Abstract
ObjectiveSierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building.Materials and methodsSemi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research.ResultsTwenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig’s Angina and Burkitt’s Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients’ predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments.ConclusionThis paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.
Highlights
Interviewees’ characteristics A total of 35 participants were contacted from October 2015 to December 2017, out of which 23 consented to participate, 21 of whom were available for interview
A higher proportion of non-responders (n = 12) were female (75%, n = 9); one participant withdrew due to illness whilst another declined without providing a reason
The findings suggest considerable unmet routine oral health needs, together with rare and life-threatening oral conditions such as osteomyelitis and Ludwig’s Angina, which result from untreated common diseases.[83,84,85]
Summary
The United Kingdom (UK) has supported Sierra Leone on its journey from independence in 1961 through economic challenges,[11,12] and the above crises,[13,14] including the provision of international aid.[15] King’s College London, a leading centre for global health, with a particular focus on sub-Saharan Africa, and King’s Health Partners (KHP), an academic health science centre in south east London, have played an important role in Sierra Leone over the past five years. King’s Sierra Leone Partnership (KSLP) within King’s Institute for Global Health,[16,17,18] established in 2013, is defined by the philosophy of partnership working involving research informed action. One of the collaborative work streams relates to dentistry and oral health,[19] following a request from Sierra Leone partners for assistance in tacking their ‘silent epidemic’.16
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