The comprehensive dental health program implementation in the province of Cagayan and its implications to primary health care / Gelandrea L. Gutierrez. 6

Thesis (Ph.D.)-- Pamantasan ng Lungsod ng Maynila, 2006.;A dissertation presented to the faculty of Graduate School of Management in partial fulfillment of the requirements for the degree Doctor of Public Management. 56

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ABSTRACT : This study examined and assessed the effectiveness of the Comprehensive Dental Health Program implementation in the province of Cagayan. Specifically, it sought to find answers to the following questions: 1. What is the status of dental health services in various health centers of the Cagayan province in terms of the following dimensions and the extent of its conformity with the prescribed minimum standards set by the Department of Health? 1.1 Organizational dimensions 1.1.1 dentist/population ration 1.1.2 trainings 1.1.3 dental facilities 1.1.4 dental equipment 1.1.5 dental supplies and materials 1.1.6 program strategies 1.1.7 procedural interrelationship 1.2 Financial dimensions 2. What is the assessment of the beneficiaries on the provision of preventive, promotive and curative dental services? 3. Is there any significant difference in the assessment of respondents in Groups A and B municipalities regarding the provision of the above-mentioned dental services? 4. What is the prevalence of the two most common dental diseases particularly dental caries among pre-schoolers, schoolers and other adults and periodontal disease among pregnant mothers for the year 2000-2004 in the province of Cagayan? 5. What is the performance of the various health centers for the period 2000-2004 in terms of preventive treatment rendered to schoolers and pregnant mothers? 6. How do public health dentists assess the management of the Comprehensive Dental Health Program in terms of work, people, resources and linkage? 7. What are the problems encountered by the program managers and public health dentists regarding the implementation of the Comprehensive Dental Health Program? 8. What are the implications of the findings of this study to primary health care? 9. What policy options or interventions should be designed to enhance dental health services in the province of Cagayan? Hypotheses The researcher tested the null hypothesis at 0.05 level of significance: 1. There is no significant difference in the assessment of beneficiaries classified according to group A and B municipalities regarding the provision of preventive, promotive and curative dental services. RESEARCH METHODOLOGY Sample Size and Sampling Technique The respondents of the study involved three types: the public health dentists assigned in municipal health centers, the dental health program managers and the program beneficiaries. As the study covered only eighteen health centers, eighteen (18) public health dentists served as respondents. Further, the study covered twenty program manager: namely, (18) Municipal/City Health Officers and two (2) Dental Supervisors (Provincial and Regional) involved in the Comprehensive Dental health Program. For the program beneficiaries, namely the other adults and pregnant mothers, a stratified sampling technique was used. The class of the city/municipality where these health centers were d located served as the basis of stratification. These municipal health centers were divided into two groups, namely Group A and Group B. There were 70 respondents from Group B chosen purposively. Instrumentation The researcher used a self-constructed questionnaire as the major instrument for gathering data in this study. A questionnaire using closed-ended questions was designed to provide possible answers from which the respondents will select the most appropriate answer. Follow-up interview was conducted with public health dentists, program managers, namely the city/municipality health officers and dental supervisors and budget officer. Documentary analysis was also used to generate secondary data particularly on the dental health services standards as set by the Department of Health for rural health units. The treatment records and annual accomplishment reports of the rural health units formed parts of the dental services. Data Gathering Procedures The researcher personally distributed the questionnaires to the public health dentists. After two weeks, the accomplished questionnaires were retrieved through the assistance of the dental supervisor and his dental aide. A personal follow-up interview was also conducted by the researcher with some public health dentists in order to elicit additional information not otherwise obtained through the use of questionnaire and ascertain some relevant data and information. For program managers, the researcher personally distributed the questionnaires and retrieved them after a week. As to the pregnant mothers and other adults, the questionnaire was distributed to the public health dentists with the assistance of their dental aides and was retrieved after 3 weeks. For gathering data on facilities, ocular inspection was done by the researcher personally. Together with the records on supplies and equipment, observation method employing a checklist was utilized for the actual collection of data and with the help of the public health dentists. Data were gathered and recorded on the same day the ocular inspection was conducted. Statistical Method The percentage, arithmetic mean, Sison's Formula (Standards), and the test were used as statistical tools to interpret the data. SUMMARY OF FINDINGS 1. The delivery of dental health services in the province of Cagayan is inadequate in terms of organizational and financial dimensions. This does not conform to the standards set by the Department of Health. 2. The assessment of program beneficiaries on the provision of preventive, curative and promotive services is satisfactory in both Group A and Group B municipalities but leaves more to be desired. 3. The assessment of the two groups of respondents classified according to Group A and Group B municipalities regarding the provision of preventive, promotive and curative services had no significant difference. 4. The preventive and promotive services are better delivered among preschoolers but not among the schoolers and other adult groups which showed an increasing rate of caries prevalence and periodontal disease prevalence, respectively. 5. The preventive service is more responsive as there is an increasing number of schoolers as well as pregnant mothers who availed of preventive treatment of overshooting of targets. 6. The performance of program managers in their managerial functions of work, people, resources and linkages in mideocre and therefore needs strengthening. 7. Since the dental health program is not a priority concern of the local government units, the implementation is hampered primarily by the inadequacy of organizational resources and poor coordination of program managers with the NGA's, NGO's and GO's. CONCLUSIONS The study arrived at the following conclusions: 1. The delivery of dental services in the province of Cagayan needs to be improved to conform to the standards set by the Department of Health. The very limited provision of supplies and materials in the public health care delivery system hampered the delivery of primary health care projects and subsequently the success of the Primary Health Care approach. 2. The level of community participation is a critical factor in influencing the effectiveness of Primary Health Care. Community residents who participate more in community activities manifest better health practices or higher knowledge levels than those who do not participate as much. 3. A decline in the prevalence rate of dental caries among preschoolers is commendable but increase in periodontal and gum diseases among schoolers and adults needs to be addressed. 4. More pregnant mothers availed of preventive treatment under the Comprehensive Dental Health Program. 5. The performance of program managers in their managerial functions of work, people, resources and linkages is below satisfactory. 6. The dental health program is not a priority concern of the Local Government Units. This contributed to the poor implementation of the Comprehensive Dental Health Program. This further implies that the implementation of primary care services or community-based development projects is likewise poor. RECOMMENDATIONS On the basis of the findings and conclusions arrived at this study, the following recommendations are presented. 1.

The Provincial Health Office must recruit the needed personnel; train the public health dentists and program managers not only in the technical aspect of their jobs but also on the administrative and management aspects. Dental auxiliaries and barangay health workers should form part of the training program. 2. A periodic performance evaluation must be conducted to monitor the performance of program implementers as well as the progress of program implementation. 3. The Local Government Units must provide motivation to deserving and efficient public health worker in the form of incentives, rewards, promotions or plaque of appreciation. 4. The Provincial Health Office and Center for Health Development (Regional Health Office ) must intensify their efforts to generate additional funding requirements to support the program. 5. For the implementation of community organizing, the City of Health Office should consider interfacing with other implementers who have expertise in community organizing such as the NGO's. This can be achieved with the support of the Local Chief Executive (LCE) who is chiefly responsible for implementing programs and projects on Primary Health Care. 6. With the integration of oral health under the cluster of family health programs, there is a need to revive the existing policy to include the 0-6 year old children as part of the target clienteles for preventive and promotive services of the Comprehensive Dental Health Program. Hence, program managers must develop a preventive oral health care program for 0-6 year old children. 7. Intensify Healthy Lifestyle campaign. It shou

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