Towards a Dental School for Malawi – the MalDent Project

Education

Overall goals

1. Establish, in parallel with the existing MB BS programme, a Bachelor of Dental Surgery curriculum at the University of Malawi College of Medicine.

2. Completing the scoping and design of the capital and technical infrastructure required for delivery of the BDS programme.

3. Recruit a small dental academic workforce to deliver the programme. In the early stages, teaching will be complemented by use of distance learning and concentrated periods of teaching by visiting faculty based in Scotland.

4. Work to develop, with the Ministry of Health and Scottish partners, a national oral health strategy.

5. Establish a national prevention programme aimed at children, based upon a version of the well-proven Scottish Childsmile programme, already adopted in other international settings.

Key UK Colleagues and Partners

University of Glasgow
Royal College of Physicians & Surgeons of Glasgow
University of Dundee
NHS Greater Glasgow & Clyde
NHS Education for Scotland
Dentaid
Bridge2Aid
Smileawi
Henry Schein Dental

International Partners

University of Malawi College of Medicine
Dental Association of Malawi
Medical Council of Malawi
Malawi Ministry of Health
Malawi National Council for Higher Education
Wits University Dental School
University of North Carolina Dental School
World Health Organisation

Sustainable development goals

  • SDG 10 - Reduced inequalities

Funding source

Scottish Government grants

Project origin

The ambition of the College of Medicine (COM), University of Malawi, to establish the first Bachelor of Dental Surgery course in Malawi was initially shared during a University of Glasgow funded visit in 2015 by a senior COM delegation. This led to the Scottish Government (SG) - funded Blantyre-Blantyre project which is now in train. Several attempts had been made to establish a BDS course over many years without success. The Head of Glasgow Dental School (JB) was subsequently invited to become an adviser on the Dental School project. JB is also a Vice-Dean of the Dental Faculty of the Royal College of Physicians & Surgeons of Glasgow (RCPSG) and a member of its Global Health Group. The RCPSG funded flights for JB to visit dental facilities in Malawi and to participate in a curriculum conference with key players from the CoM, Malawi Government Ministry of Health, Dental Association of Malawi and Medical Council of Malawi during September 2017. Great progress was made, particularly through identifying parallels with the existing medical curriculum for Years 1-3, developed through previous SG funding to COM and St Andrews University. This visit provided the opportunity for development of a strong project team that now forms the basis of the partnership. The ongoing well-established interactions of the Principal of the COM with others in the University of Glasgow College of Medical, Veterinary & Life Sciences, notably the Institute of Infection, Inflammation & Immunity (Blantyre-Blantyre project) and the Head of the School of Life Sciences, has provided a very fertile environment for the Dental School project to be nurtured and developed.

Evidence of need

Epidemiological data that illustrate starkly the oral health needs of the Malawian population have been generated by researchers in country during the 2014 Dental & Oral Health Survey (Msyamboza et al, BMC Oral Health, 2016, 16:29). The Health Sector Strategic Plan II 2017-2022 (HSSP II), published recently by the Malawi Government, quotes this survey as showing that 50% of school going children (6-9 years) and 78% of 12-17 year olds had tooth decay.

Poor access to oral and dental care has been recognised in a Policy Brief prepared and published as part of the Strengthening Capacity to Use Research Evidence in Health Policy (SECURE Health) Programme, funded by the UK’s Department for International Development (DFID), and implemented by a consortium of five organisations led by the African Institute for Development Policy (AFIDEP). It identifies a number of contributory factors including shortage of highly trained dental health workforce in the country (36 dentists for 18.8 million population), lack of a national oral / dental health policy and the need for introduction of a school’s dental health education programme, together with a national campaign on oral health.

Oral health has been identified in HSSP II as a component of the recently revised Essential Health Package (EHP). However, it is also one of the programme areas with the largest growth in commodity resource needs from 2017-2022 (estimated 111% increase in cost from 2017/2018 to 2021/22). This investment will require careful and strong management in the face of the challenges identified in the previous paragraph. Consultation with the Ministry of Health and Dental Association of Malawi has highlighted the shortage of highly skilled dental professionals, whilst direct interactions with officials from the Medical Council of Malawi, Ministry of Health and staff from the College of Medicine, have highlighted the ongoing challenges to delivering the ambitions of the HSSP II in the context of Oral Health. Success will rely on:

1. Establishment of a Dental School in Malawi which will train dentists in country with the appropriate skill set to deliver care in rural as well as urban locations. They will also provide the professional leadership as services are developed and expanded.
2. Establishment at Government level of an Oral Health Policy to permit formulation of a national Oral Health Strategy moving forward, including infrastructural and governance developments.
3. Embedding of feasible methods of disease prevention in the Oral Health Strategy, so that health promotion and education address the socioeconomic determinants that underpin oral health inequalities.

Project areas

Health service improvement
Higher education
Health policy

Project activities

Equipment donated by NHS Greater Glasgow & Clyde has been transported to Dentaid in Salisbury, serviced / repaired and is due to be shipped to Malawi in December 2019 for installation in the Dental Centre at Kamuzu Central Hospital, Lilongwe. Dentaid has also donated pre-clinical skills equipment (phantom heads) for use in Lilongwe.

A BDS curriculum has been developed, approved by the College of Medicine and is now proceeding for review and approval by the University of Malawi Senate

Changes

Improve the capacity of the dental professional workforce in Malawi
Establish an Oral Health Strategy for Malawi with a core focus on prevention of oral and dental disease

Next steps

Approval of the BDS curriculum by the Senate of the University of Malawi
Appointment of an academic lead for the Malawi Dental School
Entry of 15 students to the BDS 1 course in September 2019
Design of the Dental School facility on the College of Medicine campus at Blantyre
Establishment of a working group to develop an Oral Health Strategy with the Malawi Ministry of Health
Appointment of a Malawian PhD student to undertake a portfolio of work leading to development of a childhood dental caries prevention programme based on the Scottish Childsmile model

Challenges

The development of the plans for a Dental School facility, requiring architects, engineers, surveyors and other related design and equipment experts are challenging in country. Scottish Government is aware of these challenges for several of its funded projects and plans are afoot to work together on identifying more effective ways of working between Malawi and Scotland.

Partnership principles

  • strategic
  • harmonised
  • effective
  • respectful
  • organised
  • responsible
  • flexible

Project gains

  • leadership
  • teamwork
  • awareness
  • resilience
Towards a Dental School for Malawi – the MalDent Project

Contact information