Dental Health International Nederland
Oral Health Promotion
in Kosova

Annual Report

January 1st, 2002 to December 31st, 2002



Study Group for Oral Health Promotion
Dental School, Pristina




January 2003


Summary

Oral health of the population in Kosova is in a bad state. A local survey on 550 schoolchildren demonstrates the high caries experience in 12-year-old schoolchildren. 95% of the 12-year-old schoolchildren have decayed teeth and the average DMF-T in this age group is 6.5. Only 5% of them have healthy teeth without decay or fillings. Till end of December 2001, the Swiss NGO MEDAIR had implemented an oral health promotion project establishing a Study Group for Oral Health Promotion in collaboration with the Dental School of Prishtina.
With the financial support of MEDAIR, SSO and DHIN, this group was able to continue its promotional activities in Prishtina and surrounding communities, although at a lower level. Although there is wide acknowledgement and a big interest by UNMIK and the Dental School to continue the project, both institutions are still not able to provide sufficient financial support.

Objectives of the project are:
To improve oral health knowledge of teachers and pupils in Peje, Decan and Pristina.
To raise oral health awareness in the family health teams.
To inform Kosovar population about oral health.
To improve the knowledge of Kosovar dentists concerning oral health promotion.

With the support of Dr. Mautsch, former WHO consultant to Kosova, a new operational plan for 2002 had been developed and implemented. The planned and achieved targets are summarized in a table in this report.
Main activities comprise 40 lectures and demonstrations on oral health to 1076 teachers, the training of 120 family health nurses who in turn functioned as trainers to about 600 nurses. Further lectures have been given to dental students, dentists in specialisation as well as medical students studying social medicine in the Institute of Public Health. To all participants educational material in form of the oral health manual had been distributed.
Apart from that manual, the Study Group has published a book on preventive dentistry which was distributed to dentists, doctors and nurses and can be considered as the only actual resource on prevention and dental public health in Kosova.
Together with the Dental Association of Kosova, the First Dental Congress has been organised including a special day for Oral Health Promotion. It was an excellent forum to present 9 papers on preventive dentistry and oral health promotion. Spots for Radio and TV have been developed and emitted. In addition, the Study Group was able to participate in various radio and TV emissions talking about oral care and prevention.
There exists an intensive cooperation with the Institute of Public Health concerning integration of oral health in public health actions. Unfortunately, cooperation with the Ministry of Health still lacks of interest from part of the Chief Dental Officer who keeps on the old-fashioned restorative approach. Therefore, no significant advances have been reached concerning the integration of oral health issues in the draft of the New Kosovar Curriculum for primary schools.
The epidemiological survey of about 4000 schoolchildren has been carried out, the data has been  analysed and published in the dental journal "Apolonia" . The working group has been able to participate in a Symposium in Struga, presenting 4 papers on preventive dentistry in Kosova, raising much interest from the colleagues in their activities.  
Due to the restricted budget and the limitations in manpower, some activities could not be implemented. Therefore, the action plan for 2003 has been revised and adapted to the future reality.

Evaluation of the Activities in 2002

As aims, specific objectives and planned activities have been described in detail in the project proposal 2002, they will not be repeated in this annual report.

Within this short time period the Study Group has been able to perform considerable promotional activities and to consolidate its role as the most appropriate partner for oral health promotion in Kosovo. Thanks to intensive networking with national and international organisations and institutions such as PHC programme of WHO, Institute of Public Health (IPH), Finnish Red Cross, Danish Red Cross, Education Sector, the group is consulted for issues of oral health promotion and prevention. People ask for their publications such as manuals, posters and flyers. They have been invited to participate in TV emissions and radio programmes. The group is more and more known by other organisations and is addressed to give training courses for health personnel and teachers. They were included in the training of family health nurses, which was an excellent opportunity and decisive step to integrate oral health in a general health context, one of the primordial issues of the Primary Oral Health Care Approach.

School programme

Achievements

The Study Group has continued the  school programme in primary schools of  Prishtina in co-operation with the Dental School and the Department of Health. 40 lectures of 30 to 45 minutes have been given to1076 teachers of 30 primary schools, 9 kindergartens and 1 institution for children rehabilitation. The lectures took place in the schools, mostly at the end of the school day or between the shifts when the school was attended in the morning and in the afternoon. The lectures included a basic understanding of the etiology and progress of the most important oral diseases as well as strategies for prevention. After the lecture teachers were provided with the manual and a flyer for children.
In the institution for children rehabilitation tooth pastes and tooth brushes have been distributed and a practical demonstration was performed. In the school "Elena Gjika" 4 hours of lecture and practical  demonstrations to 150 pupils and two lectures to their teachers have been performed. Tooth pastes, tooth brushes , manuals and flyers have been distributed. This activity was implemented in cooperation with French institutions.

There was a meeting with a  representative of the Curriculum Reform Team of the Department of Education which is about to draft a New Kosovar School Curriculum. It was agreed that the Reform team would address the Study Group as soon as the formulation of the facultative assignments of the Curriculum will take place. This may become a unique chance to incorporate oral health in the facultative assignments of the school syllabus, resulting in an integrated approach of oral health promotion in schools.

About 4000 children of kindergartens and primary schools have been examined. The data has been  statistically analysed and published in three papers in the dental journal "Apolonia". A copy of the papers is attached to this report. Apart from the publication, the Study Group was able to present the data in a Symposium in Struga as wellas in the First Dental Congress of Kosova.

Problems and Constraints

Due to a lack of time, financial resources and manpower, it was not possible to do practical demonstrations with the teachers and children. Only few tooth pastes nor tooth brushes have been distributed for two reasons:
The budget limits of the group does not allow to support such activities
Being aware that such action will be only a one-off event and cannot be sustained in the future, the group decided not to raise false
expectations in the teachers, children and parents.

Lectures were one-off events and could not be repeated in the classes. Schools could not be re-visited to control whether teachers would give classes on oral health to the pupils. A monitoring system is still lacking.
It is intended, that in co-operation with the local educational authorities, these trained teachers will be responsible for oral health promotional activities in their schools. But such a system implies the political will from part of the Ministry of Health, Chief Dental Officer to establish an official co-operation with the Educational Sector. This is particularly important for the integration of oral health issues in the future Kosovar Curriculum.

There were only minor contacts to the  educational sector of the Regional Institute of Public Health in Peje which should be responsible for the future implementation of the pilot project in Peje and Decan. The Group has offered support by giving lectures, but IPH Peje only asked for educational material. Therefore, no follow-up seminars have been implemented by the Study Group in Peje and Decan.


Reorientation of dentists

Achievements

2 lectures to 94 dental students in the 5th grade have been given. They may be the start for regular inclusion of oral health promotion in the Dental Curriculum of the Dental School. The positive response to the lectures motivates the group to promote further this issue in the Dental School.
Oral health promotion lectures have been presented to 76 dentists and dentists in specialization, thus raising awareness in them about the importance of a preventive-promotional approach.

Problems, constraints

The active participation of students of the 5th and 6th year in the school programme has not been achieved in this year. It takes more time to change the organisational structure in the Dental School. In addition, this year the School had to deal with a much higher number of students than normal, as there were additional dental students from Tetovo in Macedonia.

Due to financial constraints, it was not possible to translate important scientific articles into Albanian or buy recently published literature on oral health promotion. As a functioning library system does not yet exist, the provision of books has to be postponed to next year.
The Study Group regrets that there is no access to journals, either in printed or electronic form.

The Study Group is aware that the integration of oral health promotion in the Dental Curriculum of the Dental School will be a long process and results will not be visible within the first years. It is a middle-term objective which needs diplomatic skills and the political will of the main stake-holders in the University as well in the Ministry of Health and does not depend on the Study Group.


Health Promotion

Achievements

The good collaboration with the Health Promotion Unit of the Institute of Public Health (IPH) has been maintained and even intensified. The Study Group assists permanently in the two-weekly meetings and gives its input concerning oral health to other participating organisations. Contacts exist to regional sections of IPH, such as Peje, Prizren and Ferizaj.
Dr. Begzati has given lectures to 24 medical students studying Social Medicine in IPH. In a seminar of IPH he gave a presentation about dental public health. The Study group was officially acknowledged by IPH for its valuable contributions to oral health promotion.

120 family health nurses were trained in oral health in co-operation with the IPH and the PHC unit of WHO. They act as future trainers for nurses. In 30 health centres all over Kosova, another 600 nurses have been trained by those trainer nurses. Dr. Begzati attended two of the nurses' training courses in Prishtina.

On June 6th to 8th, the  First Dental Congress of Kosova took place, organised by the Dental Association of Kosova and the Study Group. A poster was developed and distributed to draw attention of the population to oral health. A special Oral Health Promotion Day put emphasis on promotional issues giving the Group the chance to present 9 papers. In addition, Dr. Mautsch talked about primary oral health care projects in different countries.

This congress gave the opportunity to raise awareness in dentists, but also address the population by participating in radio emissions and TV interviews. Parallel to this event, radio spots and a TV video had been developed and were emitted throughout the month of June.
The Study Group has achieved to become the main partner for radio and TV emissions on oral health and prevention. The Group was actively involved in the most popular children programme of TV Kosova called "magic box",  in a children programme of Kohavision as well as in an adult TV programme demonstrating the adequate measures of oral hygiene and prevention from tooth decay.
In November, over 30 local radio stations have broadcasted a programme with the title "How can we protect oral and dental health?", in which Dr. Begzati was talking. This programme was organized and funded by Media Action International, American Committee and the Canadian International Development Agency CIDA.


Problems, constraints
Due to financial constraints, the printing and distribution of posters and flyers to the population could not be implemented. Being aware of the problems and the questionable effect of posters and flyers to improve knowledge and change attitude permanently and knowing that these means will not be very effective in changing behaviour, the group decided to cancel this activity. A summary of all planned and achieved targets for 2002 is presented in table below.

Outlook for 2003

The Study Group was able to strengthen their position within the Dental School. Prof. Adil Raka, head of the Department of Preventive Dentistry, who was initially reluctant, has officially taken the chair. He provides the necessary political backup to be able to work in the University environment. He is the adequate partner for negotiations with other departments as well as the Chief Dental Officer.
Nevertheless it has been admitted that although both the Dental School as well the Chief Dental Officer show an interest in the project, their support is more verbal than factual  and both institutions are still not able or willing to give financial support apart from the contributions below listed:

Reduction of working hours in Dental School for members of the Group to implement activities
Leave for seminars and meetings
Free provision of office room (market price for rental: Euro 500/month)
Free provision of lecture theatre for presentations, seminars
Free provision with audio-visual equipment and demonstration models for lectures
Free access to Internet (Euro 2 per hour)
Cleaning of office room

It will be a primordial task for the Study Group to tighten the connections with both institutions and to convince them that Oral Health Promotion plays an important role in modern dentistry.

Being aware of the reduced financial resources and the little manpower available, the Study Group has revised and modified its activities for the year 2003. A new plan of operations as well as a revised budget plan for 2003 are listed below.


School Programme

Lectures for teachers will continue, but there might be organisational changes. It is planned to organise joint seminars for teachers of several schools. The duration of the lectures will increase and it will be possible to give more detailed information and include practical demonstrations. It has to be discussed with the educational sector if such forms of seminars are feasible.
 A monitoring system for the activities of the teachers has to be established. Practical demonstrations in classes will only be possible if dental students can be integrated in the programme.
The integration of oral health in the New Kosovar School Curriculum remains to be one of the most important issues. Unfortunately, there are doubts that the political influence of the Study Group will be strong enough to keep that issue on the agenda. The Group will have to look for strong partners who might support their interests. These partners may be the Institute of Public Health and the Chief Dental Officer.

Reorientation of dentists

The Group finds it important to educate dental students in oral health promotion, but is well aware of the big task lying ahead. Nevertheless, the Group will offer lectures to the students and try to make attendance obligatory. This depends on the will of the Dental School to change their syllabus.
Efforts will be increased to include dental students actively in the school programme. This would provide the necessary manpower to intensify lectures and demonstrations in classes, having a longer lasting effect than one-off events.

The Group regrets that they have little access to actual literature on preventive dentistry and dental public health. Although, the University library is still not functioning, it is intended to get some basic books on those topics and keep them under their custody for the time being. Particular interest exists in subscribing to a journal on preventive dentistry or dental public health, either in written or electronic form.

The support for Apollonia has to be cut due to financial constraints of the budget. Dr. Begzati and Prof. Adil Raka have in mind to publish an own edition of a Journal of Preventive Dentistry. This idea has to be developed during this year, taking in mind the possibly high costs involved. There have to be found means and donors who might be interested in supporting such an edition. At the time being, the budget of the Group does not allow to start such an interesting and innovative project.


Health Promotion

The good cooperation with IPH will continue and the Group will actively participate in the two-weekly meetings. Contacts to IPH Prizren and Peje will be maintained.

Contacts to the Nurses School will be maintained and lectures offered to new nurses. The Group is interested  to participate in new training courses for trainer nurses. But it will be the responsibility of the Nurses School to organise such events. The Group will provide educational material for any course for nurses.

The Kosovar Oral Health Awareness Day will be organised for 8th of June. It may be a joint event with the Dental Association of Kosova (DAK), if DAK is interested. The Group has not decided yet how the Day will be organised. It depends, whether DAK and Dental School want to organise a joint event. Decisions about activities will be made till end of February.

The Group promotes the idea of  an oral health knowledge contest between the schools of Kosova. The best classes should enter in a final contest which is to be emitted by the national TV programme. This contest may increase the motivation of the teachers and the schoolchildren to know more about oral health and preventive measures and may raise awareness in the population.

Radio messages are planned to be emitted for some months. Negotiations with radio stations have to be made concerning the financial aspect. The Study Group will try to convince the radio stations to emit the messages without additional costs. Such an agreement would be very important for the future, when external financial support will cease.

Members of the Study Group intend to visit Tirana to participate in the Congress of the Balkan Society of Stomatologists from May 1st to 4th. They want to present some papers about oral epidemiology and oral health promotion activities in Kosova.



Visist of consultant

Dr. Mautsch has visited the Study Group from June 13th to 20th. He participated in the First Dental Congress of Kosova and presented a lecture on primary oral health care projects in various countries. In daily meetings the Study Group discussed with him about the progress of the project. The actual plan of operations was critically revised and modified according to the available resources on time, manpower and funds. It was noted that the original plan was to ambitious to be fulfilled completely.

The second visit to Kosova , planned for mid of December 2002, had to be postponed by the Study Group to mid of January 2003 due to time constraints. In his visit from January 16th to 25th all activites during 2002 were critically discussed. A new plan of operations was formulated which should better consider  the constraints of the Group in financial and manpower terms.
The Group handed over all receipts and bills for their activities in 2002. A new budget was established considering the fact that MEDAIR would not be able to support the Group with funds. The Study Group expressed the hope that SSO and DHIN would be willing to continue their support till end of 2004. At that time, the Study Group hopes to be strong enough to continue without external support.