National Oral Health Programme

Centre for Dental Education and Research

National Centre of Excellence for Implementation of National Oral Health Programme
WHO Collaborating Centre for Oral Health Promotion

All India Institute of Medical Sciences, New Delhi

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Progress review and reorientation workshop for SNOs under NOHP, 27-28 January 2017

28 Jan 2017

 Progress review and reorientation workshop for State Nodal Officers under NOHP

27-28 January 2017

 

Inauguration

The progress review and reorientation workshop, a yearly review meeting for the State Nodal Officers under the National oral Health Programme, was held at the Centre for Dental Education and Research, AIIMS New Delhi, on the 27th and 28th of January 2017.

It was chaired by the Joint Secretary (Health) Shri Lav Agarwal, the Director General Health Services Dr Jagdish Prasad and Prof OP Kharbanda, Chief of the Centre for Dental Education and Research; the Director AIIMS, Prof MC Misra was the Chief Guest. Dr L Swasticharan, CMO, MoHFW, Dr Dharamshaktu, Special Director General, Dr Ajay Khera Deputy Commissioner, Maternal and Child Health were also present along with the faculty of CDER AIIMS.

The Chief of CDER, National Centre of Excellence for Implementation of the National Oral Health Programme delivered the welcome address. Stressing on the low oral health seeking behaviour among the public, Prof Kharbanda asserted that National Programme like NOHP seem to be the right ways to achieve targeted outcomes. He said every dental disease is amenable to prevention by following simple home based oral hygiene methods and diet modification. Taking note of the increasing life expectancy, he said, one has to look for ways to improve teeth retention. Also mentioning the evidence based facts about the effects of periodontal diseases on glycemic control, birth weight and risks of preterm birth among pregnant women, cardiovascular disease and stroke, Prof Kharbanda said, oral health reflects as overall health of an individual. Escalating costs of oral health care products impede the reach of these to the group of people who need them the most. A strategy to cut down the costs and ensure percolation to the grass root level is the need of the hour, he added. He also added that an up keeping with digitisation in every sector is significant and a digital dental portal is in the offing As a National Centre of Excellence, CDER has developed a complete package of Print and Electronic IEC which is a wide spectrum of Radio Jingles, TV Commercial, Posters, Badges, Stickers Leaflets and Manuals. He ended his address by saying Oral Health Care should follow a comprehensive life course approach which is aptly referred to as “womb to tomb”

Shri Lav Agarwal, the Joint Secretary, health, MoHFW comprehensively reviewed the progress of the programme so far and specified that a complete involvement in the programme from every state is the only way to achieve progress at the national level. He also emphasised that a common platform needs to be created through which a fortnightly or monthly appraisal and review of the activities across all states happens. He mentioned that a plan amounting to 36.77 Cr INR, all state PIPs put together for the entire FY of 2015-16 is an issue of concern. He added that Tamil Nadu alone has proposed a plan for about 1/3rd of this total allocation. Equity is significant he added and advised SNOs to be more proactive and design PIPs in such a way that an equitable allocation goes to every state. He also suggested that an internal competition among all the states should exist to drive the SNOs to obtain a genuine allocation from the centre. Spending the allocated funds at the right time in another area of concern he added and suggested a Micro Plan of Action can be a plausible solution. Situation Analysis should also be taken into account while planning he said. He ended his address saying Management Information System once designed, will help many states come up with success stories since the information and data flow would be regulated and field level work aptly reported.

The Director General Health Services, Dr Jagdish Prasad said a revisit to the tradition of maintaining oral hygiene is needed. He said a targeted approach for establishing dental units in all districts needs to be worked out. He also suggested training of paramedical staff for oral health would be beneficial in the long run. He envisioned that by the end of 2017, every district should have a functional dental department. He also highlighted on the multifarious nature of dental diseases, the role played by stress, diabetes and salivary antibodies on oral health.

In his address, Director AIIMS Prof MC Misra said it is a well established fact that oral health has a bearing on overall health of an individual. Suggesting that review meetings are critical and reflect on the progress of the National programmes of importance like NOHP, he added that digital networking on a regular basis should also be done. He also opined that oral health should be added as a component of school health programmes and a dental health check up has to be incorporated in school curricula at every level. He said that trained nurses also play a key role in improving oral health in medical settings. He suggested it is time we rise to the occasion where Government of India does provide funds and they do not remain underutilised. He added that everyone in the system should be made accountable and that will pave way for success of every programme. He said, whatever the bottlenecks; they need to be identified and addressed promptly.

Dr L Swasticharan, CMO Ministry of Health and Family Welfare in his Vote of Thanks, thanked the DGHS Dr Jagdish Prasad, the Joint Secretary Health Shri Lav Agarwal and the Director AIIMS Dr MC Misra for sparing their valuable time for this programme. He also thanked Prof OP Kharbanda and the team at CDER AIIMS for putting in great efforts towards NOHP right from its inception and also for all the support extended in organising this meeting. He also thanked Special DG Dr Dharamshaktu, Dr Ajay Khera and the faculty CDER AIIMS. He was also thankful for the support and response received from the SNOs in the run up for this meeting. He hoped that this meeting would lead to some productive discussions and contribute to the success of the programme.

A state wise review of the RoP and PIP was done later under the chairmanship of the JS with suggestions on planning, estimating expenditures, easing the process of PIP, networking and ensuring equity.

SWOT Analysis of NOHP :Dr Swasticharan

Presenting a SWOT Analysis of the National Oral Health Programme, Dr Swasticharan presented the Strengths of the Programme, mentioning that this is the first ever and the only National Programme for oral health. Mentioning that this programme integrates the academia, stake holders and policy makers under one umbrella, he said the programme also facilitates usage of resources available at both central and state levels. However, the programme focuses more on curative aspects and the threat that oral health is not given higher priority among other health needs by the public might weaken the programme. Throwing light on some opportunities coming in way in future he suggested NOHP alone can take the giant leap forward with respect to oral health, integrate with other programmes, conduct risk surveillance and improve the oral health parameters of the nation.

Integration of RBSK and NOHP: Dr Deepti Khanna

Speaking about the integration of Rashtriya Bal Swasthya Karyakram with NOHP, Dr Deepti mentioned the 4D Component of RBSK and also described the requirements and functions of a DEIC where a dentist is placed for both screening, referral and management. A Mobile Health Team (MHT) is existent with AYUSH, ANM, Nursing and Pharmacy personnel.  Dentists are considered specialists in this programme and thus they are at the referral end. The screening she said is carried out by generalists. 92 fully functional DEICs are functional at present.

Leadership and Managerial Skills: Dr AK Sood

Talking on leadership and managerial skills, Dr Sood gave a new perspective to work management at various levels and how nodal officers can act as leaders to motivate the workforce. He instilled a lot of enthusiasm by highlighting on the need for managerial skills particularly for those in the public health system. Quoting interesting examples and anecdotes of successful Indian managers, he said simple leadership skills can drastically improve workflow and increase productivity.

Drafting a PIP: Dr Utkal Mohanty

Beginning with the importance of drafting a strong PIP, Dr Utkal said it is an indicator of total budget requirement that is need driven and gives a complete picture of each State /UT. He suggested that the PIP should be submitted well in time following a bottom-top approach where in Panchayat > Block > District should be the organisational ladder.

An NPCC meeting proposed to happen between February 15 to 22 should be an ideal time to discuss all the PIPs once they are ready. He also suggested an 80:20 distribution for hilly areas, 60:40 for the normal areas and 70% funds should go to District level and below. Focus should be given to tribal and interior areas. Cities with higher case loads should be given preference. He also suggested that the operational guidelines for PIP released by the ministry should be followed. He quoted some examples of FMR Codes that can be used in a PIP.Priority areas for 2017-18

Free essential drugs and diagnostics

Universal health check up and screening and follow up of NCDs for individuals aged 30 and above.All HR must be in one component

Patient centric health care: Toll free helpline, grievance redressal system

Screening for Common Cancers: Dr Rajani Ved

Highlighting on the frontline workers as the priority workforce for NCD Screening and early detection starting with the grass root level, Dr Rajani emphasised on making the integration of NCD Programmes seamless. She also said transformation from Vertical programmes towards integration is the need of the hour.She briefed the audience about the upcoming programme for screening and early detection of common cancers along with the NCDs like Diabetes, Hypertension, Cardiovascular diseases and stroke. She also described the activities at each level and indicated the importance of tobacco and alcohol deaddiction. Health Wellness Centres she said would be the hub for all integrated programmes where ASHAs and ANMs would be the predominant workforce.She also opined that oral cancer screening can be

 

STEPS Approach for NOHP: Dr Arpit Gupta

Proposing a different approach for the National Oral Health Programme on the lines of WHO STEPS, Dr Arpit spoke about Preventive, Promotive and Curative care. He suggested customised targets for each state based on the existing oral health parameters. He opined that the different levels of progress reached by each state needs to be taken into account before a PIP is rolled out or a target is set for the programme. Dr Arpit also suggested that the programme should shift towards a preventive approach, on the sidelines of the principles of primary health care. He also briefly outlined the goals and activities taken up under NOHP so far.

Tobacco Cessation in NOHP: Dr Vijay Mathur

Dr Mathur initiated his talk with a mention about the dangers associated with tobacco use and suggested integration of various programmes targeted for NCD to fight tobacco related illnesses .He mentioned the role of dentists in Tobacco Cessation and emphasised the role of IEC, empowerment and training including awareness generation as the way ahead for the tobacco cessation initiatives. He also highlighted on the advantages dentists have in executing tobacco control and the multifarious roles dentists can play in counselling a tobacco user.

Mobile Dental Units in NOHP: Dr Anudeep

Dr Anudeep described the work of the NHM under the Mobile Dental Unit programme and the components required to establish one. He also mentioned that in dental public health, mobile dental units are complementary to holistic dental care and cannot be a substitute for public health centres with dental facilities. He also said mobile dental units improve accessibility and also enhance awareness in interior and tribal areas. In programmes like NOHP with population based targets for improving oral health parameters, mobile dental units seem to be one of the ways towards achieving goals.

 

 

COMPILED STATE AND UT SPECIFIC ISSUES WITH PLAUSIBLE SOLUTIONS DISCUSSED IN THE MEETING

S No

Name of State

Current Status / Activities

Issue / Concern

Plausible Solutions

1

Andhra Pradesh

  • Included dental materials and other consumables required for dental treatments in the essential surgical list of the state
  • Uses Flexipool and NTCP funds for Oral Health Promotion
  • Integrated with RBSK, NTCP,NPPCF
  • Manpower shortage after bifurcation of the state
  • Unfilled posts allocated for oral health programme
  • No defined provisions for PPP
  • Propose State Oral Health Consultant in revised PIP
  • Mention Human Resources in the revised PIP, include a hygienist

[143 Dental Hygienist posts was sanctioned for FY2016-17 under NOHP]

2

Arunachal Pradesh

  • Integrated programme activities with RBSK
  • Free dental health kits
  • Manpower dedicated for oral health even at district level
  • Accessibility to oral health care through mobile dental units
  • Lack of communication
  • Training and recruitment of specialists at district level
  • Indicate manpower requirement in the PIP
  • Propose mobile units in the PIP

 

3

Assam

·         Grant was approved in FY 2015-16 for implementation of NOHP in 2 districts, but no activity has been done so far

·         State needs to prioritize the oral health care delivery in the existing public health facilities

·         Initiate the recruitment process and procure the equipment and instrument for two districts which was approved in previous FY.

4

Bihar

  • Grant was approved in FY 2015-16 for implementation of NOHP in 10 districts, but no activity has been done so far
  • State needs to upgrade the health facilities for delivering oral health care services
  • Recruitment for the approved posts should be completed along with the required instrument and equipment.

5

Chhattisgarh

  • Integration with RBSK, NTCP, NPPCF
  • Portable dental chair usage, screening camps at CHC Level, schools
  • Oral health Advisory Committee in place
  • Inclusion of dental treatments in the listed treatments under the PMSBY: Pradhan Mantri Swasthya Bhima Yojana
  • No dentists or specialists at primary level.
  • No auxiliary personnel.
  • No dental facilities at primary health care level.
  • Constitution of a state level oral health task force
  • Inclusion of manpower in revised PIP
  • Augment the funds requested from Centre
  • Advocacy for a separate allocation for oral health from the state

6

Delhi

  • NOHP is not  under implementation in Delhi since it has not submitted any proposal under it.
  • Infrastructure and Manpower for Mohalla Clinic Proposal
  • Advocacy issues: PIP not passed
  • Basic Oral Health Services
  • Suggested inclusion in the revised PIP.
  • Consult National Centre of Excellence for Implementation of NOHP with regard to Advocacy issues

7

Dadra and Nagar Haveli

 

Not presented in the meeting

Not presented in the meeting

8

Daman and Diu

  • School dental programme is functional.
  • Mobile dental units functional.
  • Integrated work with RBSK Team.
  • Oral cancer screening initiated.
  • No auxiliary personnel

Central assistance?

  • One Dental Hygienist post has been approved for FY 2016-17

9

Goa

  • School Dental Health Programmes
  • Mobile Dental Units
  • Dental Care at Primary level

 

  • Training activities requested at Primary Level
  • Dedicated Manpower and Infrastructure to expand dental workforce
  • Suggested requisition in the revised PIP under the manpower / human resources category

10

Gujarat

  • Door to door screening for oral cancer
  • Training ASHAs in cancer screening
  • Difficulties in Recruitment process
  • Procurement of equipment for dental units at district level

 

  • Advocacy through proper channel

11

Haryana

  • Central assistance used exclusively for the salaries of the manpower
  • Manpower distribution at all levels of health care
  • There is a Director Health Services (Dental) in the state
  • Integrated school health programme along with RBSK
  • Oral health pakhwada, 1-15 September every year, special emphasis on individuals with special needs
  • Manpower vacancies to be filled
  • A need based, demand driven state PIP may be prepared for2017-18 by the state for appraisal.

12

Himachal Pradesh

  • Project MUSKAAN: Prosthetic replacement for senior citizens with BPL Cards and the general public
  •  
  • Infrastructure in PHCs and CHCs
  • School Dental Health Programmes
  • Monitoring
  • Capacity building and training
  • More NOHP Clinics
  • Cancer screening programmes
  • Advocacy
  • Integration
  • Revised PIP
  • State may include the demand for  desired activities in the PIP for 2017-18

13

 Jammu

 

 

 

14

Jharkhand

  • Integrated with RBSK
  • No manpower
  • Procurement of equipment
  • Infrastructure issues
  • Integration with NTCP, TCC to be provided by dentists: training ?
  • Revised PIP

15

Karnataka

  • Functioning State Oral Health Consultant
  • Dantha Bhagya Yojane for elderly, beyond age : 60 years; Prosthetics / complete dentures; MoU with 45 private colleges
  • Integrated with RBSK Programme

 

  • Poor status of dental facilities in PHC and CHC
  • No clarity over recruitment of auxiliary personnel
  • Lack of hygienists and technicians
  • Strengthening district hospitals

 

 

  • Propose manpower in the Revised PIP
  • Improved advocacy, learning from experiences of other states

 

16

Kashmir

 

 

 

17

Kerala

  • Integrated with NTCP, NPPCF
  • State has funds for oral health promotion
  • School dental programmes
  • Oral cancer screening camps, Oral Cancer Registry
  • Mobile dental services for rural and tribal population
  • Dental Care for pregnant and lactating women
  • IEC Activities, WOHD
  • Auxiliaries: deficient
  • Manpower at the Primary level

 

  • Propose in the revised PIP
  •  

18

Lakshadweep

  • State budget supports recruitment on a contract basis.
  • Procurement of drugs, essential consumables and dental materials is an issue.
  • Geographically isolated
  • Dental surgeons and hygienists are recruited on contract basis. No technicians.
  • Lack of infrastructure, particularly for prosthetic rehabilitation
  • No insurance covers treatment costs
  • Training programmes for dentists in recent methods/ advances
  • Propose in the revised PIP
  • Advocacy

19

Madhya Pradesh

 

 

 

20

Manipur

  • Dentist and Dental Hygeinist engaged under NHM
  • Assistants need to be recruited
  • Propose manpower, infrastructure and equipment in the revised PIP

21

Maharashtra

  • Swacch Mukh Abhiyaan
  • Promotion, IEC, School and College level participation
  • Oral examination campaign for health and non-health workers, officers and students
  • Integrated with RBSK, NPCCF, NTCP, JSY,RKSK, NPHCE,RNTCP and NPCDCS, AYUSH-NMHP,ICDS, DMER, Tribal Development Programme
  • Mobile Dental Units.
  • State Oral Health Cell Established and operational.
  • No infrastructure at primary level.
  • No manpower at primary level.
  • Recruitment issues.
  • Revised PIP
  • Improved advocacy

 

 

 

 

 

 

 

 

 

 

 

 

 

22

Meghalaya

 

  • Poor infrastructure
  • Dearth of manpower
  • Lack of Dental equipment
  • No specialists available
  • Monitoring and evaluation
  • 23Mobile dental units to cater to the needs of remote areas

The existing gap should be analysed and the required support can be proposed in the state PIP under NOHP for 2017-18.

23

Mizoram

  • State government supports NOHP agenda
  • Proposal for integration with other NCDs underway.
  • Three NOHP Centres, outreach programmes being conducted at CHC and PHC Level
  • Manpower at the PHC Level
  • Mobile Dental Units
  • All the staff are contractual
  • Propose in the revised PIP

24

Nagaland

  • Oral health programme integrated with NTCP and RBSK
  • Lack of dedicated manpower and infrastructure including auxiliaries
  • Motivate dental surgeons to own up; Monitoring and evaluation more frequently
  • Mobile dental units
  • Revised PIP

25

Orissa

  • Integrated with RBSK
  • MoU Pit and Fissure Sealant Application
  • Mobile Dental Units proposed
  • PHC Level no dental facilities
  • No auxiliary manpower at any level
  • Propose manpower in the PIP

26

Punjab

  • Integration with NTCP and NPCDCS
  • Training in a tie up with PGIMER Chandigarh
  • Semi-annual Dental Fortnight
  • Pre-natal component of oral health: every Wednesday ANC Screening, awareness building to improve maternal and infant oral health care.
  • No dental technicians and hygienists at the primary level.
  • Recruitment of more Specialists at the primary level.
  • Manpower proposal can be included in the revised PIP
  • Advocacy to be improved by including other programme officers and medical professionals

27

Puducherry

  • Rural dental camps and existence of mobile dental units
  • School dental health programme
  • Cancer screening camp every week
  • Recruitment of dentists and dental hygienist at the CHC, PHC and district hospital level
  • Training programmes for school teachers and health staff
  • Manpower shortage, no oral health cell
  • No budget head for NOHP
  • No training in survey
  • Mention in the revised PIP
  • DCI Norms to be followed, not bound to IPHS Norms ?

28

Rajasthan

  • NOHP is under implementation in 3 districts of Rajasthan
  • Need adequate dental auxiliaries to support the existing dental surgeons.

 

  • State may speed up the recruitment process for 30 dental hygienists which was approved in FY 2017-18

29

Sikkim

  • Camps in rural areas, training programmes for teachers on oral health.
  • School dental programmes
  • Free health camps, oral cancer camps
  • Tobacco cessation and oral health awareness workshops local NGO s support training workshops
  • Dentists and auxiliaries need to be recruited to meet demand
  • Mobile dental services to reach remote areas
  • No integration at DEIC / RBSK?
  • Communication gaps
  • Central assistance does not reach state

 

 

  • Propose in the revised PIP

 

30

Tamil Nadu

  • One of the best performing states in providing the health services.
  • NOHP is under implementation in 350 PHCs
  • No Specific concern

 

31

Telangana

 

  • Integrated with RBSK
  • Training ASHAs AWW ANM
  • TCC Centres
  • Oral Health Camps in rural areas and referral to CHCs
  • Dental Units
  • Manpower recruitment
  • Propose trainings in PIP
  • Propose manpower in revised PIP
  • Training for TCC from National Centres of excellence / integrate with NTCP

32

Tripura

  • Started IEC activity under NOHP

 

 

33

Uttar Pradesh

  • NOHP is under implementation in 2 Districts
  • Difficulty in procuring equipment and instruments
  • Delay in recruitment
  • State may write to centre for the required assistance if any in the matter.
  • State can expedite the process of implementation of NOHP in rest of the districts for which approval was given from the MoHFW.

 

34

Uttarakhand

Merger of various NCD Programmes into one including NOHP.

Not presented in the meeting

Not presented in the meeting

35

West Bengal

  • PPP Model: for diagnosis
  • Free Implants

 

  • Establishment of clinics
  • Prosthodontic labs
  • Oral diagnosis and pathology labs
  • No manpower at PHC, None with dental facility, no dental posts sanctioned.
  • Revised PIP
  • Consultation with NPCC

 

 

 

 

 

 

 

 

 

 

Summary

A template of Power Point with the details necessary was shared with each of the states and Union Territories with segregated tables for Manpower, Infrastructure and Budget. Also, details on the current progress and existence of oral health programmes at state level were asked.

The Nodal Officer / Representative from each state presented the same during the 2 day workshop. And the proposals were thoroughly discussed and suggestions noted. There were also some quick solutions given to the SNOs on how to solve issues on advocacy / PIP and other administrative issues.

Some points emerged from these discussions and these are summarised below:

  1. A National platform for Digital Networking and Correspondence is an immediate need and this was said to aid in review as well as data sharing.
  2. A monthly / fortnightly review of the progress across each state can help in better monitoring, data flow and information access.
  3. A Micro Plan of Action with frequent reporting of work at field level will improve the deliverables.
  4. Constitution of a State Level Task Force for Oral health was proposed.
  5. An Advisory Committee was suggested to be constituted by every state with an all inclusive team of medical professionals, public health dentists and NCD personnel.
  6. SNOs were also advised to persistently sensitise their respective Mission Directors and update them with the progress with respect to oral health.
  7. The participants agreed that an interstate  competitive approach can speed up field level progress and act as a motivation.
  8. As a part of the HR component of the PIP, states were requested to ask for even consultants for oral health programme exclusively.
  9. A timely submission of the revised PIP for each FY was stressed upon.
  10. The RoPs would be reviewed and it would reflect programme execution at state level; excess of unspent balance would be a bottleneck for release of funds for the following FY.
  11. Clarity was sought on the levels at which RBSK and NOHP can be integrated.
  12. A discussion of IPHS Vs DCI norms for recruiting dental hygienists, assistants and also dentists at the primary health care level was discussed and it was agreed upon that there exists flexibility in recruitment of personnel for oral health units.
  13. Recruitment of a dentist as a District Nodal officer for NOHP was agreed upon by a majority of the participants.
  14. A vision statement with specific and measurable targets was sought for channelized work across states, on the lines of having one dental unit functional at every district in India by the end of 2017.
  15. Adjustment of funds from the NHM Flexipool toward the oral health programme was also suggested to the SNOs as a part of PIP Drafting.