Background & justification
Context of Oral Health
Oral diseases affect half of the world’s population and were confirmed to be the most common and preventable Noncommunicable diseases (NCDs) worldwide by the Global Burden of Disease 2016 study. Nearly 3 billion people have untreated dental caries, making it the most prevalent disease globally. Periodontal (gum) disease is also the 11th most prevalent disease. Oral cancers are relatively common worldwide. Noma can often be fatal if left untreated, yet affects hundreds of thousands of children aged 2-6 despite being easily preventable and treatable. Oral diseases have severe impacts including pain, suffering, impairment of function and effects on quality of life. They also produce significant economic burden, accounting for 5% of total health expenditure and 20% of out-of-pocket health expenditure in high-income countries. Simple protective measures combined with reduced exposure to risk factors can significantly reduce the burden of oral disease. This burden, as for all diseases, falls primarily upon disadvantaged and socially marginalised populations.
Protective measures against oral disease include good oral hygiene and appropriate exposure to fluoride. Oral diseases share common risk factors with a wide range of other NCDs, including the four main groups responsible for 79% of all NCD deaths : cardiovascular diseases (such as heart attacks and strokes); cancer; chronic respiratory diseases and diabetes. These risk factors include unhealthy diet, harmful alcohol consumption and tobacco use. Thus, strategies to improve oral health through disease prevention can integrate with and strengthen those targeting other types of NCDs.
The WHO Oral Health Programme workplan 2018-20 consists of five main pillars and one of them is directly targeting digital technology:
- Production of the Global Oral Health Report
- Phase-down of the use of dental amalgam according to Minamata Convention on Mercury
- Support of population-based strategies for oral disease prevention
- Use of digital technology to improve Oral Health
- Strengthening global information systems for Oral Health monitoring
In 2017, there were more mobile phone subscriptions globally than human beings. While the penetration of this technology remains unevenly distributed, it is globally substantial, as 98.7% of the population of developing countries now have mobile phone subscriptions. This provides an excellent opportunity to use mobile technology for the purpose of improving public health – an approach known as mHealth. Mobile technology may facilitate improvements in the quality of care; reduction of costs and unnecessary referrals; improved communication between providers and patients; enhanced education opportunities; integration across services and disciplines; and provision of a platform for continuous professional education.
The Be He@lthy, Be Mobile (BHBM) initiative is a collaboration between two UN bodies: the World Health Organisation and the International Telecommunications Union (ITU), seeking to harness the potential of mHealth. BHBM provides technical expertise to support governments who wish to implement mHealth interventions as part of their national health systems. It suggests general implementation mechanisms based on existing evidence and guidelines, and helps countries adapt these to their own circumstances and available infrastructure. These have primarily been based upon Short Message Service (SMS) technology, which is available on even the most basic mobile phones. mHealth programmes have been established to target a number of diseases and risk factors, for example mTobaccoCessation, mDiabetes and mAgeing.
While the application of mHealth has developed exponentially over recent years, Oral Health remains a neglected area in the implementation of such technology. There has been significant interest from partners and member states regarding a mHealth program focusing on oral health (m-OralHealth). Studies have shown that text message interventions can improve public health behaviours, including within the context of oral health. However, the evidence base for the use of mHealth for Oral Health is limited – relatively few studies have been conducted and these were mainly in high income countries.
The m-OralHealth strategy comprises the 4 following key components. These are designed to exist as flexible modules which can be implemented individually or collectively according to a country’s specific needs. The strategy can also be implemented either as a standalone intervention to improve oral health, or integrated into existing initiatives targeting other NCDs.
1. m-OralHealth Literacy
This builds on the momentum of the SDGs’ emphasis on health promotion, and the idea of positioning health literacy as a strong pillar of health promotion for SDGs. The first goal of m-OralHealth Literacy is to enable populations to access, understand and use information to help them maintain good oral health. The second aims to advocate the importance of oral health to influential groups such as policy makers and the media, to increase the implementation of effective policies.
2. m-OralHealth Training
This aims to increase the oral health knowledge of Frontline Health Workers (FHW), to improve the management of oral diseases. It also seeks to provide information to Oral Health Professionals (OHP), to expand their awareness of national and international oral health agendas.
3. m-OralHealth early Detection
This aims to use technological innovation to improve early detection of oral diseases, especially noma and oral cancers, for example using telemedicine to provide diagnosis to members of remote communities.
4. m-OralHealth Surveillance
It is necessary to strengthen existing oral health surveillance systems to ensure robust monitoring of epidemiological trends and to evaluate progress to reduce the burden of oral diseases.
The country implementation of an m-OralHealth programme supported by the BHBM initiative must be preceded by a multi-stage process to develop an intervention-specific handbook. The handbook is designed to provide a central source of general guidance which can be adapted to the specific needs of a country. Figure 1 illustrates the stages of this process for m-OralHealth.
A handbook consolidates all of the relevant background information necessary to implement an m-OralHealth programme, and presents it in the form of ready-to-use options for a country. This typically includes guidelines or resources that specify programme design; operational blueprints; SMS content libraries; case studies; literature reviews; lessons learnt and other technical tools. Each handbook is based on contributions form informal expert groups with expertise in the health area. All content in a handbook is based on WHO guidelines; existing clinical trial evidence and expert recommendations of best practice to maximise effectiveness of content and delivery. With the support of the BHBM initiative, this is then adapted to meet the specific requirements of a country’s target population and national oral health system.
m-OralHealth Global Workshop
The workshop is being organised jointly by the WHO-ITU “Be He@lthy, Be Mobile” initiative and the University of Montpellier, France. It will take place from 10th-12th October 2018 at the University of Montpellier, France. The workshop will bring together a group of around 30 participants from government, academia and civil society. It will offer a unique opportunity for participants from these different sectors to work together and to actively contribute to the development of the m-OralHealth Programme.
Objectives and outcomes of the workshop
The Global Workshop is one of the key stages of the handbook production process. It will convene experts, governments and implementers to incorporate their experience into the design of appropriate content and delivery mechanisms for an m-OralHealth programme.
Ultimately, the global workshop will serve as the foundation for the drafting of the global handbook on mobile solutions for Oral Health and country implementation of m-OralHealth programmes.
The method of work will include interactive group work, presentations and discussions. Each working group will work on specific questions related to personas.