Impact of Water Fluoridation on Workforce Planning in South Africa

An appropriate workforce to address the oral health needs and demands of the South African population has been described in a number of reports and publications. The planned introduction of water fluoridation for South Africa will impact on the oral health workforce required to deliver the minimum package of oral care in the public oral health services.

Objectives: To investigate the impact of water fluoridation on oral health workforce requirements to deliver the minimum package of oral care to 4- to 15-year-old children.

Methods: The WHO/FDI (1989) and a “Service Targets Method” model were used to calculate the workforce requirements to deliver the minimum package of oral care.

Results: Without water fluoridation, oral hygienists represent more than 50%, dental therapists between 30 to 40% and dentists less than 10% of the oral health workforce required to deliver the minimum package of oral care. At an anticipated caries reduction of 30% due to the introduction of water fluoridation, the number of dentists required decreases by 29%, dental therapists between 27.5 and 29.8% and oral hygienists between 2.1 and 10.5%. This converts to a saving in salary of R14,8 million per year.

Conclusions: This study supports an increase in the training of oral hygienists for employment in mainly the public sector. The number of dental therapists and dentists currently being trained should not be increased. On the short to medium term a year of compulsory community service after graduation, which was introduced in 2000 for dentists, should be expanded to include both oral hygienists and dental therapists to deliver the minimum package of oral care. On the long term a number of posts should be created, linked to incentives, to attract both oral hygienists and dental therapists for employment in the public oral health services.