promotional activities (56%), health educational activities (21%) and clinical work (18%) in their CS programme. Conclusion: The majority of DT students supported the concept of CS. This was in contrast to the OH students where less than half of them supported its introduction. Overall, most of the students chose the more urban provinces (Kwa-Zulu Natal, Western Cape and Gauteng) to complete their CS.

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

A organização do processo de trabalho em Saúde Bucal (SB) tem como componente principal a equipe composta pelo Cirurgião-Dentista - CD, Técnico em Saúde Bucal - TSB e Auxiliar em Saúde Bucal ASB. O trabalho em equipe, com a delegação de tarefas para o pessoal auxiliar (ASB e TSB) busca uma maior racionalidade, aumento da qualidade, da resolutividade e cobertura da atenção em saúde. O setor público tem sido o grande responsável, atualmente, pela inserção da equipe de Saúde Bucal nos serviços. O objetivo desta pesquisa, de cunho qualitativo, foi conhecer a percepção dos dentistas quanto à inserção e trabalho do TSB na equipe. O campo de pesquisa foi o município de Embu e a técnica utilizada para a coleta de dados foi o grupo focal sendo os participantes, dentistas da rede pública deste município. Os resultados apontam, segundo os entrevistados, para a importância do TSB no trabalho em equipe, principalmente, no serviço público, onde há uma grande demanda de assistência. Os participantes, ainda, ressaltam que esta experiência não lhes foi apresentada em sua formação acadêmica, vindo a conhecê-la somente no serviço público. A importância de uma formação técnica adequada e dúvidas acerca da regulamentação profissional, também surgiram como destaques no grupo focal. A partir desses resultados, conclui-se que uma melhor ordenação do processo de trabalho em equipe de Saúde Bucal é necessária, além de um aperfeiçoamento na formação dos profissionais da equipe, vinculadas às reais necessidades do SUS. Ainda que avanços tenham ocorrido nos últimos anos com a atual política nacional de saúde bucal, incentivando o trabalho em equipe, este processo requer um maior estímulo por parte de todos os envolvidos, localmente, no planejamento das ações. / The main core of the organization of the work process in Oral Health consists in the team composition which is the Dentist, Dental Therapist (DT) and Dental Assistant (DA). Teamwork with the delegation of tasks to auxiliary personnel seeks a more rational system of assistance, an increase of quality, resolution and coverage of care. Actually, the Public Health System has been greatly responsible for the integration of DT in the oral health team. The objective of this qualitative research was to acknowledge the dentist´s perception about the integration of the DT in the oral health team. The field research was at the city of Embu, State of Sao Paulo, Brazil, and the technique used for data collection was focus group with dentists working in the public health system of this city as participants. The results indicate, according to participants, the importance of the role played by the DT in the oral health team, especially in public service, where there is great demand for assistance besides lessening dentists stress. Respondents also emphasize that this practice based on teamwork was not discussed during their undergraduation and they experienced this only after beginning the public service assistance. The importance of an adequate technical training as well as doubts about the professional regulation also emerged in the focus groups. From the results it is concluded that training of managers for the better ordering of the process of oral health teamwork is required in addition to an improvement in training of dental therapists, linked to the real needs of the Brazilian Public Health System. Although advances have occurred in recent years with the current national policy on oral health, encouraging teamwork, this process requires a greater stimulus.

A organização do processo de trabalho em Saúde Bucal (SB) tem como componente principal a equipe composta pelo Cirurgião-Dentista - CD, Técnico em Saúde Bucal - TSB e Auxiliar em Saúde Bucal ASB. O trabalho em equipe, com a delegação de tarefas para o pessoal auxiliar (ASB e TSB) busca uma maior racionalidade, aumento da qualidade, da resolutividade e cobertura da atenção em saúde. O setor público tem sido o grande responsável, atualmente, pela inserção da equipe de Saúde Bucal nos serviços. O objetivo desta pesquisa, de cunho qualitativo, foi conhecer a percepção dos dentistas quanto à inserção e trabalho do TSB na equipe. O campo de pesquisa foi o município de Embu e a técnica utilizada para a coleta de dados foi o grupo focal sendo os participantes, dentistas da rede pública deste município. Os resultados apontam, segundo os entrevistados, para a importância do TSB no trabalho em equipe, principalmente, no serviço público, onde há uma grande demanda de assistência. Os participantes, ainda, ressaltam que esta experiência não lhes foi apresentada em sua formação acadêmica, vindo a conhecê-la somente no serviço público. A importância de uma formação técnica adequada e dúvidas acerca da regulamentação profissional, também surgiram como destaques no grupo focal. A partir desses resultados, conclui-se que uma melhor ordenação do processo de trabalho em equipe de Saúde Bucal é necessária, além de um aperfeiçoamento na formação dos profissionais da equipe, vinculadas às reais necessidades do SUS. Ainda que avanços tenham ocorrido nos últimos anos com a atual política nacional de saúde bucal, incentivando o trabalho em equipe, este processo requer um maior estímulo por parte de todos os envolvidos, localmente, no planejamento das ações. / The main core of the organization of the work process in Oral Health consists in the team composition which is the Dentist, Dental Therapist (DT) and Dental Assistant (DA). Teamwork with the delegation of tasks to auxiliary personnel seeks a more rational system of assistance, an increase of quality, resolution and coverage of care. Actually, the Public Health System has been greatly responsible for the integration of DT in the oral health team. The objective of this qualitative research was to acknowledge the dentist´s perception about the integration of the DT in the oral health team. The field research was at the city of Embu, State of Sao Paulo, Brazil, and the technique used for data collection was focus group with dentists working in the public health system of this city as participants. The results indicate, according to participants, the importance of the role played by the DT in the oral health team, especially in public service, where there is great demand for assistance besides lessening dentists stress. Respondents also emphasize that this practice based on teamwork was not discussed during their undergraduation and they experienced this only after beginning the public service assistance. The importance of an adequate technical training as well as doubts about the professional regulation also emerged in the focus groups. From the results it is concluded that training of managers for the better ordering of the process of oral health teamwork is required in addition to an improvement in training of dental therapists, linked to the real needs of the Brazilian Public Health System. Although advances have occurred in recent years with the current national policy on oral health, encouraging teamwork, this process requires a greater stimulus.