Oral Health Policy in Latin America: Challenges for Better Implementation (original) (raw)
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Oral health policies and decision-making process in Brazil, Colombia and Chile
Brazilian Oral Research
Public health policies are crucial for the well-being of the general population; however, the health systems of developed countries still do not include oral health in its system. Thus, it is necessary to understand the process of decision-making in oral health policies to create opportunities for countries to achieve an overall positive health outcome, including oral health. This study aimed to identify the factors influencing the inclusion of oral health on the political agenda in Brazil, Colombia, and Chile. The study sample involved decision-makers at political, technical, and academic levels. The extracted data were analyzed using the software Maxqda ® and Kingdon´s theoretical model; defining interactive variables that produce a "window of opportunity" to define the agenda and the insertion of theme in formulating public policies. The decision-making process regarding oral health is influenced by many factors like the need to improve the overall oral health of the population, identified through national epidemiological studies, and the importance of individuals in positions involving political decision-making, who advocate for oral health. Strategies were developed in partnership with the academy that focused on the health rights of the population provided by law; territorial and national programs were also developed. The inclusion and creation of oral health policies depend on actors who advocate for thematic and scientific evidence to support decision-making. A close relationship between academia and stakeholders and knowledge translation is important for the development of public policies that can be effective for health systems.
Oral Health in Brazil - Part I: public oral health policies
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This paper reviews the historical development of public health policies in Brazil and the insertion of oral health in this context. Since 1988, Brazil established a Unified National Health System ("Sistema Único de Saúde" -SUS), which was conceived to assure access to health actions and services, including oral health. However, a history of lack of access to health services and the health problems faced by the Brazilian population make the process of building and consolidating the SUS extremely challenging. Since 2004, the Oral Health National Policy has proposed a reorientation of the health care model, supported by an adaptation of the working system of Oral Health teams so that they include actions of health promotion, protection and recovery. Human resources should be prepared to act in this system. The qualifying process must take in consideration knowledge evolution, changes in the work process and changes in demographical and epidemiological aspects, according to a perspective of maintaining a balance between technique and social relevance.
Brazilian Oral Health Policy: factors associated with comprehensiveness in health care
Revista de saúde pública, 2010
To analyze the factors associated with comprehensiveness in oral health care in Centers of Dental Specialists, according to the guiding principles of the Brazilian Oral Health Policy. An exploratory cross-sectional study, based on an interview with 611 users of four specialized dental care centers, was performed in the state of Bahia, Northeastern Brazil, in 2008. The dependent variable was described as "comprehensiveness in oral health care", corresponding to having a primary dental care performed before specialized treatment or concomitantly with it. The main covariables referred to the level of coverage of the family health strategy in the city, users' sociodemographic characteristics, and organizational and geographic accessibility to the service, in addition to the type of specialized care required. Residents of the cities where the Family Healthcare Program had a coverage >50% were more likely to conclude their dental treatment (PR=2.03, 95% CI: 1.33;3.09), co...
Policymaking Challenges in the Oral Health in a Low-income Developing Country:A Qualitative Approach
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Background: As the strategies proposed for oral health improvement in developed countries do not adapt for the setting of the developing ones, this study aimed to identify the challenges and barriers of oral health policymaking in Iran as a low-income developing country. Methods: This is a qualitative study conducted in 2019 in Iran as a middle-eastern developing country. The study population consisted of all the experts who had enough experience in the oral health and were willing to participate in the study. Snowball sampling was used to select 12 participants for semi-structured interviews and saturation was achieved after 16 interviews with them. Guba and Lincoln criteria including credibility, transferability, confirmability and dependability were used to determine the reliability and transparency, and finally five-step framework analysis method was used to analyze the data. Results: The analysis of the results of the interviews resulted in identification of 7 main themes and 2...
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Ciência & Saúde Coletiva, 2015
In 2004, the National Oral Health Policy (PNSB) - Smiling Brazil was launched. Its guidelines seek to qualify Primary Health Care, ensure comprehensive actions, work on the basis of health surveillance, plan actions in accordance with the epidemiology and information available on the territory, financing and scheduling the research agenda so that the work can be based on scientific evidence. The purpose of this case study was to investigate the perspectives of health care professionals and managers on oral health care after launching the PNSB. For the gathering of information, an oral interview was conducted with health care professionals and managers and direct observation of oral health services. The interpretation of meaning method was used for analysis of the interviews. Approximately 10 years after launching the PNSB, even though the care and the oral health actions have been amplified and qualified, the cities still find it difficult to implement their basic premises.
[The Oral Health Surveillance Policy in Brazil: progresses and challenges]
Revista de saude publica
This comprehensive critical review, carried out in a descriptive-discursive style, presents the oral health surveillance policy currently in force in Brazil. Based on an appraisal of the national and international literature on the subject of health surveillance, it examines the formulation of a scientific and political agenda for oral health surveillance, which is anchored in the institutions of the Brazilian Public Health System. The accomplishment of this agenda is exemplified by the presentation of the most recent Brazilian Oral Health survey (SBBrasil 2010). A conclusive summary is presented on the search for a theoretical and methodological convergence of both the identification of the obstacles and weaknesses still detectable in this policy, and the recognition of its virtues already confirmed by important advances and achievements.
Oral health in Brazil - Part II: Dental Specialty Centers (CEOs)
Brazilian Oral Research, 2008
The concepts of health promotion, self-care and community participation emerged during the 1970s and, since then, their application has grown rapidly in the developed world, showing evidence of effectiveness. In spite of this, a major part of the population in the developing countries still has no access to specialized dental care such as endodontic treatment, dental care for patients with special needs, minor oral surgery, periodontal treatment and oral diagnosis. This review focuses on a program of the Brazilian Federal Government named CEOs (Dental Specialty Centers), which is an attempt to solve the dental care deficit of a population that is suffering from oral diseases and whose oral health care needs have not been addressed by the regular programs offered by the SUS (Unified National Health System). Literature published from 2000 to the present day, using electronic searches by Medline, Scielo, Google and hand-searching was considered. The descriptors used were Brazil, Oral health, Health policy, Health programs, and Dental Specialty Centers. There are currently 640 CEOs in Brazil, distributed in 545 municipal districts, carrying out dental procedures with major complexity. Based on this data, it was possible to conclude that public actions on oral health must involve both preventive and curative procedures aiming to minimize the oral health distortions still prevailing in developing countries like Brazil.
Describing the Primary Care Actions of Oral Health Teams in Brazil
International Journal of Environmental Research and Public Health, 2015
Objective: To describe the primary care actions performed by oral health teams (OHTs) that participated in a large national survey led by the Ministry of Health in 2012. Methods: A total of 12,403 dentists from OHTs completed a set of survey questions (response rate = 85.01%) on the organization of care, basic dental procedures and oral health surveillance actions of OHTs. Descriptive and hierarchical cluster analyses were developed. Results: The majority of OHTs (85.2%) reported that they performed "patient welcoming". The delivery of services was based on a patient's identified disease risk (83.1%), and continuity of care was ensured by 85.9% of OHTs. Individual preventive, restorative and surgical procedures were performed by the majority of the teams; however, screening for oral cancer and construction of dental prostheses/dentures occurred less frequently. Cluster 1 was composed of OHTs with the lowest proportion of oral healthcare actions related to oral cancer and dental prostheses/dentures, and the Southeastern and Southern regions had higher proportions of OHTs from cluster 2. Conclusions: OHTs adhere to some OPEN ACCESS Int. J. Environ. Res. Public Health 2015, 12 668 of the principles of primary care organizations; however, the teams perform fewer actions related to oral cancer treatment and rehabilitation with complete dentures. The geographical distribution of the clusters was unequal in Brazil.
Acta Scientiarum Health Science
The aim was to identify the perception of Oral Health Planning (OHP) of basic care (BC) dental surgeons (DSs) in João Pessoa, Paraíba State, Brazil. Seventeen BC DSs from João Pessoa were interviewed. A qualitative analysis was performed using the Discourse of the Collective Subject (DCS) methodology. DCS obtained: Impact - “My work is effective when the user’s need remains at the BC”. Social Control - “The population participates in the organization of promotional activities, but I think it doesn’t have enough maturity to opine on OHP”. OHP Basis and Organization - “The OHP has a diverse organization and is based on user needs”. It can be concluded that the knowledge of the DSs on OHP is varied. There is limited understanding about problem-solving. Social control is considered incipient and weak. It is understood that the organization of the local OHP assumes a diverse character and should be based on user demands.
Oral health in the context of primary care in Brazil
International Dental Journal, 2013
This article presents an integrative literature review that analyses the advances and challenges in oral health care of the Brazilian primary health care system, based on a political agenda that envisages re-organising the unified health system (Sistema Unico de Sa ude-SUS). It is presumed that the actions suggested by the Alma-Ata Conference of 1978 are still up-to-date and relevant when adapted to the situation in Brazil. Several studies and policies are reviewed, including works demonstrating the importance of primary care as an organising platform in an integrated health-care network, Brazil's strategy for reorganising the primary care network known as the Family Health Strategy, and the National Oral Health Policy. This review discusses results obtained over the last twenty years, with special attention paid to changes in oral health-care practices, as well as the funding of action programmes and assistance cover. The conclusion is that oral healthcare in the Brazilian primary health care system has advanced over the past decades; however, serious obstacles have been experienced, especially with regard to the guarantee of universal access to services and funding. The continuous efforts of public managers and society should focus on the goal of achieving universal coverage for all Brazilians.