Nigeria dental profession has not got to where it ought to be but it has left where it used to be. Though, the rate at which doctors are leaving the country is alarming, we can always hope for a better tomorrow. It is a matter of time, something will be done to improve the situation on ground so that it can augur well with us as a nation. What the brain drain is causing is simply retrogressive and anti-socialistic. Dental care is scarcely available in many towns in Nigeria and even in the main cities where it is available, it is not affordable to the common man. The inaccessibility and unaffordability of oral health care is a big issue. The Nigeria of my dream is a great Nigeria. My dream of this country has many parts.
First, I want all dentists in Nigeria to be healthy, happy and comfortable. For them to be very rich is not necessary, though it would be nice if they are just like every other dentists all over the world who believe and know that life is small but dentists live it large. I want them to be able to harness every resources available to us and use their brains and skills to become a great instrument of change; frustrating traditions with their creativity and intelligence so that their existence will be towards making Nigeria a better place where people can live happily. But more than any of these, I dream of a peaceful atmosphere for growth and expansion. I want all health care professionals here to understand and help each other, regardless of our union, political party affiliations, religion, creed, ethnicity, tribe and geo-political zones, just because we are all members of the same species destined to be Nigerians. Second, I want Nigeria to be declared a nation with best oral hygiene practices first in Africa, then one of the best in the world. I know, that’s not easy, but it is a dream I have. (No further explanation necessary).
Most oral health surveys in Nigeria have been sporadic and based on convenience or haphazard samples. The drawback of this is that the sample may be quite unrepresentative of our population because some areas may be over-selected and others may be under-selected or missed altogether. This is partly due to the enormous costs and resources required for a representative nationwide studies in this huge country with an area of 923,773km.sq, and a population of over 180 million. Therapeutic dental services are available in the public and private sectors, mainly situated in the urban areas such as LAGOS, IBADAN, BENIN, PORT-HARCOURT, ABUJA and ENUGU cities, as a result of this, most of the dentists (approximately 3,000) practising in Nigeria are located in urban areas. The first generation dental schools in Nigeria are situated in the southern part of the country- LAGOS, IBADAN, ILE-IFE AND BENIN. They trained thousands of great dental surgeons in about 40 years and the teaching hospitals attached to these schools rendered fantastic dental care for Nigerians for years before the era of the new dental schools at MAIDUGURI, ENUGU, KANO, PORT-HARCOURT AND CALABAR which has recently improved the turn-out. There are several federal medical centres and few state general hospitals who also joined in rendering of dental services to the nation at large. Also, companies such as UNILEVER, GSK, P&G, COLGATE who produce toothpaste, toothbrushes and mouthwashes or dentifrices sprang up over the years and really helped prevent oral diseases through their products, research grants and sponsorship of oral health campaign programs across the nation.
So, in the public sector, dental treatments are provided at dental centers & departments in government general/specialist hospitals, as well as Armed Forces hospitals. In the private sector, dental services are available in the few dental clinics located in the major cities. Apart from occasional visits of dentists from the government general/specialist hospitals to the rural areas, the rural population has little or no access to modern dental treatment. There are few dental hygienists/therapists who also graduated from school of health technologies but their duties are limited mainly to oral prophylaxis and oral health education, and they function under the supervision of dentists. Yet, there appears to be no coordinated national strategy for preventive dental services in Nigeria. With the magnitude of oral health problems in Nigeria as a nation and several challenges that we are facing concerning oral health in Nigeria, there is need to develop sustainable strategies for national preventive and therapeutic oral health services to cope with them.
The overriding objective of economic and social development is to improve the quality of lives that people live, to enhance their well-being, and to provide them with the opportunities and choices to become productive assets in the society. The roles of dentists in Nigeria is to attend to the dental need of all citizens. General access to oral health care services is compromised by poverty, geographic location, age, limited education or language skills, gender, disability, or an existing medical condition. Hence, oral health disparities abound. For too long, the perception that oral health is in some way less important than and separate from general health has been deeply ingrained in Nigerians’ consciousness. Activities to overcome these attitudes and beliefs have started at the grassroots level, and this over time will lead to a coordinated national movement to increase NATIONAL ORAL HEALTH LITERACY which is defined as the degree to which individuals have the capacity to obtain, process, and understand basic oral health information and services needed to make appropriate health decisions. By raising Nigerians’ level of awareness and understanding of oral health, people can make informed decisions and articulate their expectations of what they, their communities, and oral health professionals can contribute to improving health; health professionals and researchers can benefit from work with oral health partners.
Dentists are to make sure that oral diseases are prevented and oral health is promoted by collaborating with government and vice-versa. Oral health promotion should be done in every state within the country by advocating for healthy public policies through legislation (getting involved in the political process and ensure bills that would favour dental care is sponsored and passed at the house of assembly), liaising with the ministry of health to help accommodate more dental procedures in the national health insurance scheme, Identifying and removing all hindrances to adoption of new healthy policies and upgrading the federal medical centres to improve the availability of dental services. There must be political will on the part of government and commitment among dental professionals so as to ensure policy shift. Though, we view health as a social service, it needs to be managed as an economic commodity.
There is still a high level of unemployment among dentists in Nigeria. Slots for house jobs are not enough and not all of them are paid by the respective states during national youth service year, many cannot find a befitting job to do after youth service due to the fact that most jobs are in the cities and accommodation in the cities are on the high side complicated by crazy transport fares and feeding. There is a huge difference in salaries between those who work in private sector (mainly clinics) as compared to those work in public sectors (mainly hospitals) and this has seriously threatened the growth of the young dentists in Nigeria. The public sector is concerned with meeting societal needs and ensuring universal health coverage. It is often claimed that public providers of oral health care are inefficient and slow to adopt technological innovations. They are irresponsive to the needs and wants of patients, showing more concern for the welfare of those who work within them than those who use their services. They have little incentive to change, preferring to stay with long-established patterns of working, particularly if these are in the interests of the professionals or other workers concerned while the private sector aims at providing the best of service at a profitable cost. They are anxious to maximize their profits, are keen to eliminate waste, keen to adopt new technologies and working practices
The private sector and public sector each has unique characteristics and strengths. Linking the two can result in a creative synergy capitalizing on the talent and resources of each partner. If government had left the management of the heavy economic sectors like NNPC, PHCN, ROAD & SOLID MINERALS etc. to the private companies and just regulate them and diverted the extra funds into the social sector which are mainly non-productive (health, education and security), the situation would not become so apparent and this compelling for dentists to leave the country. But there are some obvious constraints which are; the unacceptability of the new public- private partnership in oral healthcare delivery program by those hitherto benefiting from the old system, difficulty in getting people to change from their old ways of doing things, no flexible business models because of budget legislation, lack of appropriate legal framework, quality control, social-economic obstacles, trade Unions, bureaucracy in the public sector.If implementation of strategies to overcome barriers in oral health care service, disparities particularly among those most vulnerable been made a priority, the situation we are in now would have been avoided.
We all know that demands on health care systems will always outweigh the resources available to meet them. Every country has witnessed an increase in budgetary allocation for healthcare expenditure. Despite this, the demand for health services always outweigh the scarce resources available. The solution to this problem is to prioritise, pushing resources to those areas of more pressing need, university medical education system should give room for absorption of young graduates into the university as dental graduate assistants and encourage them to pursue their career through master and PhD degree programs. This will over time expand the profession as some people will extend their tentacles and venture into more research and academic works. The residency job openings have become more reduced due to limited space and lack of commitment on the part of the government to fund the training program, thus there are more dentists with primaries without job placement. These problems have seriously threatened the continuous development of our great profession.
The prevalence of dental diseases is increasing, the impact of the diseases on individual is much and overall impact on the wider society is overwhelming. The good news is that dental diseases are preventable and treatable. Government needs not wait until it can provide all that is needed in oral health care rather it can out-source the provision of dental equipment, materials and instruments. Also, dental products’ companies and other multinational companies, Banks, NGOs and foreign investors should be allowed to offer more assistance to Nigerians by giving loans to those interested in setting up new dental clinics especially in rural areas. Cost of dental equipment and materials is exorbitant due to the fact that they are all imported. Roles of donors like WHO, USAIDS, UNFPA, FORD FOUNDATION, BILL& MELINDA GATES FOUNDATION, SMILE TRAIN etc. should not be undermined also. Companies like Dentsply, Henry Schein, Kerr, 3M, Pulpdent, etc. who have invested a lot in dental research and produce materials and equipment and their local subsidiaries can be encouraged to invest in Nigeria having patronized them for years and finally companies like Vamed Medical Engineering, Siemens, G.E, etc. can be invited to discuss PPP arrangements with the teaching hospitals as an entity.
My dream is to project the dental profession in a good light to the citizens of this country so that we can receive greater attention from government towards an improved oral health for all the citizens. Political, religious, tribal, ethnic and economic dividers are still very much in place in our nation, and overcoming such forms of bias comes only with affirmative action as well as educating our people against prejudice and discrimination. In the same vein the crisis and rivalry between health care professionals in the country should be managed well and peaceful co-existence should be our desire. And most importantly, it is our duty to remember our nation’s involvement in corruption, our deliberate mistreatment of Nigeria’s native peoples, and our apathetic complacency during the worst act of terrorism in history–these must all be painfully remembered to prevent such blots to fall on our account again. I wish to be actively involved in history, a living history that will affect every person out there in our great land, who will remember our past, its glories, triumphs, and yes, its failures. To do this is our responsibility to future generations, to make our nation a more thoughtful nation and our people more thoughtful people.
Long live Nigeria,
Long live Dental profession.