Number of dentists to be trained
The majority of reports on human resources in South Africa have highlighted the inequitable distribution between urban and rural on the one side and the private and public sectors on the other. Recommendations were put forward by the Commission of Enquiry into the Dental Services and the Training of Non-White Dentists as a result of which three new dental schools were opened and existing facilities expanded. The Commission predicted that 1,708 dentists would be registered in South Africa by 1980 (Republic of South Africa, 1967). Another study indicated that this figure had already been reached in 1973 and that South Africa would be faced with an overproduction of dentists by 1983 (Germishuys, 1979).
Reports and opinions on training of dentists in South Africa continued during the 1980s. In 1984 it was suggested that no new dental schools be established, but that existing faculties be expanded and opened to all ethnic groups (Dreyer, Lemmer and Dreyer, 1984). An ad hoc committee of the DASA warned that an overproduction of white dentists might become a reality and that intake of white students had to be reduced (Dreyer et al., 1986).
During the 1990s there was a shift in emphasis on dentists as the main dental service providers to an oral health care workforce consisting of health educators, assistants, oral hygienists, dental therapists, dentists, specialists and technicians. A 50% decrease in the number of dentists trained was suggested with a corresponding increase of 250 auxiliaries per annum over the next 5 to 10 years (Dreyer et al., 1992).
Dentist to population ratios
A comparison of the geographical spread of dentists in South Africa between 1972 and 1982 confirmed a decrease in dentist to population ratio from 1:12,133 in 1972 to 1:9,868 in 1992 (Smith and Cleaton-Jones, 1985). A follow-up study indicated that this had further decreased to 1:7,991 in 1992 (Van Wyk et al., 1994). Both these studies highlighted the maldistribution of dentists in South Africa.
The number of dentists increased by 135.6% from 1,599 in 1972 to 3,767 in 1992. When dental therapists were included (112 in 1992), the operator to population ratio decreased further to 1:7,991. This represented 1.25 dentists/operators per 10,000 of the population (Van Wyk et al., 1994).
Any health system attempts to achieve the objective of equitable distribution of resources. Table 9 summarises the dental operators to population ratios for magisterial districts with the lowest (all urban) and the highest (all rural) ratios. It clearly illustrates the extent of maldistribution of dental operators in South Africa (Van Wyk et al., 1994). It was estimated that 78% of all oral health personnel are employed in the private sector with the remaining 13% in the public sector required to serve 65 to 80% of the total population (Rossouw, 1995).
Based on information from the 1988/89 NOHS (Department of Health, 1994), 57% of dentists practice within the five major metropolitan areas of South Africa with male dentists dominating the profession (92.8%). Of the dentists responding to the questionnaire, 68.5% qualified after 1970 and 38% after 1980. Only 12.8% of dentists employed an oral hygienist on a full-time and 11% on a part-time basis. There was a perception amongst dentists that there was no need to employ oral hygienists (62%), with 11% of dentists indicating they did not do so because of unavailability. Conservative dentistry was the most frequently practiced service (91.6%) followed by scaling and polishing (74.2%). Topical fluoride application and placement of fissure sealants were ranked low (Rudolph, Brand and Gilbert, 1995).
A Health Systems Trust report estimated the distribution of public sector dentists per 100,000 of the public sector dependent population decreased from 1.7 in 2000 to 1.58 in 2003. Some provinces had 4 times as many dentists in the public sector compared to others. The 2003 ratios for the Eastern Cape and KwaZulu-Natal were 0.7 and 0.99 respectively, compared to 2.79 and 3.35 for Gauteng and the Western Cape. Despite the introduction of CCS for dentists in 2000, the number of dentists in the public sector had steadily declined. Based on a 2% population growth per annum, a 25% net loss of graduates to other countries and using WHO simulation models, this report estimated that the dentist to population ratio would decrease from 1:9,400 in 1999 to 1,7800 by 2029 (Padarath, Ntuli and Berthiaume, 2004).
CHAPTER 1: PROBLEM STATEMENT, AIMS, RESEARCH DESIGN AND STRUCTURE
1.1 Problem statement
1.2 Aims and objectives of the study
1.3 Research design
1.4 Structure of thesis
CHAPTER 2: LITERATURE REVIEW
2.1 Overview of water fluoridation
2.2 Human resources planning
2.3 South African policy documents on health and oral health service delivery
CHAPTER 3: COST EVALUATION OF THE IMPLEMENTATION OF WATER FLUORIDATION IN SOUTH AFRICA
3.2 A model to calculate per capita cost, cost-effectiveness and cost-benefit of the implementation of water fluoridation in South Africa
CHAPTER 4: COST EVALUATION OF DELIVERING THE MINIMUM PACKAGE OF ORAL CARE TO SOUTH AFRICAN CHILDREN
4.2 A model to calculate the per capita cost of delivering the minimum package of oral care
CHAPTER 5: ORAL HEALTH HUMAN RESOURCES NEEDS FOR SOUTH AFRICAN CHILDREN
5.2 World Health Organization/Fédération Dentaire Internationale human resources planning model
5.3 A “Service Targets Method” model to calculate human resources
CHAPTER 6: CONCLUSIONS AND RECOMMENDATIONS