United Arab Emirates - Assignment Report 1995-96 with recommendations to build a comprehensive oral health care

Assignment Report on Oral Health in the United Arab Emirates,
29 December 1995 - 12 January 1996, by Dr Heikki Tala, WHO Consultant
(Report entered in ORH CPP April 1996 by D. Bratthall)

EXECUTIVE ACTION DOCUMENT ORAL HEALTH IN THE UNITED ARAB EMIRATES

Executive Summary
Dr Heikki Tala, WHO Consultant, was assigned to the United Arab Emirates from 29 December 1995 to 12 January 1996, to:

set methods to implement the national oral health strategy in the United Arab Emirates.
monitor and evaluate the implementation of the preventive oral health programmes; and
conduct courses and seminars for dentists on preventive measures in oral health.

A fair number of WHO consultants had conducted surveys during the past 15 years in the United Arab Emirates and made recommendations. Considerable information and data on oral health status and care are available. The alarming fact is that dental caries is increasing, most carious lesions on children and youth are untreated, and only little preventive activities have been carried out.

The most urgent need is to build a nationawide preventive programme supported by restorative and rehabilitative care. In addition, a reliable information system has to be established for goal setting and monitoring of oral health status and care.

In April-May 1995, a plan was prepared to build a school-based self-care preventive programme to stop the increase of dental caries among children. An analysis of oral health status and care among children and youth was performed. Two teams (Abu Dhabi and Al Ain) were trained to develop a preventive programme for kindergartens and primary schools. The goal was to include in the programme those children who were at risk of first carious lesions in their erupting permanent teeth.

It was a big positive surprise to see that a number of preventive programmes have been started during the Autumn 1995, and they are in full operation in Abu Dhabi, Al Ain, Dubai, Ras Al Khaimah, Sharjah, and Umm Al Qaiwain.

The SHARJAH model could and should be an example for the entire Middle East to develop a prevention programme to control any disease.

Recommendations
To build a comprehensive oral health care in a multicultural country, such as the U.A.E., is a challenging task. The list of recommendations could include dozens of items to be completed during the next 5-10 years. Only the most vital aspects have been mentioned below:

A comprehensive information system for oral health care to cover both private and public sector should be established in the UAE. Standardized clinical record system has to be developed. Without information there is no quality. Data alone is not information.
A national plan for oral health services including specific goals for oral health in the year 2000 and 2010 (WHO/FDI global goals for the year 2000) should be drawn up.
An administrative "umbrella" needs to be set up to pool together the present fragmented oral health services to coordinate the efforts of providing the entire population of 2.4 million with high quality care.
A target number of oral health personnel for 2000 and 2010 including all categories of workforce should be developed. Emphasis should be given to oral hygienists rather than dentists.
Prevention of oral and dental diseases should be given top priority. The present programmes should be spread out to cover the entire country. The programmes need constant support to be carried out for many coming decades. Goals for 2000, 2005, 2010, 2015 etc.

Plan of Action

	Activities	Responsibility	Time Frame
1	Preparation of comprehensive programme for prevention of oral and dental diseases	Ministry of Health Ministry of Education National Committee for Oral Health Services	1995 on continuously
2	National plan for oral health and care for the entire population of the U.A.E. in 1995, 2000 and 2010	Ministry of Health Departments of Informatics	1996
3	Strengthening and enlarging of existing school-based preventive programmes for oral health. MCH and PHC should be included as soon as possible in the programme	Ministry of Health Ministry of Education	Starting in Fall 1996
4	Preparation of a human resources plan for oral health services. The plan should include all categories of personnel needed in both public and private sectors. Emphasis should be given to oral hygienists rather than dentists	Ministry of Health Ministry of Planning Ministry of Education	starting in Fall 1996
5	Computer-based information system for oral health including all oral health oranizations in the U.A.E. (public and private)	Ministry of Health Department of Informatics	1996-1998
6	Adopting the Sharjah model with necessary modifications in all Emirates in the U.A.E., and sharing the experiences with all Member States in the Region	WHO/Ministries of Health and Education	1996-2000
7	Determining priorities in oral health care, including the philosophy of approach; balance between preventive, curative and rehabilitative care. All these should be in written form, and written guidelines and instructions should be sent to all oral health care untis; public and private	All levels of administration: Federal, Emirate, District	1996-2000

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ASSIGNMENT REPORT
United Arab Emirates
a. Assignment: EM UAE ORH 001 RB 94, 01.010.STC.01
EM/95/909452, EM/95/076971, 08.11.95

b. Consultant: Dr Heikki Tala
Kalliokuja 6 D, FIN-01230 Vantaa,Finland
Tel/Fax + 358 0 876 5273, GSM + 358 400 607 317

Dr Heikki Tala, WHO Consultant, was assigned to the United Arab Emirates from 29 December 1995 to 123 January 1996, to:

set methods to implement the national oral health strategy in the United Arab Emirates.
monitor and evaluate the implementation of the preventive oral health programmes; and
conduct courses and seminars for dentists on preventive measures in oral health.

The SHARJAH model could and should be an example for the entire Middle East to develop a prevention programme to control any disease.

OVERVIEW
Implementation of national oral health strategy:
During the assignment several meetings were held to discuss the methods of implementing a national strategy for oral health care. These included discussions with Officers at the Ministry of Health in Abu Dhabi, Dubai and Sharjah. In addition meetings were held at the Tawam and Al Jimi Hospitals in Al Ain.

The results of these discussion are expressed in Recommendations and in the Plan of Action.

Monitoring and evaluation of the implementation of the preventive oral health programs:

Abu Dhabi:
A total of 3.000 children 4-5-years old in 15 public kindergartens are covered by daily toothbrushing and fluoride-tablets. In addition a survey of 280 children has been conducted.
In winter 1996 the programme will be strengthened in order to keep it in operation.
In school year 1996-97 children in the 1st grade in primary schools will be included (this means that 5-year-olds of 1995-96 will be kept in the programme: so called incremental approach).

Al Ain:
3.800 children in public kindergartens and primary schools are participating in a daily prevention programme. There has been lack of fluoride tablets, and now the problem will be solved by the help of the Tawam Hospital Dental Center in Al Ain.

Ras Al Khaimah:
A small pilot project has been initiated.

Umm Al Qaiwain:
A small pilot project.

The SHARJAH program:

By far the largest and most comprehensive program has been started in the Sharjah Emirate. It contains all the elements of a successful programme.

* Why did they succeed in Sharjah?

1. Everybody's commitment
The Director of Health at the MoH, Sharjah Health District, H.E. Sheihk Mohammed Al Qasimi established a High Commission to guide the programme.

The Committee consists of representatives from MoH, MoE, health educators, school health personnel, dental centers, Women's Association, Sharjah TV, private dentists, oral hygiene companies, etc. Meetings are held regularly; first every second week, and now every 3-4 weeks according to the need. Sheihk Al Qasami is the Chairman of the Committee. The first meeting was held in August 1995.

2. Comprehensive Plan
The goal was to include all 4-6 years old children in public and private school in a caries prevention program. This means 39 govt schools with 9.500 pupils, and 60 private schools with 14.350 pupils.

The program consist of health education session and daily tooth brushing at schools, regular TV-programs on oral health, newspaper cartoons, booklets on dental health (Arabic and English), Puppet show "Rabbit and Bear", posters in the city (roundabouts provided with one poster for a week, and then moved to another place; post offices, public gardens, etc), caravans to visit people's homes.

Each child is provided with 2 brushes and 3 toothpaste containers (50 ml) per year. The material is donated by Signal and Golgate.

3. Information system
All 24.000 children in public and private schools were examined. Three voluntary trainee dentists did the survey in public schools, and voluntary private practitioners in private schools. A simplified WHO survey form was used.

In addition a random sample of 230 children were examined by one dentist (Dr Jihan Hamdi, PhD in Public Health, Alexandria).
This baseline data can be utilized to monitor regularly the results of the programme.

The Sharjah program is the best what I have seen ever in the Middle East or any of the dozens of countries in the second or third world. I do not hesitate to recommend it to any country wanting to control dental caries which is the most common chronic disease among children in most countries.

It should be kept in mind, however, that the prevention programmes in the U.A.E. at present include some 50.000 children, and the entire target group of 0-18-year-olds consists of at least one million children. In the long run the entire population of 2.4 million should be included in the prevention of dental and oral diseases. It means a long-term project of several decades.

The Sharjah programme is a wonderful example of community approach to a certain health problem. It is, however, vulnerable in some respects such as utilizing a large number of volunteers who are not paid for their work. In the long run there has to be funds to hire people in more permanent basis. Another fact is that teachers, school nurses, and parents are now very enthusiastic about the programme. There is a need to encourage people to continue with the programme for many years to come. New attractions are needed to keep the interest alive.

Courses and seminars on preventive measures:

Two seminars, one national meeting and a TV-programme were conducted during the assignment:

Seminar on prevention of dental caries. Jan 2, 1996 at the Abu Dhabi City Dental Center. 30 participants.
Lecture at the Kuwait Hospital in Sharjah. Jan 9, 1996. 60 participants.
TV-programme at the Sharjah Television. One hour program about oral and dental health for all Gulf countries.

A national meeting on preventive oral health care at the MoH in Dubai, 10 Jan 1996. 25 participants.

ACKNOWLEDGEMENTS
This report is a result of the efforts of a large number of people and agencies. I wish to express my gratitute to the Ministry of Health for the U.A.E. for valuable assistance, advice and cooperation.I am especially grateful to Dr Mohammed Hamdan, the Chief Dental Officer of the U.A.E.. Dr Samer Al Khateery of the Tawam Hospital Dental Center offered vital help to the prevention program. In Dubai Dr Ibrahim Arab and Tariq Khoory explained the prevention activities in the Dubai Health District. In Sharjah I had the privilege of talking with H.E. Sheikh Mohammed Al Qasimi, Director of Health Services at the MoH. A large number of colleagues; Drs Yassin Mekki, Jihan Hamdi, Amjad Dablan, Samer Faisal, Ragda Moh'd, Busra, Ameena Hashim and Aisha Al Swaidi.

There is additionally a large number of other colleagues and friends who made my assignment both enjoyable and resultful. I express my gratitude to all of them. Thank you!
/Signed Dr Heikki Tala.