DENTAL MANPOWER PLANNING IN INDIA Guided by: Dr. Girish R Shavi Dr. Mayank Agrawal Presented by: Dr. Preyas Joshi Second year postgraduate student Public health dentistry 06/09/2022 1
1. DENTAL MANPOWER PLANNING IN INDIA Guided by: Dr. Girish R
Shavi Dr. Mayank Agrawal Presented by: Dr. Preyas Joshi Second year
postgraduate student Public health dentistry 5/4/2015 1
2. Manpower The number of people working or available for work
or service.1 All the people who are available to do a particular
job or to work in a particular place.2 5/4/2015 2 Manpower surplus:
there are more people than available jobs. Manpower deficit:
available people are fewer than jobs.
3. Planning A detailed scheme, method, etc, for attaining an
objective. a proposed, usually tentative idea for doing something.3
5/4/2015 3
4. MANPOWER PLANNING Thomas H. Patten(1971) defines manpower
planning as "the process by which an organisation ensures that it
has the right number of people and the right kind of people at the
right place at the right time, doing things for which they are
economically most useful.4 In the words of Filppo(1976), "A
manpower planning programme can be defined as an appraisal of an
organisation's ability to perpetuate itself with respect to its
management as a determination of measures necessary to provide the
essential talent.5 5/4/2015 4
5. H E A LT H M A N P O W E R P L A N N I N G Health manpower
planning is the process of estimating the number of persons and the
kind of knowledge, skills and attitudes they need to achieve
predetermined health targets and ultimately health status
objectives. Such planning also involves specifying who is going to
do what, when, how and with what resources for populations, groups
and individuals. It must be a continuing and not a sporadic
process, and it requires continuous monitoring and evaluation. -
Mejia and Flp (1978) 5/4/2015 5
6. T H E P R I N C I P L E S O F O R G A N I S AT I O N A N D M
O D E L S O F D E L I V E RY O F O R A L H E A LT H C A R E 6 Oral
health care system includes: Health policies to promote oral
health. Resources including personnel and facilities. Strategies
that organise those resources to provide services. (Andersen et al,
1995) There are no definitive models of different types of oral
health care delivery and various countries have developed a range
of systems. 5/4/2015 6
7. T H E S Y S T E M S C O N C E P T A P P L I E D T O O R A L
H E A LT H A system is a set of elements, actively interrelated
which operates in a bounded unit. A systems approach is valuable
for examining the organisation of oral health care delivery.
(Andersen et al,1995; Edelstein, 2002) Oral health care systems
usually have a goal to attain freedom from diseases and impairments
for the population served. (Baker, 1970; Scott, 1987) Systems are
influenced by society structure and cross-cutting social policies.
(Thomson et al,2002) Generally, oral health care systems seek to
improve the quality of life of the population through research,
education, provision of services, and through the promotion of
policies such as fluoridation.they are made up of health policies,
resources and strategies available to provide care. 5/4/2015 7
8. Oral health care systems respond to: Changes in population
demographics. Changes in patterns of oral diseases. Impact of oral
diseases in relation to other systemic diseases. Social, political
or economic structure and societal norms as reflected in national
policies, legislation, regulations, and payment system.
Characteristically, system analysis includes: Who provides What
service/functions For whom In what location With what resources. By
what payment mechanisms With what effects 5/4/2015 8
9. C H A R A C T E R I S T I C S O F T H E O R A L H E A LT H C
A R E S Y S T E M Oral health care systems worldwide can be
described by: Policy Organisation Payment mechanisms Outcomes Oral
health care systems respond to specific oral diseases and policies
that focus on identified populations such as age groups. (andersen
et al, 1995; boerma et al, 1998) A different system will develop in
a nation that has stated objectives for school age children than in
a country that targets infants or no specific age group. 5/4/2015
9
10. Worldwide, systems differ in the focus placed on the range
of functions. The appropriateness of organisations to carry out
system functions varies. Universities and governments are logical
components of the system to carry out functions of administration,
policy, and research. Often oral health care systems have been
described on the basis of only one or two characteristics, perhaps
reflecting what is more unique to that country: New Zealand
School-based system employing dental nurses British National health
service U.S.A Fee-for-service private practice system Each system
should be understood for all its characteristics, since systems are
not unidimensional, and most have adapted over the years. (Hancock
et al, 1999; Wang et al, 1998) 5/4/2015 10
11. 5/4/2015 11 TA X O N O M Y F O R S Y S T E M AT I C C R O S
S - N AT I O N A L C O M PA R AT I V E A N A LY S I S O F O R A L H
E A LT H C A R E S Y S T E M S Personnel Dentist Dental hygienist
Dental therapist Expanded-duty assistant Dental assistant Oral
health community worker Community worker Other health care and
social work professionals (e.g., physicians, nurses)
Structure/Location Government facilities Universities Worksites
Hospitals, institutions Schools Health/dental clinics Mobile units
Individual dental offices General community facilities Financing
General government revenue Specific taxation Compulsory insurance
Insurance or prepayment supported by employer or individual Direct
payment, private income Reimbursement Fee-for-service Capitation
Contract salary Target population Infants Preschool children
School-age children Young adults Adults Older adults Special care
populations Identified occupational groups Functions Policy
development & implementation Administration Quality control
Research Professional education Public oral health education
Preventive services Emergency services With what effect(examples)
Appropriate dental care Improved knowledge, values, opinions and
behaviors regarding oral health Less dental caries among adults
Reduced tooth loss Improved oral health
12. O V E R V I E W O F T H E O R A L H E A LT H C A R E D E L
I V E R Y S Y S T E M SOCIO-POLITICAL AND ECONOMIC ISSUES AT
SOCIETAL LEVEL POLICIES ORAL HEALTH CARE DELIVERY SYSTEM Personnel
Target population(s) Financing Functions Structure Reimbursement
ORAL HEALTH OF POPULATION 5/4/2015 12
13. P O L I C I E S A N D O B J E C T I V E S Goals &
objectives: Some countries have neither clearly articulated oral
health objectives nor a well defined system of care (or have one
but not the other). Other countries have oral health objectives
that appear to have been developed independentaly of the
organisation of care, with a system that is unresponsive to those
objectives. Yet others have clearly stated objectives and a system
designed to response to those objectives, both of which are
outdated. At the very basis of the system of oral health care are
the goals and objectives the purposes and expected outcomes of care
(WHO, 2003) 5/4/2015 13
14. Oral health systems may have one or any combination of the
following objectives: Management and elimination of dental
emergencies Treatment of existing diseases Elimination of
progression of diseases Prevention of future diseases Finding new
ways of preventing and treating diseases (research) Improved use of
new and existing preventive and treatment approaches (education)
Often uncoordinated programs and appearances of ambivalence about
oral health care as a social good result when there is no clearly
articulated policy. WHO has developed conceptual models and
strategies to facilitate evaluation of and planning of system
performance. (WHO, 2003) 5/4/2015 14
15. Systems of oral health care are influenced by societal
policies and have policies of their own that affect the
organisation of the system and services provided. Policies,set for
meeting the objectives of the oral health system, provide
guidelines for securing and organising resources and may be either
explicit or implicit. Policies might be represented by national
nutrition guidelines or mandated governmental sponsored research,
provision of care, or school education and service programmes,
among others. the facilities, numbers, types and distribution of
personnel, sources of revenue, and reimbursement procedures are
representative of resources in the oral health care system that are
influenced by policy (Gift, 1993;Boerma, 1998; kallestal et
al,1999) 5/4/2015 15
16. National policies influence: Who is entitled to care Which
age group are emphasised What type of care are received Who
provides the care Where the care is provided Recognising the
complexity of the many combined issues, the world health
organisation(WHO) and other organisations are increasingly
encouraging evaluations. (WHO, 2003) Major evaluations have been
undertaken in many countries during the past decade. (Neenan et al,
1993; IOM, 1998; Hancock et al, 1999; Seldin, 2001; Seldin and
brown, 2002; Van Palenstein Heldermann, 2002) 5/4/2015 16
17. O R G A N I S AT I O N Generally, the organisation of the
delivery system has been described using a medical model, limited
to the oral health care professionals associated with dental
schools, clinics, individual dental practices, and government
components directly associated with policy, remuneration, or
delivery of oral health care. More recently, comprehensive
community/public health models have gained favour over the medical
model (Andersen et al, 1995; Chen et al, 1997) Using this expanded
model, pharmacists, physicians, nurses, school teachers, and water
work supervisors become part of the oral health care delivery
system. Similarly, worksites, hospitals, nursing homes, and
institutions are appropriate facilities for care. 5/4/2015 17
18. The following description focuses on more traditional oral
health care facilities and personnel. Structure a) National level
At the national level, oral health care may be: Entirely centrally
organised Partly decentralised Completely decentralised. Oral
health care may also be: Well identified with defined structures
and leadership Integrated with other medical services Not
acknowledged as part of a national agenda at all. b) Practice level
The most frequently observed structures for delivery of oral health
care are independent practices with one or more dentist (owner or
employed associates), clinics (public or private), and community
outreach programmes in mobile units or any available and convenient
facility. (Arnljot et al,1985; Neenan et al,1993; Andersen et al,
1995) 5/4/2015 18
19. S T R U C T U R E O F O R A L H E A LT H C A R E S RV I C E
S Much of the current oral health care approach has developed from
The demands of treating caries in children and Providing
restorations for dental caries and treatment for periodontal
diseases of healthy, mobile young adults However, the traditional
structure of dental practices may be less suitable for case of
Older adults Individuals in remote locations Provision of many
health promotion and disease prevention initiatives, particularly
for people who do not routinely visit a dentist (Boerman et al,
1998; Mertz and ONeil, 2002; Pacza et al, 2001) 5/4/2015 19
20. O R A L H E A LT H C A R E P E R S O N N E L EDUCATION AND
TRAINING: The education and training of oral health care personnel
set the stage for the organisation of the oral health care delivery
system. (Weaver et al,2000) The time devoted to education and
training of dentists usually is more than that for other oral
health personnel, and the system is organised through licensing and
credentialing to produce competent professionals. (Jeffcoat and
clark, 1995; Kress, 1995; Tedesco, 1995) There has been continued
pressure to increase training of dentists for preventive approaches
and care of specific groups such as young children and medically
compromised patients. (Atchison et al, 2002; Crall, 2002;
Valachovic, 2002) 5/4/2015 20
21. F I N A N C I N G , R E I M B U R S E M E N T, A N D R E M
U N E R AT I O N Financing reflects how money gets into the system
The most common approaches being General government revenues
Specific taxation Insurance or prepayment premiums paid by
individuals and/or employers Out-of-pocket direct payment by
individuals. Reimbursement, including remuneration, is the
mechanism for payment for services, e.g. fee-for- service,
capitation, contract, or salary 5/4/2015 21
22. Dental Manpower7 DENTIST - A dentist is a person licensed
to practice dentistry under the law of the appropriate state
province territory or nation. These laws ensure that to become
licensed, a prospective dentist must satisfy certain
qualifications. Dentist are concerned with the prevention and
control of diseases of the oral cavity and the treatment of
unfavorable conditions resulting from these diseases, from trauma
or from inherent malformations. They are legally entitled to treat
patients independently, to prescribe certain drugs and to employ
and supervise auxiliary personnel. Dentists must be registered.
Dentist must satisfy, Completion of an approved period of
professional education in an approved institution. Demonstration of
competence. Evidence of satisfactory personal qualities. 5/4/2015
22
23. D E N TA L A U X I L I A RY / A N C I L I A RY A dental
auxiliary is a person who is given responsibility by a dentist so
that he or she can help the dentist render dental care,but who is
not himself or herself qualified with a dental degree. The duties
undertaken range from simple tasks such as sorting instruments to
relatively complex procedures. CLASSIFICATION(WHO, 1967)
Non-operating auxiliaries: 1) Clinical: This is a person who
assists the dentist in clinical work but does not carry out any
independent procedures. 2) Laboratory: A person who assists the
dentist by carrying out certain technical laboratory procedures.
5/4/2015 23
24. Operating auxiliary: person who not being a professional
can carry out procedures under the supervision of a professional.
REVISED CLASSIFICATION Non operating auxiliaries: dental surgery
assistant dental receptionist dental laboratory technician dental
health educator 5/4/2015 24
25. Operating ancillaries: school dental nurse dental therapist
dental hygienist expanded function dental ancillaries 5/4/2015
25
26. DENTAL SURGERY ASSISTANT Dental assistant is a non
operating auxiliary who assists the dentist and the dental
hygienist in treating patients, but who is not legally permitted to
treat patients independently. Dental assistant may work under the
supervision of a licensed dentist, carrying out duties prescribed
by the dentist or by a dental hygienist employed by the dentist.
5/4/2015 26
27. D E N TA L S E C R E TA RY / R E C E P T I O N I S T
5/4/2015 27 This is a person who assists the dentist with his
secretarial work and patient reception duties.
28. D E N TA L L A B O R AT O R Y T E C H N I C I A N A dental
laboratory technician is a non operating auxiliary who fullfills
the prescription provided by dentist regarding the extra oral
construction and repair of oral appliances and bridge-work. This
category of personnels have also been known as dental mechanics. As
per the dentist act of 1948, dental mechanic is a person who makes
or repairs dentures and dental appliances. 5/4/2015 28
29. D E N T U R I S T 5/4/2015 29 Those dental laboratory
technicians who are permitted to fabricate dentures directly for
the patients without a dentists prescription. they may be licenced
or registered.
30. T H E D E N TA L H E A LT H E D U C AT O R This is a person
who instructs in the prevention of dental disease and who may also
be permitted to apply preventive agents intraorally. In sweden, two
additional weeks of training is given, after which ancillaries are
allowed to conduct fluoride mouth rinsing programmes. 5/4/2015
30
31. T H E S C H O O L D E N TA L N U R S E 5/4/2015 31 This is
a person,who is permitted to diagnose dental disease and to plan
and carry out certain specified preventive and treatment measures,
including some operative procedures in treatment of dental caries
and periodontal disease in defined group of people, usually school
children. dental nurses are presumed to provide care more cheaply
than dentist.They are less expensive to train unlike dentist and
their salaries are similar to those of physical therapist and
school teachers.
32. T H E D E N TA L T H E R A P I S T 5/4/2015 32 This is a
person who is permitted to carry out to the prescription of a
supervising dentist, certain specified preventive and treatment
measures including the preparation of cavities and restoration of
teeth. The training of the therapist is about 2 yrs involving both
reversible and irreversible procedures. Their duties include,
clinical caries diagnosis. Cavity preparation in deciduous and
permanent teeth. vital pulpotomies using rubber dam in deciduous
teeth. Extraction of deciduous teeth under local anaesthesia.
33. T H E D E N TA L H Y G I E N I S T 5/4/2015 33 The dental
hygienist is a person licensed and registered to practice oral
hygiene under the laws of appropriate state, province, territory or
nation. The dental hygienist works under the supervision of the
dentist. Who does oral prophylaxis, gives instructions in oral
hygiene and preventive dentistry, assists the dental surgeon in
chairside work and manages the office. As per the Indian dentist
act of 1948, a dental hygienist means a person not being a dentist
or a medical practitioner, who scales, cleans or polishes teeth, or
gives instruction on dental hygiene.
34. 5/4/2015 34 Dental council of Indias norms for dental
hygienists: 1) The course of studies should extend over a period of
two academic years and lead to the qualification of dental
hygienist certificate. 2) The candidate should be at least 15 years
of age at the time of admission or within 3 months of it and should
be medically fit. 3) the candidate must have passed at least
matriculation examination of a recognized university taking science
subject or an equivalent recognized qualification.
35. E X PA N D E D F U N C T I O N D E N TA L A U X I L I A RY
( E F D A ) 5/4/2015 35 An EFDA is a dental assistant or a dental
hygienist in some cases, who had received further training in
duties related to direct treatment of patients, though still
working under the direct supervision of a dentist. They take
reversible procedures i.e which can be corrected or redone without
any undue harm to the patient. They do not prepare cavities or make
decisions as to pulp protection after caries has been excavated,
but work along side dentist and take over routine restorative
procedures, as soon as cavity preparation and base have been
completed.
36. 5/4/2015 36 They Perform following Duties: placing and
removing rubber dams. Placing and removing temporary restorations.
placing and removing matrix bands. condensing and carving amalgam
restorations. placing of acrylic restoration in previously prepared
teeth. Applying the final finish and polish to the previously
listed restorations.
37. F R O N T I E R A U X I L I A R I E S In developed
countries, dentists remain in urban centers and a large number of
areas are too distant from public or private dental offices for the
inhabitants to receive regular comprehensive care or emergency pain
relief. Nurses and former dental assistants can in such areas,
provide valuable service with minimum amount of training.
Functions: Simple dental prophylaxis. Basic dental health
education. Dental first aid can be rendered in cases with pain and
patients can be referred to the nearest dentist more intelligently
than would be possible by untrained people. They can also organize
fluoride rinse programs. Simple denture repairs. 5/4/2015 37
38. N E W A U X I L I A RY T Y P E S The expert committee on
auxiliary dental personnel of the WHO(1959) has suggested two new
types of dental auxiliaries: 1) The dental licentiate - He is a
semi-independent operator, trained for two yrs to perform dental
prophylaxis, cavity preparations and filling of deciduous and
permanent teeth, extrations under L.A, drainage of abscess,
treatment of most prevalent diseases of supporting tissues, early
recognition of more serious dental conditions. 2) The dental aide -
The duties performed are extraction of teeth under local
anaesthesia, control of haemorrhage, recognition of dental disease
which is important enough to justify transportation of the patient
to a center where proper dental care is available. 5/4/2015 38
39. H E A LT H W O R K F O R C E I N I N D I A 8 5/4/2015
39
40. Health-worker availability Table 1 shows the absolute
numbers and category-wise density (per 1000 population) of doctors,
dentists and nurses including midwives at the national and state
levels. In 2009, India had 761 806 doctors, 104 603 dentists and 1
650 180 nurses and midwives. At the national level, the aggregate
density of doctors, nurses and midwives was 2.08 per 1000
population, which was lower than WHOs critical shortage threshold
of 2.28.[9] There were gross inequalities in the availability of
these health workers at the subnational level. For example, states
such as Bihar, Uttar Pradesh, Uttarakhand, Jharkhand and
Chhattisgarh had especially severe shortages of health workers
[less than 1 per 1000 population]. 5/4/2015 40
41. D E N TA L H E A LT H W O R K F O R C E I N I N D I A
5/4/2015 41 [Table/Fig-1] shows the absolute numbers and category-
wise density (per 1000 population) of dentists at national and
state levels. In 2009, India had 104603 dentists. There were gross
inequalities in the availability of these health workers at the sub
national level.[10]
42. 5/4/2015 42 Three important developments highlighted: First
is the recent rapid expansion in the training capacity of dentists.
Between 1991 and 2013, the number of admissions to dental
institutions expanded from 3100 to 23 800, i.e. by 66.8%[11]. There
were clear inequalities in the distribution of these training
institutions among states. Although the Empowered Action Group
states account for almost half of the countrys population, they
house approximately a quarter of the dental institutes [8]. Second,
there has been a notable increase in the private sectors
involvement in Dental education. Before 1991, there were only 49
dental colleges, of which 23 (47%) were government owned. As of
2013, 246 new dental institutions recognized or approved by the DCI
have been added to the existing list, of which almost all (229) are
in the private sector [8,11]. Third, despite the consistent
increase in dentists production, posts in public health
sectors/government are still questionable.
43. 5/4/2015 43 [Table/Fig-3] shows an inter-state inequality
among public health dentists.
44. As India strives to achieve universal health coverage,
improvement in oral health care delivery with skilled and motivated
dental health workforce is necessary. Human resource shortages
hinder scale up of health services and limit the capacity to absorb
additional financial resources [12]. A clear understanding of the
dental health-workforce situation is very critical to develop
effective policies. Strength: In the past two decades, there has
been drastic progress in increasing the training capacity [13].
This review shows that key finding regarding workforce production
is the increase in training capacity because of the growth in
private sector involvement in dental education. This trend seems
likely to increase, since incentives and regulation relaxations
have been introduced to encourage private investment in dental
education. 5/4/2015 44
45. Weakness: The primary data used in this review are the
numbers of dental health personnel registered with the Dental
Council of India & Dental Public Health Association and
therefore have several limitations. These councils do not maintain
live registers, except for doctors in Delhi. The information they
provide may be inaccurate owing to non adjustment for deaths,
migrations and retirements, or double counting of workers
registered in more than one state. Furthermore, not all state
councils follow the same procedure for registration, which may
compromise direct comparisons. In spite of these limitations, this
review is an attempt to highlight some key issues that the
Government of India and development partners should consider when
addressing the health human resource crisis. There is gross
inadequacy in availability of the current stock of dentists [13,14]
& public health dentists and significant inequalities in their
distribution between the different states. Poorly performing
states, in terms of health outcomes, have a greater shortfall in
the number of dentists. 5/4/2015 45
46. Threats: 1. Privatization of dental education has helped to
overcome the shortcomings resulting from inadequate expansion of
the training capacity in the public sector, but also raised
questions on the quality of dental training. An example was an
initiative to standardize the quality of medical & dental
education by MCIs decision to introduce a single National
Eligibility and Entrance Test for undergraduate admissions at all
government and private dental colleges. This test has not yet been
implemented and there is scepticism as to how it might be
transparently and fairly applied to the 800,000 students who would
take the test each year [8,15]. 2. The gross inequality in the
distribution of the training institutes among the different states.
These institutes are primarily clustered in states with high GDPs,
where the issues related to shortages of dentists are relatively
less acute. 3. Increased mismatch between dentists production and
job opportunity in government hospitals/public health sector. This
finding suggests that increases in the production and overall
supply of dental graduates will not necessarily address the public
sector shortages. Other strategies will need to be introduced to
encourage dental health workers to serve in the public sector.
5/4/2015 46
47. 4. Immigration & migration of dentists, changing
disease pattern & treatment needs along with numerous
challenges for expanding oral health care in India. The biggest
challenge is the need for dental health planners with relevant
qualifications and training in public health dentistry. There is a
serious lack of authentic and valid data for assessment of
community demands, as well as the lack of an organized system for
monitoring oral health care services need to guide planners [13].
5/4/2015 47
48. The most important resource of the country is its 1027
million population (2001 census), distributed in 28 States, 7 Union
Territories, 5564, tehsils/talukas, 640,000 villages and 5161 towns
and cities.14 India is predominantly rural, as over 72% of people
continue to live in rural areas.15 Rural health infrastructure has
been well designed to cover rural population through 136815
subcentres (SCs), 26952 Primary Health Centres (PHCs) and 3708
Community Health Centres (CHCs). Oral health care of necessity has
to be delivered through primary health care infrastructure, because
of limited resources and manpower of dentists. Though the country
is producing 7000 dentists per annum, the dentist: population ratio
is 1:30000, the distribution of dentist to population requirement
is grossly uneven. More than 90% of doctors are available in urban
settings and only 10% available to 72% of rural population.16,17
5/4/2015 48 NATIONAL ORAL HEALTH POLICY16
49. National Oral Health Policy has been formulated by the
"Dental Council of India", through the inputs of two national
workshops organized way back in 1991 and 1994 at Delhi and Mysore
respectively. These workshops considered the recommendations of
national workshops on oral health goals for India, Bombay 1984 and
a draft oral health policy prepared by Indian Dental Association in
1986. As a follow up measure of these efforts, the core committee
appointed by Ministry of Health and Family Welfare, could succeed
to move the resolution in fourth conference of Central Council of
Health and Family Welfare in the year 1995. 5/4/2015 49
50. 1. There is an urgent need for an Oral Health Policy for
the nation as an integral part of the National Health Policy. 2.
Special, well coordinated, National Oral Health Programme be
launched to provide Oral Health Care, both in the rural as well as
in urban areas due to deteriorating oral health conditions in the
country as revealed by various epidemiological studies.
Dentist/population ratio in the rural areas is only 1:300,000.
Whereas, 80% of the children and 60% of the adults suffer from
dental caries, more than 90% of adult community after the age of 30
years suffer from periodontal diseases which also has its inception
in childhood. In addition, 35% of all body cancers are oral
cancers. Large segment of the adult population is toothless due to
the crippling nature of the dental diseases and about 35% of the
children suffer from malaligned teeth and jaws affecting proper
functioning. In view of these facts, it is important to launch
preventive, curative and educational oral health care programme
integrated into the existing system utilizing the existing health
and educational infrastructure in the rural, urban and deprived
areas. 5/4/2015 50 Ten points resolution has been brought out by
the Councill7:
51. 3. A post of full time Dental Advisor at appropriate level
in the Dte.G.H.S. should be created as a first step towards
strengthening the technical wing of the Dte.G.H.S. 4. Studies have
revealed that dental diseases have been increasing both in
prevalence and severity over the last few decades. There is,
therefore, an urgent need to prevent the rising trend of dental
diseases in India. The method used for primary prevention of dental
diseases aims at achieving primary prevention of periodontal
diseases and oral cancers. 5. The council, therefore, resolves that
preventive and promotive Oral Health Services be introduced from
the village level onwards and accordingly a pilot project on Oral
Health Care may be launched by the Ministry of Health and Family
Welfare during 1995-96 in five districts, one each in five States.
6. The Council further resolves that legislative measures be
adopted to ensure a statutory warning on the wrappers and
advertisement of sweets, chocolates and other retentive sugar
eatables TOO MUCH EATING SWEETS MAY LEAD TO DECAY OF TOOTH. Similar
measures are also called for tobacco and Pan Masala related
products. 5/4/2015 51
52. 7. The Council recommends that a National Training Centre
be established or the existing centres be strengthened for training
of various categories of oral health care personnel. 8. The Council
also resolves that all District Hospitals and Community Health
Centres have dental clinics. All Dental Colleges should have
courses on Dental Hygienists and Dental Technicians. 9. The Council
further resolves that the Pilot Project may be extended to all the
States at the rate of one District in every State. 10. The Council
also resolves that there is an urgent need to have a National
Institute for Dental Research to guide oral health research
appropriate to the needs of the country. 5/4/2015 52
53. Fourth Conference of Central Council of Health & Family
Welfare in October 1995, New Delhi resolved that: There is an
urgent need for an Oral health Policy for the nation as an integral
part of the National Oral Health Care Programme Health Policy.
Special, well coordinated, National Oral Health Care Programme be
launched to provide Oral Health Care, both in the rural as well as
urban areas due to deteriorating oral health conditions in the
country as revealed by various epidemiological studies.
Dentists/population ratio in the rural areas is only 1:300,000
whereas 80% of the children and 60% of the adults suffer from
dental caries, more than 90% of adult community after the age of 30
years suffer from periodontal diseases which also have its
inception in childhood. In addition, 35% of all body cancers are
oral cancers. Large segment of the adult population is toothless
due to the crippling nature of the dental diseases and about 35% of
the children suffer from mal-aligned teeth and jaws affecting
proper function. In view of the above facts, it is important to
launch preventive, curative and educational oral health care
programmes integrated into the existing system utilizing the
existing health and educational infrastructure in the rural, urban
and deprived areas. 5/4/2015 53
54. A post of full time Dental Advisor at appropriate level in
the Dte. G.H.S. (Directorate General of Health Services) should be
created as a first step towards strengthening the technical wing of
the Dte.GHS in this regard. Studies have revealed that dental
diseases have been increasing both in prevalence and severity over
the last few decades. There is, therefore, an urgent need to
prevent the rising dental diseases in India. The method used for
primary prevention of dental diseases aims at achieving primary
prevention of periodontal diseases and oral cancers. The Council,
therefore, resolves that preventive and promotive Oral Health
Services be introduced from the village level onwards and
accordingly a pilot project on Oral Health Care may be launched by
the Ministry of Health & Family Welfare during 1995-96 in five
districts, one in each in five states. The Council further resolves
that legislative measures be adopted to ensure a statutory warning
on the wrappers and advertisement of sweets, chocolate and other
retentive sugar eatables TOO MUCH EATING SWEETS MAY LEAD TO DECAY
OF TOOTH. Similar measures are also called for tobacco and Pan
Masala related products. 5/4/2015 54
55. The Council recommends that a National Oral Health Care
Programme Training Centre be established or the existing centres be
strengthened for training of various categories of Oral Health Care
Personnel. The Council also resolves that all District Hospitals
and Community Health Centres have dental clinics. All Dental
Colleges should have courses on Dental Hygienists and Dental
Technicians. The Council further resolves that the Pilot Project
may be extended to all the States at the rate of one District in
every State. The Council resolves that there is an urgent need to
have a National Oral Health Care Programme Institute for Dental
Research to guide oral health research appropriate to the needs of
the country. 5/4/2015 55
56. For the purpose of Implementation, the Programme is divided
into three phases, Developing the Implementation Strategies: During
1999-2000, four regional and two National Workshops were organized
to sensitize the dental personnel in various parts of the country.
The outcome of these workshops has been compiled in the form of
Implementation Strategies. Training and Re-orientation of Dental
Surgeons: In order to train the Health Workers at various levels
and the Schoolteachers, the Dental Surgeons from various Govt.
Hospitals, Training and Re-orientation Programmes are being
conducted in pilot states. So that the Dental Surgeons can act as
Master Trainers for the National Oral Health Care Programme. Till
now 11, workshops for the master trainers have been conducted for
Delhi, Assam, Meghalaya, Maharashtra, Punjab, Arunachal Pradesh,
Manipur and Tripura states and Indian Railways. 5/4/2015 56
57. Training of Health Workers: As a part of background
material for training of health workers, an educative video film on
oral health Kripaya Muskuraiye and pictorial training manual on
oral health for health workers have been produced. Till now 13
training programmes in the Delhi, Meghalaya, Punjab, Maharashtra,
Arunachal Pradesh, Manipur and Tripura have been conducted for the
health workers and Schoolteachers. Apart from these, symposiums are
conducted in various professional workshops and conferences to
involve more and more Dental Professionals in the National Oral
Health Care Programme. Till now, five symposia have been conducted
in Delhi, Bhubaneshwar, Allahabad, Kochi and Vijaywada. The nodal
agency conducts Free Oral health Camps for the lower socio-economic
population at various places. Till now, about 43 oral health camps
and awareness programmes have been organized under the aegis of
National Oral Health Care Programme. 5/4/2015 57
58. IEC Material Publication and Distribution Following IEC
aids have been produced as a part of this programme and are
distributed to various Govt. Organization, State Health Education
Bureau, Dental Colleges, IDA Branches and NGOs for Oral Health
Awareness programmes. 1. National Oral Health Care Programme:
Implementation Strategies 2001 2. Training Manual on Oral Health
for Health Workers in Hindi and English in the year 2001 3.
Educative video film on Oral Health entitled Kripaya Muskuraiye in
Hindi and English in the year 2002 4. Single Sheet colored Oral
Health Information for Health Workers in Hindi for their Ready
Reference in the year 2002 5. Training Manual on Oral Health for
Schoolteachers in Hindi and English in the year 2003 6. Posters on
Oral Health Dant fit to Life Hit series of four posters in English
and Hindi in 2003. 7. Educative Poster Series of five posters for
schoolchildren Swastha Muskan Aapka Vardan in Hindi and English in
2004. 5/4/2015 58
59. B A R R I E R S I N O R A L H E A LT H P R O M O T I O N I
N T H E C O U N T R Y During the implementation of the National
Oral Health Care Programme in the pilot phase, it was perceived
that most of the times our policymakers give oral health last
priority. They are inadequately informed about burden of oro-dental
problems and its connection with the systemic health and possibly
minimal threat to human life due to oro-dental problems makes step
motherly treatment for dental public health programmes. One of the
major disadvantages is that in India, health is a state subject and
most of the states in the country are suffering from financial
burden even for subsistence rather than providing quality health
care. Mostly the health care is looked after by the private sector
and individual practices including non-formal medical facilities.
However, the treatment cost for oral diseases is enormously
expensive and it has not been possible for any Govt. setup to
provide dental services to all. 5/4/2015 59
60. Moreover, our country lacks experts in dental public
health. The curriculum for graduation is outmoded with very little
importance to prevention. The dental graduates are unable to
perceive the importance of learning prevention of oro-dental
problems for the community and they are not aware of their
responsibilities towards the society. The internship programme is
also underutilized by the dental colleges for services to the grass
root level and dental health needs of our geriatric population are
overlooked. We do not have organized school oral health education
programmes so that children may learn right oral health practices
from the beginning. Over and above fastest growing population,
rapid westernization and lack of resources are increasing the
burden of oral diseases in our country. Tobacco abuse is further
causing menace for not only the poor and disadvantaged but also
civilized population. Early initiation of tobacco habits in
children is causing havoc in terms of morbidity and mortality of
our younger generations. 5/4/2015 60
61. N AT I O N A L O R A L H E A LT H C A R E P R O G R A M M E
[ 2 0 ] National Oral Health Care Programme a project of DGHS and
Ministry of Health & Family Welfare was initiated in 1998 with
aim of providing oral health care in the country through organized
primary prevention and strengthening of Oral health setup as per
the recommendations made in National Oral Health Policy. Later on
the Department of Dental Surgery, All India Institute of Medical
Sciences was chosen as the nodal agency to implement it. 5/4/2015
61
62. Ministry of Health and Family Welfare, Govt. of India
accepted in principle National Oral Health Policy in the year 1995
to be included in National Health Policy. In pursuance to National
Oral Health Policy 'National Oral Health Care Programme' has been
launched as "Pilot Project" to cover five States (Delhi, Punjab,
Maharashtra, Kerala and North eastern States) for its
implementation. To begin with, one district in each of these States
has been chosen to test run the strategies evolved through 2
national and 4 regional workshops organized in the country, to
achieve the following goals20 : 1. Oral Health for all by the year
2010. 2. To bring down the incidence of oral and dental diseases to
less than 40% from the existing prevalence of 90%. 3. To bring down
the DMFT in school children between 6-12 years of age to less than
2 which is approximately 4 at present. 4. To reduce high prevalence
of periodontal diseases to lower prevalence. 5. At the age of 18
years, 85% should retain all their teeth. 6. To achieve 50%
reduction in edentulousness between the age of 35-44 years. 7. To
achieve 25% reduction in edentulousness at the age of 65 years and
above. 8. To achieve 50% reduction in the present level of
malocclusion and dento-facial deformities. 9. To reduce the number
of new cases of Oral Cancers and precancerous lesions from the
existing levels. 5/4/2015 62
63. ELEVENTH FIVE-YEAR PLAN (2007-2012)21 Time-Bound Goals for
the Eleventh Five Year Plan: Reducing Maternal Mortality Ratio
(MMR) to 1 per 1000 live births. Reducing Infant Mortality Rate
(IMR) to 28 per 1000 live births. Reducing Total Fertility Rate
(TFR) to 2.1. Providing clean drinking water for all by 2009 and
ensuring no slip-backs. Reducing malnutrition among children of age
group 03 to half its present level. Reducing anaemia among women
and girls by 50%. Raising the sex ratio for age group 06 to 935 by
201112 and 950 by 201617. 5/4/2015 63
64. Expected achievements and goals (oral health related) :
Establishment of national,state & district oral health cells
for proper monitoring, planning of dental public health,
interventional measures and research activities. Strengthening
manpower and infrastructure at PHC/CHC & district hospitals and
providing basic oral health care to the rural population. To reduce
the prevalence and incidence of oral diseases in the country. To
reduce the mortality and morbidity of oral diseases. Early
detection of oral cancer from stage 3&4 to stage 1&2.
5/4/2015 64
65. 1 2 t h F I V E Y E A R P L A N (2012-2017)22 Core
strategies (oral health related) : 1. Promote access to improved
oral healthcare 2. At PHC level, either specially trained dental
hygienist or staff nurse may deliver simple preventive,
interceptive and curative oral health services (like pain relief,
ART, early diagnosis of oral cancer and HIV/AIDS related oral
lesions and their referral) in addition to giving oral health
education. 3. Strengthening existing CHCs and formulation of Indian
Public Health Standards, defining personnel, equipment and
management standards for oral health care provision. Supplementary
strategies: 1. Promotion of public private partnerships for
achieving public health goals. 2. Reorienting dental education to
support rural health issue. 5/4/2015 65
66. H E A LT H C A R E AT P R I M A RY H E A LT H C E N T R E (
P H C ) 2 2 PHC is the first contact point between village
community and the Medical Officer. The PHCs are established and
maintained by the State Governments under the Minimum needs
Programme (MNP)/ Basic Minimum Services Programme (BMS). They are
established on the basis of national norm of one PHC for every
30,000 rural population in the plains, and one PHC for every 20,000
population in hilly, tribal and backward areas for more effective
coverage. There are 22,370 PHCs functioning as on March 2007 in the
country, achieving an average coverage of 33,191 population per
PHC. At present, a PHC is manned by a Medical Officer supported by
14 paramedical and other staff. It acts as a referral unit for 6
Sub Centres. It has 4 -6 beds for patients. The functions of the
primary health center include the 8 "essential" elements of primary
health care including medical care, Maternal and Child Health (MCH)
including family planning, safe water supply and basic sanitation,
prevention and control of locally endemic diseases, collection and
reporting of vital statistics, health education, National Health
Programmes, referral services, training of village health workers
and basic laboratory services. 5/4/2015 66
67. Primary Health Centre is the cornerstone of rural health
services- a first port of call to a qualified doctor of the public
sector in rural areas for the sick and those who directly report or
referred from Sub-Centres for curative, preventive and promotive
health care. 5/4/2015 67
68. With an average prevalence of dental caries of 50% in all
the age groups, approximately 15,000 people in a catchment area of
a PHC would require restorations/extractions. About 45% of adults
(60% of the population) i.e. 8100 persons would require oral
prophylaxis. As many as 7% of the population i.e. up to 2100 people
may suffer from oral premalignant and malignant lesions. Oral
health care with emphasis on preventive and promotive aspects needs
to be provided at PHC level. This would include oral health
education, tobacco cessation counseling, oral prophylaxis, and pain
relief, early identification of oral precancer/ cancer and other
common oral diseases and referral. Also, a minimally invasive
procedure using hand instruments Atraumatic Restorative Technique
(ART) may be carried out to restore carious teeth. 5/4/2015 68 O R
A L H E A LT H C A R E AT P R I M A RY H E A LT H C E N T R E ( P H
C ) 2 2
69. These services can be provided by an extended-duty dental
hygienist. Till the time enough number of extended-duty hygienist
can be produced, these services can be provided by trained nurses.
Also, adoption of suitable number of PHCs (minimum 3) by each
dental institution for carrying out oral health education and
screening should be made mandatory. Existing PHCs need to be
upgraded with respect to equipments and materials for carrying out
the above procedures. The monitoring and evaluation would include
process indicators such as percentage of PHCs with dental
hygienist/ trained nurse and dental equipments. Outcome indicators
such as number of times IEC activity and oral prophylaxis performed
in a given time-period and number of referred dental patients/
dental hygienist need to be evaluated. This would require
maintenance of records and its monthly submission to District HQ.
Annual survey of oral health knowledge, attitude, practices and
oral hygiene status of the catchment area would be useful impact
indicators. 5/4/2015 69
70. Service Delivery23: From Service delivery angle, PHCs may
be of two types, depending upon the delivery case load Type A PHC:
PHC with delivery load of less than 20 deliveries in a month, Type
B PHC: PHC with delivery load of 20 or more deliveries in a month.
All Minimum Assured Services or Essential Services as envisaged in
the PHC should be available. The services which are indicated as
desirable are for the purpose that we should aspire to achieve for
this level of facility. Appropriate guidelines for each National
Programme for management of routine and emergency cases are being
provided to the PHC. 5/4/2015 70
71. 5/4/2015 71 Dental health care services are not provided at
PHC level
72. I N D I A N P U B L I C H E A LT H S TA N D A R D S F O R C
O M M U N I T Y H E A LT H C E N T R E S [ 2 2 , 2 4 ] The
Community Health Centres (CHCs) constitute the secondary level of
health care, were designed to provide referral as well as
specialist health care to the rural population. Indian Public
Health Standards (IPHS) for CHCs have been prescribed under
National Rural Health Mission (NRHM) since early 2007 to provide
optimal specialized care to the community and achieve and maintain
an acceptable standard of quality of care. CHCs are being
established and maintained by the State Government under MNP/BMS
programme. Each CHC covers a population of 80,000 - 1.20 lakh
population (one in each community development block). As on March
2007, there are 4045 CHCs functioning in the country. It is manned
by four medical specialists i.e. Surgeon, Physician, Gynecologist
and Pediatrician supported by 21 paramedical and other staff.
5/4/2015 72
73. One anesthetist and one Medical Health Administrator are
also employed on contractual basis. Recently, an Opthalmic surgeon
has been added at CHC level. It has 30 in-door beds with one OT,
X-ray, Labour Room and Laboratory facilities. It serves as a
referral centre for 4 PHCs and also provides facilities for
obstetric care and specialist consultations. Unfortunately, dental
care has not been included under the Assured Services to be
provided at CHC. However, if the oral disease burden of the
population served at CHC is considered, it is tremendous. 5/4/2015
73
74. O R A L H E A LT H C A R E AT C O M M U N I T Y H E A LT H
C E N T R E ( C H C ) 2 2 With an average prevalence of dental
caries of 50% and average DMFT of 1 in children (34% of
population), 40,800 restorations would be required. With an average
prevalence of dental caries of 50% and average DMFT of 3 in adults
(60% of population), 2,16,000 restorations would be required.
28,800 children would require preventive therapy in the form of
fluoride varnish and pit and fissure sealing, if provided to
children up to 9 years of age (24%). About 45% of adults (60% of
the population) i.e. 32,400 persons would require oral prophylaxis.
30% of geriatric population (8% of the population) i.e. 2880
persons would require prosthetic care. As many as 7% of the
population i.e. up to 8400 people may suffer from oral premalignant
and malignant lesions. 5/4/2015 74
75. Therefore, there is a need to provide routine an emergency
care in dental surgery at CHC level. This would include oral health
education and School Health Education Programme as an outreach
activity, identification of oral pre cancer/cancer and other common
oral diseases, oral prophylaxis, dental extractions, biopsy of oral
lesions, restorations and application of topical fluorides. 1
dental surgeon along with 1 chair-side assistant is a necessary
requirement to provide the above mentioned services. Also,
public-private partnership should be considered for providing
removable prosthesis. 5/4/2015 75
76. Service Delivery : Unlike Sub-centre and PHCs, CHCs have
been envisaged as only one type and will act both as Block level
health administrative unit and gatekeeper for referrals to higher
level of facilities. The revised IPHS (CHC) has considered the
services, infrastructure, manpower, equipment and drugs in two
categories of Essential (minimum assured services) and Desirable
(the ideal level services which the states and UT shall try to
achieve). All essential services as envisaged in the CHC should be
made available, which includes routine and emergency care in
Surgery, Medicine, Obstetrics and Gynaecology, Paediatrics, Dental
and AYUSH in addition to all the National Health Programmes.
5/4/2015 76
77. Standards of services under existing programmes were
updated and standards added for newly developed non communicable
disease programmes based on the inputs from various programme
divisions. Standards for Newborn stabilization unit, MTP facilities
for second trimester pregnancy(desirable), The Integrated
Counselling and Testing Centre (ICTC), Blood storage and link Anti
Retroviral Therapy centre have been added. 5/4/2015 77
78. 5/4/2015 78
79. 5/4/2015 79 Basic Dental health Care Services are delivered
at the CHC level
80. 5/4/2015 80
81. C O M M U N I T Y H E A LT H C E N T E R 5/4/2015 81
82. L I S T O F E Q U I P M E N T S ( D I S T R I C T H O S P I
TA L ) [ 2 2 ] 5/4/2015 82 S. No Item 1. Electrically Operated
Fully Programmable Dental Chair 2. Autoclave 3. Storage Cabinet 4.
Dental X-ray Unit with Day-light Manual Developer 5. Panoramic with
Cephalomatric X-ray unit 6. Electro Cautery Unit 7. Digital Pulp
Tester 8. Digital Apex Locator 9. Surgical Micromotor
83. S U B - D I S T R I C T H O S P I TA L / C H C S.No. Item
1. Electrically Operated Fully Programmable Dental Chair 2.
Autoclave 3. Storage Cabinet 4. Dental X-ray Unit with Day-light
Manual Developer 5. Electro Cautery Unit 6. Surgical Micromotor
5/4/2015 83
84. P H C ( if dental surgeon is appointed at phc as per
recommendation) S.No. Item 1. Electrically Operated Fully
Programmable Dental Chair 2. Autoclave 3. Storage Cabinet 4. Dental
X-ray Unit with Day-light Manual Developer 5. Electro Cautery Unit
5/4/2015 84
85. S M I L E T R A I N [ 2 5 ] Every year 35,000 children in
India are born with clefts. Without corrective surgery, these
children are condemned to a lifetime of isolation and suffering.
The tragedy is that a cleft can be completely corrected with a
simple surgical procedure that could take as little as 45 minutes
and is TOTALLY FREE! Since 2000 Smile Train has sponsored over
450,000 surgeries across India. But there are still an estimated 10
lakh untreated cases of clefts in India. The goal of Smile Train is
to continue providing cleft surgeries across India until we have
completely eradicated the problem of clefts. 5/4/2015 85
86. 5/4/2015 86 provided free cleft surgery for more than
1,000,000 children in thirteen years. provide free surgery for more
than 300 children every day. provided free education and training
for more than 20,000 medical professionals. Smile Train offers the
following funding opportunities: Treatment Partnerships Treatment
Grants Education & Training Grants
87. F U N D I N G P R I N C I P L E S Smile Train funds
hundreds of programs throughout the world dedicated to helping poor
children with cleft lip and palate and improving the safety and
quality of cleft care. General guidelines for funding: Smile Train
funds programs and projects that focus exclusively on helping
children with cleft lip and palate. funds treatment for poor
children in developing countries through partnerships with local
medical professionals, hospitals and organizations. Smile Train
does not fund treatment missions unless there is no other source of
treatment within the country. Smile Train funds programs that help
the maximum number of children for the minimum amount of money.
Smile train dont fund large capital expenses such as construction
or maintenance of facilities or major equipment expenditures. Smile
Train funds should not replace any other existing funding source.
5/4/2015 87
88. PA RT N E R S H I P P R O G R A M S Treatment Partnerships:
Smile Train has provided free cleft surgery and related treatment
for more than 1,000,000 children around the world. All of these
surgeries are performed by local doctors that Smile Train has
empowered through various partnerships and grants. Treatment
Partnerships involve an on-going relationship with Smile Train and
require a long- term commitment providing free surgical treatment
for children with cleft who would not otherwise be helped.
Treatment Partnerships significantly increase the number of cleft
surgeries performed at a qualified hospital/center. The Treatment
Partner must meet and adhere to The Smile Train Safety and Quality
Improvement Protocol. Treatment Partners are reimbursed based on
the number of patients treated. All Treatment Partners are required
to participate in Smile Train Express, an online patient
record-keeping database. 5/4/2015 88
89. Treatment Grants: Treatment Grants are one-time grants for
medical professionals, hospitals, and organizations that provide
treatment for poor children with clefts in developing countries,
but who may not meet the requirements to become a treatment
partner. These grants are designed to supplement care for children
who would not otherwise receive help through free treatment (i.e.
surgery, orthodontia, speech therapy), improving the quality of
treatment or providing for related expenses such as equipment,
outreach programs, and patient travel. The grants may also be
designated for a specific project or need that help poor children
with cleft lip and palate. Education and Training Grants: Smile
Train programs come in all shapes and sizes, but the objective of
every one is the same: to help the local medical community become
self-sufficient. With the proper education and training, surgeons
and nurses in developing countries are empowered to deliver
excellent treatment and care. They are our best hope of helping the
millions of children who need it. 5/4/2015 89
90. Smile Train provides Education and Training Grants for
doctors, hospitals and medical schools to develop and deliver
advanced in-country cleft lip and palate teaching and education
programs. These programs are made available to doctors, nurses, and
medical professionals who could not otherwise afford them.
Education and Training Grants are designed to improve the safety
and quality of cleft care performed by existing cleft care
professionals. They are designed to support in-country training and
education, not U.S. based training. Education and Training
sponsored by Smile Train should lead to improved treatment for poor
children. The grants are not intended for funding individual travel
needs to conferences and symposiums. Training grant applicants are
chosen in accordance with their medical education, experience and
ability. 5/4/2015 90
91. C O N C L U S I O N It seems it is important to act now to
strengthen dental health policy and planning. Up-to-date oral
health data are rarely available at national level. A national oral
health policy developed as a result of the processes will be both
new and innovative, with the best chance of making real,
sustainable improvements in the oral health of the population. A
national dental health policy must ensure there is an effective
monitoring system in place so you can recognize problems as they
occur and find solutions for them. To provide adequate,
respectable, and attractive Employment opportunities to the
workforce while maintaining a balanced geographical distribution is
the main challenge and the root of all the issues facing the dental
profession in India. To cope with number of dentists graduating
each year will require a massive infrastructure, a factor that
requires the very urgent attention. This vicious cycle has to be
stopped to get at the root of the problem and begin providing
sufficient employment opportunities in an equitable manner. Effects
of dental health burden induce health inequality on health of a
society are profound. In a large, overpopulated country like India
with its complex social structure and economic extremes, the effect
of inequity on health system is multifold. 5/4/2015 91
92. Unequal distribution of resources is a reflection of this
inequality and adversely affects the health of underprivileged
population. The socially underprivileged population groups are
unable to access the oral healthcare due to geographical, social,
economic or gender related distances. 5/4/2015 92
93. B I B L I O G R A P H Y 1. Oxford English dictionary;2010;
3rd edition; Oxford University Press. 2. Michael Rundell, Macmillan
English dictionary;2007; 2nd Edition; Macmillan education
Publishers. 3. Stephanie Meyer; Collins English dictionary; 2009;
Special edition; Collins Publisher. 4. Thomas H. Patten, Jr.
Manpower planning and the development of human resources. 1971
Wiley-Interscience 5. Edwin B. Flippo. Principles of personnel
management. 1976; 4 edition; McGraw-Hill. 6. Cynthia pine and
Rebecca Harris, Community oral health- 2nd edition, Quintessence
publishing co. ltd, 2007 7. Soben Peter. Essentials of preventive
and community dentistry; fourth edition; 2011:412- 420. 8. Indrajit
Hazarika. Health workforce in India: assessment of availability,
production and distribution. WHO South-East Asia Journal of Public
Health.2013;2(2):106-12 9. World Health Organization. The world
health report 2006 Working together for health. Geneva, World
Health Organization. 2006. 10. Mythri Halappa, NaveenB H et al;
SWOT Analysis of Dental Health Workforce in India: A Dental alarm.
Journal of Clinical and Diagnostic Research. 2014;8(11):3-5 11.
Dental Council of India. Available from: http://www.dciindia.org/
12. Anand S, Brnighausen T. Human resources and health outcomes:
cross country econometric study. Lancet. 2004;364:1603-09. 5/4/2015
93
94. 13. Shobha T. Challenges to the Oral Health Workforce in
India. J Dent Edu. 2004;68(7):28- 33. 14. Ashish Bose. Health for
the millions, Population Scan, First results of census of India,
2001, March-April 2001. 15. Bulletin on Rural Health Statistics in
India March-2003. Issued by infrastructure division, Deptt. of
FamilyWelfare, MOH&FW Nirman Bhavan New Delhi. 16. National
Oral Health Policy: Prepared by core committee, appointed by the
Ministry of Health and Family Welfare, 1995. 17. Fourth conference
of Central Council of Health and Family Welfare - Proceedings and
resolutions. October 11-13,1995 New Delhi. Bureau of planning,
Directorate General of Health Services, Ministry of Health and
Family Welfare, Govt. of India, New Delhi. 18. Ramandeep SG,
Prabhleen B,et al. Utilization of dental care: An Indian outlook. J
Nat Sci Biol Med. 2013;4(2):29297. 5/4/2015 94
95. 19. Khader seeks dentists help in implementing dental
policy. The Hindu. Available
fromhttp://www.thehindu.com/todays-paper/tp-national/tp-karnataka/khader-seeks-dentists-
help-in-implementing-dental-policy/article5701403.ece 20. National
oral health care programme implementation strategies, DGHS,
MOH&FW. Govt. of India. Prepared by Dr. Hari Parkash, Project
Director, Dr. Naseem Shah, Addl. Project Director, Department of
Dental Surgery. AIIMS, Ansari Nagar, New Delhi. 21. Report of
working group on communicable and non-communicable diseases for the
11th five year plan. September 2006 22. Prevention and control of
non-communicable diseases, proposal for the 12th five year
plan,2011 23. Indian Public Health Standards (IPHS) Guidelines for
Primary Health Centres Revised 2012 24. Indian Public Health
Standards (IPHS) Guidelines for Community Health Centres Revised
2012 25. http://www.smiletrainindia.org/ 5/4/2015 95
96. 5/4/2015 96 Sometimes people just need to sleep!! ..Thanks
anyways!