ECHO India. Moving Knowledge, Not people

Author: Dr Karan Rai, General Manager, Monitoring, Evaluation & Research, ECHO India and Dr Shikha Yadav, Senior Executive, Monitoring Evaluation and Research, ECHO India

Oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex [1]. It impacts a person's quality of life and is crucial to general health and well-being [2,3]. The theme for World Oral Health Day (2024-2026), "A Happy Mouth is…A Happy Body," also emphasizes the relationship between oral health and both physical and emotional well-being, reflecting the significant impact oral health has on overall health and well-being [4]. Poor oral health can have significant implications on individuals’ health, it can lead to various conditions including tooth loss, dental caries, periodontal disease, oral cancer, noma, oro dental trauma, and birth defects such as cleft lip and palate [3]. It is also interrelated with other chronic conditions, such as diabetes and heart disease [5]. Neglecting oral health can exacerbate existing medical conditions, lead to the development of new diseases, and create other health complications.

According to estimates by the World Health Organization (WHO), roughly half of the global population (46.83%) as well as India's population (46.61%) are affected by some form of oral disease. Dental caries, severe periodontal disease, edentulism, and oral cancer are among the leading oral health diseases. These are most prevalent in India, followed by China, the United States of America, Indonesia, Nigeria, Brazil, the Russian Federation, Pakistan, and Spain [6]. Oral cancer incidence in India is more than one-fourth of global with approx. 1,43,759 new cases and 79, 979 deaths reported in 2020 [7]. The concern of oral cancer is significantly higher in India as about 70% of the cases are reported in the advanced stages (American Joint Committee on Cancer, Stage III-IV) [8]. Oral diseases not only impose a significant health burden but also impacts the economy. The economic burden of oral disorders worldwide amounts to approximately US$ 387 billion in direct costs and an additional US$ 323 billion in indirect costs [9].

Figure 1: Prevalence of oral diseases Figure 1: Prevalence of oral diseases[6]

Figure 2: Prevalence of oral diseases in India (2019)

Figure 2: Prevalence of oral diseases in India (2019)[6]

To effectively address the population's health needs, it is essential to have an adequate health workforce. Presently, there are 313 dental colleges nationwide (2020) with 49 of them being run by the government. Together, these institutions offer 30,570 student positions annually. [10]. The recommendation for the dentist-to-population ratio in developing countries is 1:7,500 (1.3: 10,000), according to WHO. In India, the ratio has increased over the years, with 1.59 dentists per 10,000 people in 2020 [11]. Even though it is higher than the target, there is a disparity in the dentist-patient ratio in urban and rural population [12]. Compounding this issue is the insufficiently trained healthcare workers appointed at Sub-Centers (SC) or Primary Health Centers (PHC) to effectively diagnose oral diseases [13–15]. This deficiency further widens the gap in access to oral health services between urban and rural communities, leaving those in remote areas particularly underserved. To address the oral health situation in the country, Government of India initiated a National Oral Health Programme in 2014 to provide integrated, comprehensive oral health care in the existing health care facilities. However, there is need for periodic trainings for dentists as well as healthcare workers at SCs and PHCs to improve oral health literacy and diagnostic capabilities.

The engagement of ECHO India in capacity building of the health workforce in oral health and screening of oral cancers is an essential step in bridging this gap. ECHO India's innovative approach leverages technology to connect healthcare providers in underserved areas with experts from medical centers, facilitating knowledge sharing and capacity building. Through ECHO India's programs, primary care providers receive ongoing training, mentorship, and case-based learning sessions from experts. ECHO India has partnered with prestigious institutions such as AIIMS Bilaspur, Cancer Institute WIA Chennai, CHIP Foundation, Dental Institute RIMS Ranchi, Homi Bhabha Cancer Hospital and Research Centre Vishakhapatnam, Malabar Cancer Centre, Ministry of Health and Family Welfare, NHM Mizoram, NHM Nagaland, NICPR Noida, NHM Karnataka, Shri Guru Ram Rai University Dehradun, SIHFW Vadodara, SIPHER, TMC Kolkata, and NIMHANS to conduct numerous programs in this field. Collaborative efforts with esteemed institutions have enabled ECHO India to conduct numerous programs focused on oral health, oral cancer screening, and tobacco cessation, involving various healthcare professionals such as dental students, practicing dentists, medical officers, nurses, school teachers, counselors, and social workers.

ECHO India is trying to make a tangible difference in improving the quality of life of individuals and communities by empowering healthcare providers with the knowledge and resources they need and engaging communities in preventive efforts.

References:

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