The adage, “Give a man a fish and you feed him for a day. Teach him to fish and you feed him for a lifetime,” seems tailor-made for oral health care professionals who travel internationally with nongovernmental aid organizations (NGOs) to preach the gospel of good oral hygiene. According to a recent study published in the Journal of the American Dental Association, such missions can fall short in improving outcomes and extending long-term results. In fact, the study found that—due to a lack of integration into existing local systems and little collaboration with local professionals—current aid models have limited effect.1
To assess limitations and strengths of dental outreach programs, study authors reviewed 30 articles, published from 1995 through 2018, on such missions. They then formulated corrective strategies for four key areas.
Scope encompasses the type of care (local training or direct care), range (curative treatments or prevention), and coverage (period of delivery or number of recipients) of aid. Researchers found that when the number of people receiving aid is limited and when the focus is mostly on treatment rather than prevention, health promotion, or advocacy, long-term benefits were few. Proposed strategies to counteract such shortfalls include educating and training local healthcare professionals and workers, recruiting existing local professionals, and supporting local education in oral healthcare and disease prevention.
APPROPRIATENESS OF ACTIONS
Another finding concerns lack of understanding of host cultures and local protocols on the part of volunteers, who reportedly receive little to no sociocultural guidance by aid organizations. This leads to a misalignment of efforts with local resources, needs, and infrastructure. Researchers also noted that because local professionals and organizations may have difficulty meeting the standard of care provided by aid programs, aid efforts and delivery of care may end up being unsustainable, confusing, and inequitable. To foster better intercultural understanding, study authors suggest adequate volunteer training on global oral health care, cultural differences, ethical practices, and empowerment in global health and attitudes.
INTEGRATION AND COOPERATION
Researchers found that outreach programs are often lacking in integrating outreach strategies with local priorities. This can only hamper cooperation and lead to a lack of local work contracts, poor collaboration and continuity of care, and feelings of competition within local care systems. Patients may even begin to see local care as inferior, leading to ongoing dependence on outreach programs. To better integrate with local systems, researchers suggest an enhanced awareness of possible adverse effects of outreach programs on local systems. They stress the importance of cooperation with local authorities and other local entities, and support of education for local professionals.
ACCOUNTABILITY AND EVIDENCE
The study authors assert that outreach programs must deliver evidence-based interventions that meet the needs of the community. Their research suggested that due to limited protocols for quality control, volunteers are potentially operating beyond their scope of abilities and formal training.
The takeaway is, that rather than merely advocating the benefits of good oral healthcare, the best aid programs empower local communities to help themselves. In this way, outreach programs can better provide sustainable and effective aid.
- Arefi P, Cardoso E, Azarpazhooh. Reexamining dental outreach programs: A model for local empowerment and sustainable development. J Am Dent Assoc. 2020;151:340–348.