Inequality Assessment of Oral Health Workforce’s Distribution in Iran’s National Oral Health Promotion Program

Abstract

BACKGROUND Oral health is a major factor in public health. Children aged 6-12 years are the most important target group for oral and dental hygiene programs due to the high prevalence of dental caries, development of permanent teeth, and formation of lifestyles in this period and schools are the easiest and most cost-effective way to reach them. The latest national oral health promotion (NOHP) program in Iran was implemented in 2016-2017 to provide preventive and treatment services such as fluoride varnish treatment (FVT) to 7-14-year-old children. The purpose of this study was to evaluate the status of oral health promotion services and inequality assessment of total inequality in oral health workforce distribution in Iran based on distribution indices. METHODS The data about the number of oral health related workforce and also primary students (6-12 years) in NOHP program was obtained from the report of oral health office in Iranian Ministry of health. The geographic unit of analysis was 50 medical universities in all provinces of Iran. The human resource per target population ratio was used as oral health workers accessibility. The Gini coefficient and Robin Hood index was used to assess inequality. Number of dentists, dental therapists and oral hygienists in medical universities per 100,000 primary students was calculated. FVT coverage reported by each medical university was considered as NOHP program outcome. RESULTS In terms of human resources to student's ratio, the results showed that North Khorasan and Tehran centers respectively had the highest (8.94) and lowest (0.03) ratio of health workers, and Ardabil had the highest ratio (0.79) of oral hygienists. Kerman had the highest (0.73) and Iranshahr had the lowest (0.07) ratio of dentists. The Gini coefficient was 0.28 for dentists and 0.76 for oral hygienists. CONCLUSIONS Although the coverage of programs for oral and dental health promotion among students in Iran seems adequate, unfair distribution of human resources and the lack of serious consideration for those involved in preventive care can negatively affect the quality of services. Fair distribution and adoption of corrective policies for redistribution of oral and dental care providers must be addressed more seriously by health policymakers in Iran.