Dentistry is a healthcare specialism that is often forgotten about or given less importance than other areas. However as diets change to include more sugary snacks it has fewer fruits and vegetables due mainly to globalisation and a wider variety of goods, there is an increasing need for children and young people to have regular dental check-ups and sometimes even actual dental treatment.
Unfortunately Ghana, like most developing countries, is not blessed with a numerous supply of dentists. World Health Organisation data shows that in 2008 Ghana had only 148 dentists, which is equivalent to 0.06 dentists per 10,000 people. This compares well to the dentist ratios of Burkina Faso, Togo and Benin but unfavourably to Nigeria, who have 0.25 dentists per 10,000 people, However, in the UK there are 5.17 dentists per 10,000 people (Information collected from the WHO).
Obviously, there is by no means enough dentists to meet the needs of the Ghana’s population, especially in the rural areas. Research has found that about 70% of dentists are based in Accra and Kumasi, also where the only two dental schools are located.
The importance of oral health should not be underestimated, as it can seriously impact on the rest of the body. When bacteria build up on the teeth, plaque is formed. If plaque is not removed it will harden into calculus, which can cause the gums to become inflamed, leading to periodontal disease.
Chronic periodontal disease will often increase the risk of other health conditions, including heart disease, respiratory disorders and diabetic complications. It can even affect the health of babies born to a mother with periodontal disease.
There is no doubt that a good dental service is vital for a good health service, however the huge shortage of dental professionals is impacting heavily on Ghanaians’ oral health. There are certainly a number of reasons for the lack of dentists in Ghana, many related to the country’s financial situation.
The major problem is that many of Ghana’s trained dentists are leaving to work abroad. According to the OECD, in 2007 over 122 Ghanaian-trained dentists were known to be working overseas. Ghanaian dentists may earn on average USD 8,000 a year, however in countries such as the UK, dentists can have a starting salary of the equivalent of USD 50,000. Dentists are required to give two years’ service in Ghana before they get their license but once they have completed this many of them choose to work abroad.
A second problem is that the working conditions overseas are much better than in many of Ghana’s dental surgeries. Developed countries will often have the most modern equipment available whereas Ghanaian surgeries can even be lacking in vital apparatus. State-of-the-art instruments increase the ease of practice for the dentist and reduce pressure on them. Indeed in some rural areas there may not even be a hospital or surgery for miles where the dentist can practice.
Yet another problem is that there is not enough training in Ghana to meet the demand for new dentists. Many developed countries have the capability to train more than 500 dentists every year, compared to Ghana who have a total of only 148 dentists in the entire country. Furthermore, according to a 2006 report by the Ghana Medical Association, only an average of 7 dentists were being trained each year. Fortunately, in recent years this number has risen but is still only about 20 dentists per dental school with just two dental schools. There are limited opportunities for postgraduate training in Ghana, however, in developed nations there are copious amounts of postgraduate courses and a number of different specialities. This current situation cannot be sustained as the population is set to increase in the following years and thus the dentist ratio will decrease even more.
To increase the number of dentists practicing in Ghana the government must first improve education. There needs to be a greater output of qualified dentists in Ghana. Even if the emigration problems were solved, there would still be far too few dentists. More scholarships need to be given to students to encourage them to study dentistry but the high schools also need to raise awareness for the profession, as many high school students aspire to be doctors rather than dentists.
The availability of postgraduate courses must be improved. Dentists in Ghana have long complained about the difficulty of getting onto such programmes and due to the tough admission requirements. These courses could also impose an additional compulsory service in Ghana to keep the dentists in the country for longer.
Ghanaian dentists could be required to spend a number of months teaching children about the need for dental hygiene and the risks of bad oral health. In the long-term this could reduce the requirement for as many dentists because less treatment would be needed.
The other component of the solution involves direct financial investment. Although the budget is tight, there needs to be more spending on the hospitals and dental surgeries in Ghana, especially in the rural areas. Improving these facilities would provide dentists a better place to work, encouraging them to stay and also benefiting patients.
Money also needs to be invested in the dentists themselves. They are the people improving Ghana’s mouths and general health, so should be paid deservedly well for doing so. Any increase in salary above the rate of inflation will encourage dentists to at least stay longer in Ghana, if not for their entire career. As more dentists stay in the country the quality of the profession will further improve, which will help to lower the long-term costs.
Improving the Ghana Dental Service will improve Ghanaian society as a whole. Toothache can be very painful and can result in reduced performance at work and school, stifling Ghana’s potential to develop. If added complications arise from poor dental health then this will only exacerbate these issues further.
It is vital that more pressure is put on the government to increase the spending in the health sector, especially for the dental service. Education needs to be primarily improved but also Ghana’s aged healthcare facilities. The rewards for increased spending will not be seen immediately but when they emerge they will be great and many aspects of Ghanaian society will benefit.
Now the case seems clear that in Ghana there is a lack of dentists and more dentists are needed. However the discussion must be raised as to how extra training should be payed for and how dentistry should be funded. When faced with paying for dental treatment, most Ghanaians would rather go without and if dentistry not going to have sufficient funding the number of dentists in Ghana will never be adequate.
Nicholas Robson and Stuart Bolus