Towards a Dental School for Malawi – the MalDent Project

Year established	2015
Sectors	Education
Country	Malawi

Overall goals

Establish a Bachelor of Dental Surgery degree programme at the University of Malawi College of Medicine (now Kamuzu University of Health Sciences).
Work to develop a National Oral Health Policy in partnership with the Malawi Government Ministry of Health, Scottish and Malawian partners and WHO AFRO.
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.

International Partners

University of Malawi College of Medicine (now Kamuzu University of Health Sciences)
Dental Association of Malawi
Medical Council of Malawi
Malawi Government Ministry of Health & Population
Malawi Government Ministry of Education
Malawi National Council for Higher Education
Wits University Dental School
University of North Carolina Dental School
World Health Organisation

Sustainable development goals

SDG 3 - Good health and well-being
SDG 4 - Quality education
SDG 10 - Reduced inequalities

Funding source

Scottish Government
The Borrow Foundation
HOPE Foundation, Royal College of Physicians & Surgeons of Glasgow

Project origin

The ambition of the University of Malawi College of Medicine (now Kamuzu University of Health Sciences [KUHeS]) to establish the first Bachelor of Dental Surgery (BDS) course in Malawi was initially shared during a visit to the University of Glasgow in 2015 by the Principal and some of his academic colleagues. Several attempts had been made to establish a BDS course over many years without success. The then Head of Glasgow Dental School (JB) was subsequently invited to become an adviser on the newly established Dental School project. JB was 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 College of Medicine, 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 subsequently formed the basis of the partnership.

Evidence of need

Epidemiological data that illustrated starkly the oral health needs of the Malawian population had 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 by the Malawi Government, quoted 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 had 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 identified a number of contributory factors including shortage of highly trained dental health workforce in the country (36 dentists for 18.8 million population at the time), 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 was identified in HSSP II as a component of the revised Essential Health Package (EHP). However, it was 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). Consultation with the Ministry of Health and Dental Association of Malawi 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, had highlighted the ongoing challenges to delivering the ambitions of the HSSP II in the context of Oral Health. It was agreed that success would rely on:

1. Establishment of a Dental School in Malawi which would train dentists in country with the appropriate skill set to deliver care in rural as well as urban locations. They would also provide the professional leadership as services were developed and expanded.
2. Establishment at Government level of a National 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

The BDS curriculum was approved in March 2019 and the first students entered the course in August 2019. There are currently (May 2024) 118 students on the BDS course, with the pioneer cohort of 10 students due to graduate as dentists in January 2025.

A National Oral Health Policy has been created and was launched by the Ministry of Health & Population in April 2022. An action plan has been developed and is now in the process of being implemented.

Malawi’s first National Child Oral Health Survey was undertaken in October 2023 and has identified a significant burden of untreated dental caries.

Work is underway to identify caries preventive interventions that would be appropriate for testing in Malawian schools.

Design of a new clinical dental teaching facility on the Blantyre campus of Kamuzu University of Health Sciences is nearing completion. Construction is due to start in 2024, funded by a $5.2m package from the World Bank.

Changes

The BDS course that has been established at Kamuzu University of Health Sciences will provide an annual outflow of young dentists, which will slowly improve the capacity of the dental professional workforce in Malawi. The latter currently stands at 40 dentists and approximately 100 dental therapists for a population of 20 million citizens.

The development and launch of the National Oral Health Policy for Malawi has laid down a blueprint for oral health improvement, with a core focus on prevention of oral and dental disease in concert with enhancement of facilities for treating established oral and dental disease.

Next steps

Ensure completion of design and construction of the new clinical dental teaching facility on the Blantyre campus of Kamuzu University of Health Sciences to provide necessary capacity as the course develops.

Maintain momentum of the National Oral Health Policy implementation plan.

Test and evaluate interventions to reduce dental caries in children as part of the development of a child oral health improvement programme for Malawi.

Begin a programme to enhance provision of clinical dental services in Malawian district hospitals and health centres.

Challenges

The current economic situation in Malawi impacts on all aspects of the project:
• Dentistry is an expensive course for Kamuzu University of Health Sciences to deliver.
• It is challenging for students to identify sufficient funds for a five year programme.
• Significant capital funding is required to upgrade dental clinics in Malawi’s Ministry of Health facilities.
• Many citizens are unable to afford oral health consumables such as toothpaste and toothbrushes

Mitigating challenges

Further grant funding is being sought through a consortium of UK and Malawian organisations, to ensure sustainability of the gains that have been made to date.

Partnership principles

strategic
harmonised
effective
respectful
organised
responsible
flexible

Project gains

leadership
teamwork
awareness
resilience

Related websites

The Maldent Project

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