Global Health Through Oral Health
Oral Health of Haiti (OHOH): A Year Later
By Saskia Estupinan-Day, DDS; and Lois K. Cohen, PhD
On January 12, 2010, Haiti, the poorest country in the western hemisphere, suffered an earthquake measuring 7.3 on the Richter scale, resulting in the most damage incurred in more than two centuries, killing 220,000 people, injuring more than 300,000 people, and causing more than 1 million Haitians to be displaced from their homes. The enormous human impact, on top of an already fragile infrastructure and institutions, was further compounded in October 2010 with a cholera outbreak that spread to all ten departments across the country. The country’s response to the cholera outbreak was complicated again in November by Hurricane Tomas. By the close of 2010, 148,787 cases had been reported with 3,333 deaths.1
Haiti has been included as one of five priority countries of the Pan American Health Organization/World Health Organization (PAHO/WHO) to receive international assistance. This assistance has involved a considerable organizational presence in the country to strengthen national capacity. The intent is for national authorities within the Haitian Ministry of Health and Population (MSPP) to assume leadership and coordinate the actions of humanitarian donor organizations with the United Nations (UN) and their experts and advisors. Successfully ensuring that the resources garnered from the international community are used to rebuild and strengthen the national infrastructure and institutions depends very much on international donors being able to work as partners with coordinating bodies and with each other.
The UN, therefore, designated the Global Health Cluster as the interim coordinating body and appointed PAHO as the lead UN agency to work with the Haitian authorities. This entity continues to meet daily to coordinate resources and ensure appropriate distribution and delivery of basic health services and medications. Certainly, limited human resources continue to exist, and since the early days of the disaster when financial resources were being solicited and offered generously, financial resources still remain a major limiting factor in the disaster relief initiatives. Nonetheless, nearly 400 health partners have registered with the UN Health Cluster, including national and international nongovernmental organizations (NGOs).
To coordinate rsponse activities, PAHO/WHO established field offices in Jimani (Dominican Republic), Leogane, and Jacmel. Sub-clusters that focus on mobile clinics, hospitals, disability and rehabilitation, health information management, disease surveillance, reproductive health, mental health, and psychosocial support are also in operation.
Oral Health of Haiti (OHOH)
Alongside these efforts, the PAHO/WHO, through its Regional Office for Oral Health in Washington, DC, issued a call for action to develop institutional partnerships to address the oral health needs of the Haitian people. Working with the private and public sectors throughout the Americas, partners were identified and meetings were convened with professional associations, dental school associations, dental research agencies and associations, public health associations and organizations, and trade alliances. By the end of January 2010, a coalition of partners was formed, named Oral Health of Haiti (OHOH). The members of the coalition include representatives of the Haitian Dental Association, University of Haiti Dental School, Latin American Dental Fed eration (FOLA), FDI World Dental Federation, Pan American Health & Education Foundation, American Dental Education Association, American Dental Association, International and American Associations for Dental Research, US Public Health Service, National Institute of Dental & Craniofacial Research, Centers for Disease Control and Prevention, National Dental Association, Hispanic Dental Association, Alpha Omega Foundation, New York University College of Dentistry, Harvard School of Dental Medicine, Temple University Kornberg School of Dentistry, and the University of Maryland Dental School..
The OHOH coalition was designed to meet the immediate oral health needs of the people of Haiti and to work closely with the University of Haiti and the profession to address the long-term objective of rebuilding and strengthening an oral health infrastructure for delivering oral health services. A sustainable model is envisioned that includes the following essential ingredients: harnessing and empowering local talent; transferring knowledge and techniques by training local community members to engage in appropriate oral health practices and behaviors; developing monitoring and evaluation metrics and systems to assess the impact of interventions; developing methods to ensure quality of services with the Ministry of Health in Haiti; and targeting the most disadvantaged segments of the population.
The immediate challenge was to integrate oral health relief efforts within the UN Health Cluster, because that is where resources could be leveraged from the many humanitarian donor sources and where services and supplies might be more efficiently distributed, delivered, and monitored. This challenge was met by the good fortune of having Christina Lafontant, DDS, MPH (NYU), a Haitian national, as the oral health focal point located in Port-au-Prince. Dr. Lafontant was able to participate in the daily coordination meetings of the integrated disaster response team. Importantly, with the help of funds contributed by the Alpha Omega Foundation (AOF), PAHO was able to develop Post-Disaster Guidelines for Oral Health that outlined the steps and methodology involved in planning and implementing systematic remedial actions.2 One of the first steps also made possible by the AOF contribution was the Post-Disaster Needs Assessment (PDNA)2 tool, which provided the basis for securing donations from various private donors, particularly the American Dental Trade Alliance and Henry Schein, Inc, as well as universities such as New York University’s School of Dentistry and Harvard’s School of Dental Medicine, along with the international office of the American Dental Association.
Post-Disaster Needs Assessment (PDNA)
The oral healthcare system in Haiti before the earthquake had limited capacity to provide basic preventive oral care for the majority of the population. According to the 1999 national oral health survey, Haiti reported the dentist-population ratio at 0.12 dentists per 10,000, and Decayed/Missing/Filled Teeth (DMFT) at age 12 was 0.7.3 Extractions were recorded as the most common dental treatment at public health facilities. Most dentists in Haiti practice privately and are largely concentrated in the capital city, providing dental care to less than 1% of the population—mostly those who can afford payment for dental services. There is no dental insurance in Haiti.3 The needs-assessment instrument developed and refined by PAHO and consultants and included in Post-Disaster Guidelines for Oral Health provided an update of information on the oral healthcare needs and available resources in the areas affected by the earthquake and identified institutions/individuals positioned and able to participate in any planned oral healthcare initiatives. A valuable outcome of the PDNA was a list of materials, instruments, equipment, and other related goods that was generated and distributed to donors. This list greatly contributed to securing valuable donations that addressed the specific needs demanded by the situation on the ground.
Through the efforts of the PAHO team working with Haitian authorities, a systematic plan for distributing donations was prepared that details the allocation sites, appropriate repackaging, delivery of materials and supplies, and monitoring of the distribution. Currently, most of the donations have been distributed. The preparation of a final report is in progress that will provide an accounting to all the stakeholders. The dental donations have been delivered primarily to dental public health centers and institutions in the NGO sector that did provide free oral health services following the earthquake. There have been approximately 16 dental institutions benefiting from these donations donated for Haiti from January 2010 through January 2011.
Reconstruction and the Way Forward
The MSPP has the responsibility of strengthening the health services network. Beginning in June 2010, the Ministry, with PAHO support, implemented a plan known as Soins Infantiles Gratuits (SIG), to provide free healthcare for children younger than 5 years of age. The SIG provides free services through an agreement with 27 of the largest public and private hospitals in Haiti that also receive funds for training health workers, developing triage centers, purchasing medications, and organizing the delivery of pediatric services. SIG receives major support from various donors, including the United States Agency for International Development (USAID), the Canadian Agency for International Development, and the Japan International Cooperation Agency, as the organizers seek to mount a comprehensive and effective response to scale-up and strengthen integrated healthcare services delivery across the country. With support from PAHO, measures and actions are being developed to include oral healthcare in the SIG health package plan.4-6
Financial and other contributions continue to be solicited by the OHOH coalition. In accordance with the strategies generated from the continuing monitoring and updating of requirements in Haiti, such donations will be distributed as needed. For further information, please contact Dr. Saskia Estupinan-Day at email@example.com.
1. Pan American Health Organization. 2010: A Year of Health Challenges for Haiti. Washington, DC: Pan American Health Organization; January 11, 2011.
2. Estupinan-Day, S. et al. PAHO Post-Disaster Guidelines for Oral Health. Washington, DC: Pan American Health Organization; 2010.
3. Psoter WJ, Saint Jean HL, Morse DE, et al. Dental caries in twelve- and fifteen-year-olds: results from the basic oral health survey in Haiti. J Public Health Dent. 2005;65(4):209-214.
4. MSPP/OPS-OMS/ACDI. "Proyecto Cuidados obstétricos gratuitos en Haití." February 2009. . Accessed January 28, 2011.
5. OPS-OMS. "HSS Activities Report." Presentation made on September 14, 2010.
6. OPS-OMS. "Objectifs 2010 mensuels et annuels SOG II." August 2010. Accessed January 28, 2011.
About the Authors
Saskia Estupinan-Day, DDS
Regional Advisor for Oral Health, Pan American Health Organization/World Health Organization
Lois K. Cohen, PhD
Paul G. Rogers Ambassador for Global Health Research