Mitigating inequities in access to oral health care in Kenya

Oral health is an important and integral part of general health. However, general health and oral health continue to be worlds apart given that oral health is not accorded the same importance in health care policy as is general health.

The Global Burden of Disease Study 2017 estimated that oral diseases affect 3.5 billion people worldwide.

According to the International Agency for Research on Cancer, cancers of the oral facial region are among the top 15 most common cancers worldwide, with nearly 180,000 deaths each year.

There is scanty data on the oral health disease burden in the country given that the District Health Information Systems (DHIS) lacks the basic minimum oral health indicators.

Kenya’s first National Oral Health Survey (KNOHS, 2014) indicates that 2 out of 10 children in the country have decayed teeth while 3 out of every 4 children have bleeding gums.

Among the adult Kenyans, 3 out of every 10 have decayed teeth and 9 out of every 10 have bleeding gums. Only 2 out of 10 children and 7 out of 10 adults in the country have ever had a dental checkup, against a recommendation of biannual checkups.

The massive construction of water boreholes in the country is not accompanied by user education on water purification.

Thus, with settlements around suburbs of major cities and towns in Kenya characterized by consumption of borehole water, the burden of fluorosis (discoloured teeth) is now at 4 out of every 10 children against 2 out of every 10 adults.

The country has 7,000 licensed dentists with a good number of them no longer practising. Among those practising, 80% are in the urban areas hence service gaps in rural areas.

Therefore, the current dentists: population ratio of one dentist to 68,520 Kenyans is far below the WHO recommended ratio of 1:7,000 and with only two institutions training dentists in the country, this ratio will not be met any time soon.

Community Oral Health Officers (COHOs) are supposed to provide preventive and promotive health services in the communities. However, only a fraction of the 364 licensed COHOs are working in the communities due to weak regulations of their practice.

Oral health care services are capital intensive but they remain underfinanced nationally, at the county government level and in the individual public health facilities. Therefore, the KNOHS reports that most dental equipment in public health facilities are not functional while the supply of dental consumables is erratic.

Treatment in the private sector is beyond reach for most Kenyans. Indeed, only one out of 10 Kenyans has a dental health insurance cover, but even then, most insurance companies in Kenya including the NHIF limit dental health coverage at Sh40,000 annually for a family with an average of 4 members.

Current oral health policy interventions are well aligned to the aforementioned gaps. They are addressing: leadership, governance, partnerships and resource mobilization; strengthening integrated preventive community oral health interventions; training and equitably distributing dental health care workers; improving infrastructure, equipment, commodities and technologies; promoting surveillance and information; and promoting the eco-friendly practice of dentistry.

In addition to the above, stakeholders in oral health need to prioritize: use of performance measures to improve oral health outcomes; advocacy for higher taxation of sugar-sweetened beverages and confectionaries; advocacy for changes in the dental insurance policies; integration of oral health into primary health care service delivery models including MCH clinics; presence in intersectoral policies/actions to give oral health visibility in general health; water fluoridation and defluoridation measures; school oral health programs; prevention of oral cancer as an integral part of national cancer control interventions;  strengthening oral health research; and advocating for optimal oral care health financing.

At an individual level, every Kenyan can keep their teeth for a lifetime by maintaining healthy mouths and strong teeth: drinking fluoridated water and brushing teeth with fluoridated toothpaste; brushing teeth thoroughly twice a day and flossing daily between the teeth to remove dental plaque; visiting a dentist at least twice a year; avoiding tobacco products; and limiting alcoholic drinks among other measures.  

The author is a dental surgeon & a post-doctoral research fellow in Global Health at the University of Washington