|BRIEF RESEARCH ARTICLE
|Year : 2016 | Volume
| Issue : 3 | Page : 224-227
Evaluation of governmental oral health-care infrastructure in the state of Haryana
Ashish Vashist1, Swati Parhar2, Ramandeep Singh Gambhir3, Ramandeep Kaur Sohi4, Puneet Singh Talwar1
1 Senior Lecturer, Department of Public Health Dentistry, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
2 Senior Lecturer, Department of Oral and Maxillofacial Pathology, Swami Devi Dyal Dental College, Barwala, Haryana, India
3 Reader, Department of Public Health Dentistry, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India
4 Reader, Department of Public Health Dentistry, Sri Sukhmani Dental College and Hospital, Dera Bassi, Punjab, India
|Date of Web Publication||24-Aug-2016|
Dr. Ramandeep Singh Gambhir
Reader, Department of Public Health Dentistry, Rayat and Bahra Dental College and Hospital, Mohali - 140 601, Punjab
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Health system should be organized to meet the needs of entire population of the nation. Oral diseases are the most common of the chronic diseases, but there are few efficient dental care systems to cope with these problems. The present cross-sectional study was conducted among 135 dental care units of various primary health centers, community health centers, and general hospitals existing in the state to evaluate the government oral health-care infrastructure in Haryana. Data regarding provision of water and electricity supply, dental workforce and their qualification, number and type of instruments in the dental operatory unit, etc., were collected on a structured format. There is a shortfall in infrastructure and significant problem with the adequacy of working facilities. This can prove to be a big hurdle in the provision of adequate oral health care to people with greatest health-care needs. A great deal of effort is required to harmonize the oral health-care delivery system.
Keywords: Evaluation, facilities, government, Haryana, oral health
|How to cite this article:|
Vashist A, Parhar S, Gambhir RS, Sohi RK, Talwar PS. Evaluation of governmental oral health-care infrastructure in the state of Haryana. Indian J Public Health 2016;60:224-7
|How to cite this URL:|
Vashist A, Parhar S, Gambhir RS, Sohi RK, Talwar PS. Evaluation of governmental oral health-care infrastructure in the state of Haryana. Indian J Public Health [serial online] 2016 [cited 2019 Sep 20];60:224-7. Available from: http://www.ijph.in/text.asp?2016/60/3/224/189030
Oral problems are emerging as one of the main public health concerns in India. Oral problems are not only causing pain, agony, functional, and esthetic problems but also lead to loss of working man-hours. Hence, in the long run, they are bound to have a significant impact on our economy. 
In developing countries, there is a vast difference in oral health status between urban and rural populations, with enormous and widening disparities in access to quality care, predominantly in rural areas.  There are approximately 300 dental colleges in India, and annually 25,000 graduates pass out including 5000 specialists. Moreover, as per the latest statistics, there is concentration of only 10% of dentists where approximately 70% of the Indian population resides (rural areas) and 90% of concentration of dental professionals where only 30% of population resides (urban areas). 
Year-wise budget for health infrastructure in the state of Haryana was raised which resulted in the creation of new health institutions from 1999 to 2010 with addition of 16 hospitals, 32 community health centers (CHCs), 41 primary health centers (PHC) and 32 subcenters.  Now, Haryana's network of health infrastructure comprises 441 PHCs, 97 CHCs, and 52 general hospitals (GHs).
A huge infrastructure is well required to address all the aspects of health of a huge population of 2.53 crores of Haryana.  There has been many studies on rural population, elders population of old age homes, children of high schools, Group D workers, police personnel and prisoners, etc., in Haryana indicating high prevalence of dental disease. ,, However, there is no report of any evaluation done on oral health-care infrastructure in the State of Haryana rendered by the state government. Hence, this study has been taken up as a pioneer study to evaluate the infrastructure of oral health-care delivery system in the State of Haryana.
The study was conducted after obtaining ethical clearance from the concerned ethics committee and consent from the Directorate of Health Services (Dental), Haryana. The study was conducted over a period of 9 months (September 2010-June 2011).
The list of government health centers (in four divisions of Haryana) where dental health-care delivery is provided and number of dental personnel posted in the center was obtained from the office of The Directorate of Health Services, Haryana. All the centers were visited personally by the investigator (pursuing postgraduation in public health dentistry) according to a schedule and telephonically contacting the dentist posted at the center before the visit. A pilot survey was conducted in a Government Health Centre in Panchkula before starting the main survey to assess the feasibility and time requirement for the study. A total of 135 dental care units (DCUs) were surveyed out of 283 purely on the basis of feasibility. Dentists working in the health centers were interviewed using the oral health-care Pro forma. The Pro forma comprised various questions on the workforce distribution, demographic details of the dental professionals and dental infrastructure and equipment, etc.
Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 16.0 for Windows). Data were analyzed in terms of frequencies and percentages. Chi-square test was used to find out any association between different demographic/equipment parameters. The significance was set at <0.05.
A total of 283 DCUs were having a post of dentist (166 in urban and 116 in rural areas). However, only 135 DCUs were visited during the survey in which 52.6% (71) of DCUs visited were in rural areas, and 47.4% (64) were in urban areas [Table 1]. However, statistically insignificant results were obtained when the proportion of dentists at urban and rural areas at different divisions was compared with the state as a whole (P > 0.05).
|Table 1: Distribution of dental care units among total number of primary health centers, community health centers, and general hospitals in four divisions of Haryana |
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A total of 166 dentists were present during the scheduled visit. Out of the 166 dentists, 93.4% (155) were graduates (BDS) and 6.6% (11) were postgraduates (MDS). Almost 50% of dental surgeons belonged to the age group of 31-40 years. Dental technicians were present in 28.1% (38) of the places.
[Table 2] enlists the basic facilities and various dental equipment present at the health center. An alternative source of electricity (generator) existed in only a few of health centers. Moreover, only 54.5% (42) of PHCs which were visited were having exclusive toilet facility. Seventy-eight (57.8%) DCUs were having cemented floor, while 36.3% (49) places were having marble flooring. However, ultrasonic scaler was present in the majority of PHCs, CHCs, and GHs. There was no significant difference regarding provision of basic facilities at DCUs in four divisions of the state (P = 0.074).
|Table 2: Basic facilities and dental equipment in dental care units at various health centers |
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None of the DCUs surveyed were provided with eye protection gear. 96.3% (130) of the surveyed dental units were managing their waste through collaborations, whereas 3.7% (5) of the units were having independent arrangements for waste management. Outpatient department (OPD) register, stock register, and treatment register were maintained at all the 135 dental units situated in PHCs, CHCs, and GHs. Very few DCUs (14%, 19) were maintaining medico-legal register.
The results of the present study showed that there is critical shortage of DCUs and the dental workforce in the government sector catering to the needs of the general population. A similar finding was reported in another study conducted in Mangalore where four PHCs did not have any government-appointed dentists but were managed by dentists from the private colleges in and around the area.  Furthermore, the specialist workforce was found to be very low (6.6%) as compared to the general dentist (93.4%) which was in sharp contrast to the required numbers of specialist at any health center in Haryana.
One of the positive findings of the study was that almost all the DCUs had 24 h water supply. However, alternative source of electricity like generator was found only in 18.5% of the places, thus hampering the daily OPD work at the time of electricity failure which is in contrast to IPHS standards. In a CHC, the IPHS guidelines state that it should have the facility for electricity, all weather road communication, adequate water supply, telephone, etc. 
Only 54% of the PHCs visited were having exclusive toilet facility for doctors which are also contrary to IPHC guidelines. IPHS Guidelines recommend that public utilities should be separate for males and female; for the patient as well as for paramedical and medical staff. Disabled friendly, water closet with wash basins as specified under guidelines for disabled friendly environment should be provided. 
Majority of the DCUs were having cemented floor. The cemented flooring is considered to be a disadvantage in places like health centers because of its porous nature as compared to granite floors which leads to infections from different mediums like spilled blood from surgical extractions, etc. 
Intraoral periapical X-ray unit was also absent at majority of places which is mandatory for proper diagnosis and treatment. It was also found that eye protection gear was not available at any DCU, thus exposing the dentists to different types of eye infections  and showing inefficiency of the concerned authorities in maintaining infection control practices. The maintenance of Medico-Legal Register was not appropriate in all the PHCs as either the medico-legal opinion was given on plain sheets or such cases were referred to GHs.
The present study had some limitations as well. Only 47.7% of the DCUs were visited because of unavailability of the dentists at some units during the survey. Sample size selection in the study was purely based on feasibility. This was done as it was not practically possible to cover all health centers within limited time and resources (finances and workforce) that were available to complete the study. Moreover, the study was a part of postgraduate curriculum of a dental institution; therefore, more detailed survey needs to be conducted by the government which should include issues such as the programs, the funds allotted, and special programs conducted regarding oral health.
The findings of the study reveal that present situation is grim as far as government oral health-care infrastructure is concerned. Present DCUs are limited to diagnosis, prescriptions, and treatments; however, there should be an inclusion of preventive and rehabilitation programs to make it an efficient overall oral health-care delivery system. Moreover, it was also noted that there were no provisions of any training facility for para-dental workforce at any of the health centers. Health planners and policy makers considering the future delivery of oral health care for the public must include a reevaluation of their traditional image of the dental practice setting.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]