Executive Summary
The purpose of the report is to look at the measures and step that have been taken by the government of NSW in improving the oral health services of the people in that area. The report covers the objectives of the oral health plan as well as the strategies that have been developed by the Department of Health (2008) for NSW and the Centre for Oral Health Strategy to meet the objectives. The report also highlights the performance indicators that will be used to measure the strategies in terms of whether they have been fully implemented or not. It also covers gaps in the plan, who has been excluded from the plan and also the commitment of the NSW government to the plan.
The report looks at the NSW oral health plan which highlights the various oral health needs in the area and the strategies that are needed to ensure that the quality of healthcare is improved. The report highlights various groups that are in need of specialised and improved oral health care. These groups are the elderly, the Aborigine community, and people in need of specialized care, people in low income or disadvantaged groups and people who live in the rural and remote areas.
The strength of the plan is that it is mainly focused on the Aborigine community who are known to suffer from poor health and they also have access to poor health services. It also covers fluoridation of water to reduce the cases of oral diseases of people living in areas that have high fluoride levels in their water. The weakness of the plan is that it fails to provide extensive oral health coverage to people from high risk areas or refugees.
Introduction
The need to develop a new plan arose because of the high number of oral diseases in NSW. While the New South Wales area has high quality dental treatment services, the area still experiences a high number of oral health cases because of the high number of low income and disadvantaged people that are unable to access proper dental services. The dental system in the area is unable to deal with the high demands for good oral services because of the lack of proper dental infrastructures, poor investment and funding as well as shortages in dental staff (OHA, 2010)
Groups identified to have bad health practices in Australia are the Aborigines, low income people, the elderly, and refugees, people in the rural and remote areas and people who need specialized healthcare (ABS, 2007). These groups experience poor oral health care because of the systematic barriers that do not allow them to access proper dental healthcare services. Most of the dental services offered in NSW are offered by private dentists who charge a high fee for their services, locking the above groups from accessing good oral health care (OHA, 2010).
Evaluation of the Implementation Plan Strategy
The objectives of the oral health plan will be to improve on the accessibility of health care programs for people in the rural and remote areas, low income groups, the elderly and those in specialized residential care, reduce the amount of Fluoride in the public water supply, improve the quality of preventive and health care services in NSW, improve the accessibility of low income groups, rural dwellers and the elderly to oral health service, reduce the amount of waiting times, improve the accessibility of special care groups and communities at high risk to specialist health care; increase in the awareness of oral health care services to the target population, improve the knowledge of non-dental health personnel on oral care and improve the working environment for oral health care staff in NSW (Department of Health, 2008).
The strategies that have been identified to meet the objectives according to the Department of Health (2008) are: develop supplementary, preventive and maintenance programs that will meet dental needs in the rural and remote areas as well as for elderly people, low income, disadvantaged people and specialized care patients, support fluoridation of local water supplies, support educational, training and specialist services for new employees in the dental profession, and ensure the Aborigines; the elderly and special care people have their own specialized dental providers.
Groups Included in the Plan
The NSW plan has mostly focused on the disadvantaged groups in the area, low income earners, the elderly, people from high risk communities or refugees and people in need of specialized care. These groups have been identified to have poor dental health and also they cannot be able to access good oral services because of the expense. The elderly people and those who need specialized care have been identified as being high risk developers of oral diseases. This is because they face a myriad of health problems that require a huge amount of money. These groups also face barriers to receiving proper dental services because there are no specialised centres. The main people who provide the services are the care givers found in the nursing homes and specialized care facilities who mostly lack the training, skills and knowledge to provide proper oral health care (Chalmers et al, 2009).
Groups that have not received much focus when it comes to dental aspects are children and young adults. The reason for this exclusion is because the dental health service for young adults and children is the best when compared to that of other developed countries. According to data that showed the comparisons dental services of 44 countries, Australia was seen to have the lowest number of children with dental problems. The report however noted that children from areas with high amounts of Fluoride faced poor dental health when compared to those from areas that had less Fluoride in their water (Armfield et al, 2007).
Organizational Commitment to the Plan and Performance Indicators
The government of New South Wales approved a budget that would extend over a four year period with the total amount of money contributed to the plan amounting to $40 million. This amount will cover items such as data collection and evaluation of oral health practices and modes of patient care in New South Wales that will see $1.5million and $3.6million allocated for these activities respectively, the recruitment of dentists in the area which will cost $8.2 million, as well as contracted staff that will see the amount of $6 million being allocated. To ensure that the dental clinics are functioning properly and effectively, the budget allocates half a million dollars. The recruitment of additional staff in the rural and remote areas and their retention will cost a total of $7.7 million while the recruitment of specialist staff for Aborigines will cost one million dollars. The introduction of specialised services and specialist staff for the elderly people, specialized care patients and refugees will cost $ 6 million of the budget allocation (Department of Health, 2008).
To determine whether any of the strategies in the NSW oral health program have been achieved, the following performance indicators can be used to measure results of the plan; the number of oral health programs implemented, number of oral disease preventive models in place, number of dental providers employed, number of specialist staff recruited for specialised dental services, the waiting times for people in high priority groups and number of Fluoridation plants in place (Department of Health, 2008).
Strengths and Weaknesses of the Oral Health Plan
The strength of the oral health plan is that it covers the Aborigine group which is a minority group in Australia that has faced poor health services. When compared with the overall population in Australia, the Aborigine community face the highest number of dental problems with young children having untreated caries and the adults having a lot of missing teeth. The Aborigines in the rural and remote areas face higher dental problems than those in the urban areas with Fluoridation being the major cause of dental problems. This is because the water they use has high amounts of Fluoride. Other causes of dental problems are the poor diets of Aborigines, their high levels of alcohol consumption and smoking (NACOH, 2010).
Oral illnesses are associated with diseases such as diabetes, pneumonia, and cardiovascular diseases which have been noted to cause poor health problems to the Aboriginal community. From 1996 to 2007, the rate of hospitalisation in New South Wales for dental services in Aboriginal children below the age of 15 was 20 percent higher than that of children who were not of Aboriginal descent. The rate of restoration of teeth for non-aboriginal children was higher when compared to that of aboriginal children who had a higher rate of tooth removals. These revealed the poor state of oral health among this group (Jamieson et al 2007).
Studies conducted by the Australian Institute of Health and Welfare (AIHW) into the number of Aborigine patients in hospitals in 2007 shows that the percentage of patients admitted from the Aborigine community in the NSW area was 88 percent. The number of Aboriginal patients in major cities was 81 percent while those in the inner region were 89 percent. The patient percentage for Aborigines admitted for dental problems in the outer regions was 95 percent while those in the rural and remote areas was estimated to be 100% (AIHW, 2008). Another major strength of the health plan is that it considers fluoridation of water which is a cost effective and safe means of protecting against tooth decay in the communities that have high levels of Fluoride. A high consumption of fluoride leads to dental disorders known as Fluorosis which affects the tooth enamel, altering the whiteness of the teeth (AIHW, 2008).
According to the Australian Research Centre for Population Oral Health (ARCPOH, 2006), the total number of people in New South Wales who did not have access to fluoridated water supply was 7.3 percent. The results also showed that the North Coast area had 53 percent of its inhabitants not having any access to fluoridated water supply. Having fluoridated water is important as it reduces the amount of Fluoride intake a person consumes in their water. According to the United States Centre for Disease Control and Prevention, the fluoridation of water is seen to be rated among the top ten public health measures for the 20th century. Water fluoridation is placed alongside eradication of smallpox and polio in the ratings (NSW Health, 2008).
The weakness of the plan is that it does not provide extensive oral health coverage for people of high risk communities or refugees. This is as a result of the changing immigration environment for refugees that come to Australia which makes it difficult to create a plan that effectively caters for their oral health needs. The refugees are known to have poor general health problems because they cannot access proper health services and there is also the issue of language barriers especially for those refugees from non speaking English countries (Owen et al, 2009).
Conclusion
The report has identified groups in need of better oral health services in NSW. Formulating and implementing the plan is one step to improving the oral health care services and delivery in NSW. The government however still needs to do more to ensure that everyone in the area is able to access proper and affordable dental services. The funding for public dental services could be increased so that the disadvantaged groups can be able to access affordable dental services that are of high quality in the public clinics. The government should also focus on the major inequalities that exist in the general healthcare of the groups identified in the plan. Government initiatives should focus on reducing this wide gap of inequality in healthcare delivery.
References
Armfield, J.M., Slade, G.D. & Spencer, A.J. (2007). Water fluoridation and children’s dental health: the child dental health survey, Australia 2002. Canberra: Australian Institute of Health and Welfare. Web.
Australian Bureau of Statistics (ABS) (2007). The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Web.
Australian Institute of Health and Welfare (AIHW) (2008). Australia’s Health 2008. Web.
Australian Research Centre for Population Oral Health (ARCPOH) (2006). The Use of Fluorides in Australia: Guidelines. Australian Dental Journal, Vol. 51, No.2, pp 195-199.
Chalmers, J.M., Spencer, A.J., Carter, K.D., King, P.L., & Wright, C. (2009). Caring for Oral health in Australian residential care. Canberra: Australian Institute of Health and Welfare.
Department of Health (2008). NSW Oral health implementation plan 2005-2010. NSW: Centre for Oral Health Strategy.
Jamieson, L.M., Armfield, J.M. & Roberts-Thompson, K.F. (2007). Oral health of Aboriginal and Torres Strait Islander children. Australian Institute of Health and Welfare. Web.
National Advisory Committee on Oral Health (NACOH) (2010). Healthy mouths healthy lives: Australia’s national oral health plan 2004-2013. Adelaide: Government of South Australia.
NSW Health (2008). Access to fluoridated water. Web.
Oral Health Alliance (OHA) (2010). Issues in oral health for low income and disadvantaged groups in NSW. Web.
Owen, A., Grootemaat, P. Samsa, P. Fildes, D. & Eagar K. (2009). A Review of the Literature and Practice on Models of Care for Refugee Health. University of Wollongong: Centre for Health Service Development.