Brittany Seymour, assistant professor of oral health policy and epidemiology, accompanied Barrow on the first visit of the HHR team to present a dental surgery program to Rwanda`s ministers of health and education. The oral health team presented a “diagonal” program concept for the proposed new dental surgery program. The diagonal concept combines opportunities for horizontal interdisciplinary training with vertical targeting and discipline-specific training. This diagonal approach to curriculum design is similar to a diagonal strategy for health programming and intervention, which combines the use of disease-specific vertical programmes and horizontal programmes relating to general and broader health systems and common risks and associations for diseases (34). The aim of this project is to break down isolated educational silos and fragmented vocational training and to include the provision of intervocational training (20). Skills, training program, insurance and payment systems, licenses and other challenges are currently being addressed. While the Ministry of Health supports the efforts of dental HRH and fully recognizes the importance of oral health, everyone hopes that these developments will ultimately lead to more robust oral health data collection, a well-trained and well-maintained dental profession, and significantly improved oral and overall health for the Rwandan people in the coming decades. In response to the Rwandan government`s comprehensive and innovative HHR program, the oral health team proposed the launch of a world-class dental education and training program focused on top-notch dentists. As part of the HRH scale-up plan, the Government of Rwanda aims to radically change the quantity and skill level of trained health professionals. The oral health team felt that establishing the first dental surgery program in Rwanda could help achieve HHR goals by involving dentists who can complement dental therapies with team-based practice in Rwanda`s primary health system. Over time, this approach can ultimately close the gaps in oral health and enable targeted investments in the Rwandan population (33). Other challenges that arose included the lack of resources, staff, faculty and equipment at potential clinical training institutions for dental students.
More data on the specific oral health needs of stratified populations in rural and urban areas need to be collected and used for system planning. Current dental therapist rotational positions must be calibrated to operational standards that provide a productive learning experience for dental students. All these challenges will continue to be addressed during the HRH initiative with input from leading experts from the Rwandan Faculty of Dentistry, organized dentistry and government officials. Dental experts, lecturers and colleagues from neighbouring countries have also provided invaluable information and input to the design of the programme and will be advised on its implementation. Since 2011, the Harvard School of Dental Medicine (HSDM) has been a leading partner in the introduction of the new Faculty of Dentistry and the Bachelor of Dental Surgery program at the University of Rwanda. While much has been accomplished since the initial announcement of the HHR program and the convening of the faculty consortium, much remains to be done for the dental component. The final refinement and approval of BDS competencies and the full curriculum needs to be done at all levels, and integration with other programs, especially the medical program, needs to be further refined for the diagonal approach to work. Finally, the Higher Education Council and the Parliament of the Ministry of Education must ensure that the new curriculum meets the quality and standards of higher education in Rwanda. With a population of over 12 million people and fewer than 40 registered dentists serving them, the addition of 10 new graduates with bachelor`s degrees in dental surgery was an important milestone for the future of oral health in Canada. “Some of the students had never had a visit to the dentist and didn`t know any dentists,” Hackley said. “It wasn`t just a new school and a new program, but also a whole new field for them, so they`re really pioneers. They have been loyal and resilient throughout the program.
I`m incredibly proud of everything they`ve accomplished. Because the number of dentists is so limited, most oral care in Rwanda is performed by dental therapists. Currently, the Kigali Institute of Health (KHI) offers a Bachelor of Dental Therapy (BDT) program, with an annual class of about 27 therapists graduating each year. Currently, dental therapists in Rwanda are trained with limited scope to provide non-invasive basic restorative and periodontal procedures, as well as simple tooth extractions. The 78 dental therapists working in Rwanda work in publicly funded institutions. It is clear that millions of Rwandans with such a limited number of oral health care providers do not have adequate care, which is a major obstacle to improving health and economic development. Despite this profound morbidity and the need to treat oral diseases in Rwanda, there is a severe shortage of properly trained oral health workers. There are approximately 92 public oral health providers, including dentists and dental therapists, serving a country of approximately 11 million people (31). There are only 13 dentists of Rwandan origin, working mainly in municipal, public or private settings, so only about 10 foreign dentists, perhaps fewer, occupy training institutes and teaching and referral hospitals. Because Rwanda does not have a training program for dentists, all dentists practicing in the country graduated outside Rwanda, increasing the risk of what is often referred to as “brain drain” or insufficient long-term retention of Rwandan-trained dentists. The vertical component of the program concept proposal included didactic concepts and clinical skills specifically required for a dental provider.
