Application of policy analysis models in oral health issues: A Review
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Cited by 4 publications
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Background Calls are emerging for oral health system reform under the Universal Healthcare (UHC) domain, while internationally there is an absence of political priority for oral health. In the Republic of Ireland there is very limited coverage of oral healthcare for the whole population. ‘Smile agus Sláinte’ Ireland’s oral health policy published in 2019, represents the first change to national policy in over 25 years. Methods This research examined the key factors influencing oral health policy, development, and implementation in Ireland during the period 1994–2021. A case study approach was adopted with two strands of data collection: documentary analysis and semi-structured interviews with elite participants. Analysis was guided by Howlett’s five stream framework. Results Ireland shares the international experience of oral health having very low political priority. This has perpetuated unequal access to public dental services for children and special needs populations while austerity measures applied to adult schemes resulted in increased unmet need with no universal coverage for dental care. The only area where there is political interest in oral health is orthodontic care. This low political priority combined with a lack of actor power in national leadership positions in the Department of Health and Health Service Executive has contributed to successive non-implementation of oral health policy recommendations. This is most evident in the failure to publish the Draft National Oral Health Policy in 2009. The research finds a failure to adequately engage with key stakeholders, particularly the dental profession in the development of the 2019 policy. All these weaknesses have been exacerbated by the COVID-19 pandemic. Conclusions Ireland’s new oral health policy, ‘Smile agus Sláinte’, presents an opportunity for the provision of much needed public dental services. However, successful reform will require strong political will and collaboration with dental leadership to provide advocacy at national level. Global calls to incorporate oral health into the UHC agenda and an agreed political consensus for UHC in Ireland may provide an opportunity for change. Genuine engagement of all stakeholders to develop an implementation strategy is necessary to harness this potential window of opportunity for oral health system reform.
Background Calls are emerging for oral health system reform under the Universal Healthcare (UHC) domain, while internationally there is an absence of political priority for oral health. In the Republic of Ireland there is very limited coverage of oral healthcare for the whole population. ‘Smile agus Sláinte’ Ireland’s oral health policy published in 2019, represents the first change to national policy in over 25 years. Methods This research examined the key factors influencing oral health policy, development, and implementation in Ireland during the period 1994–2021. A case study approach was adopted with two strands of data collection: documentary analysis and semi-structured interviews with elite participants. Analysis was guided by Howlett’s five stream framework. Results Ireland shares the international experience of oral health having very low political priority. This has perpetuated unequal access to public dental services for children and special needs populations while austerity measures applied to adult schemes resulted in increased unmet need with no universal coverage for dental care. The only area where there is political interest in oral health is orthodontic care. This low political priority combined with a lack of actor power in national leadership positions in the Department of Health and Health Service Executive has contributed to successive non-implementation of oral health policy recommendations. This is most evident in the failure to publish the Draft National Oral Health Policy in 2009. The research finds a failure to adequately engage with key stakeholders, particularly the dental profession in the development of the 2019 policy. All these weaknesses have been exacerbated by the COVID-19 pandemic. Conclusions Ireland’s new oral health policy, ‘Smile agus Sláinte’, presents an opportunity for the provision of much needed public dental services. However, successful reform will require strong political will and collaboration with dental leadership to provide advocacy at national level. Global calls to incorporate oral health into the UHC agenda and an agreed political consensus for UHC in Ireland may provide an opportunity for change. Genuine engagement of all stakeholders to develop an implementation strategy is necessary to harness this potential window of opportunity for oral health system reform.
Assessing Malawi’s recent development of a National Oral Health Policy – learning for the future
Background Policymakers in many low- and middle-income countries do not prioritize oral health and are inadequately informed about the burden of oral and maxillofacial problems, their connection with systemic health and the possible threat to human life. In Africa, the absence of oral health policies is a key problem contributing to increased oral disease burden, health workforce shortage, and inadequate oral health service provision. Context-relevant policies and research to determine needs and monitor progress are key components in eradicating oral health inequalities. This paper focuses on the work of Malawi to follow the direction of travel outlined at the 2021 World Health Assembly by developing its first National Oral Health Strategy and Implementation Plan. Methods A case study approach examined the processes followed by Malawi to develop its National Oral Health Policy, launched in April 2022. The aim was to understand how oral health policy is being developed within the context of an African country. Specifically, the objectives were to identify how oral health policy was being developed in Malawi and the contributors to the development of that policy. Qualitative data were collected from semi-structured interviews (n=8) of purposively selected key informants from the Malawi National Oral Health Policy Taskforce team involved in the policy creation. Data were analyzed in the thematic areas within the Health Policy Triangle of actors, context, processes, and content. Results The policy development process was guided by Malawi’s Ministry of Health and involved a diverse group of actors, both local and international. The funding of the policy development process by the Scottish Government and Borrow Foundation provided critical support. Five groups of stakeholders have conducted the relevant background investigations and written the Oral Health Policy: international development partners, academics, policy experts, dental practitioners, and civil society organizations. The partnership skill-sharing and well-managed dynamics of the group, together with the reliable funding base, all contributed to a successful outcome. Conclusions A multisectoral approach was used. Malawi is uniquely placed in its oral health policy development, having a solid stakeholder base (local and international) and resources to support the policy development and, partly, its implementation.
Introduction: The purpose of this review is to establish how the theory of complexity is understood and instituted in dentistry. Methods: The stomatognathic system can be understood as a dynamic, complex, and adaptive system. Each pathological or physiological condition of this system involves physical, chemical, and biological processes in constant, open, and changing interactions with social, emotional, nutritional, political, and economic processes. Against this background, specifically, the following research questions were posed: How do researchers use complexity science in dentistry? How is complexity science described in dentistry articles?. Results: A brief literature search was implemented, which identified 11 PubMed articles as well as two from the Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) database and one from the Cochrane Library for a full text review. Studies on complexity in the dental sciences are mostly presented in the form of critical opinion articles, which corresponded to 50% of the reviewed articles. In dentistry, complexity is understood as less of a theory and more as a line of thinking regarding procedures that can become complex at any given time. Conclusion: This article shows that there are great difficulties in integrating complexity and understanding it in dentistry. There are many aspects from complexity science that still need to be understood in oral health.
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