location: nan, 'Thailand 
year: 2002 source: HSRI 
title: The dental personel from health system reform in Thailand 
abstract:The present study aims to reassess and synthesyze the framework of dental personnel development, focusing on dentist and dental nurse, through literature review and qualitative study.The results of the study showed that;  The influential  future streams of changes came from various directions and dimensions.  The main influence induced from the Health System Reform in Thailand  which reshuffled the legitimize structure of all sectors in the broadly defined “health system”, as well as extensively mobilized the current social paradigm and norms, particularly through the concepts of  health-oriented rather than disease-oriented and holistic health.  The health care services was remodeled mainly by financial and administrative measures and expanding the public sector service to include more private involvement.  The reform occurred concurrently with the amendment of the government service system, education system and the decentralization of authority over public enterprises to peripheral units.  In the other side, the expansions of capitalism, comsumerism, free  trade,  globalization, information technology, medical technology were also indicated for their influential  effects.  The change of Thai social structure as well as the current weak points of dental profession including insufficiency of self-dependency dental technology,  the imbalance of institutional knowledge /technology and the appropriate dental knowledge concerning the contexts of Thai society, as well as the limitation of some competence and attitude in graduated dental personnel, should also be taken into account. Apart from these, the reviewed of current dental public health situations and their trends showed that:  Dental caries rate of primary teeth in pre-school children was highly increased, notably in the rural area.  The rate of consuming cariogenic food also deeply increased during the past decade. Dental service utilization of the people was low, especially in elderly and rural people, mostly driven from acute symptom rather than from preventive approach.  The cases of dental profession code of ethics were in the increasing trend.    The future characteristics of dental personnel, apart from the basic professional knowledge and skill, should focus attention on:  the knowledge and skill of health promotion and social mobilization, thinking process, research and long life learning, team work coordination, communication skill, patient relationship and the extensive background of  non-professional knowledge to comprehend the situation and changes of the holistic world.  For the personality aspect, dental personnel should be raised in leadership, emotional literacy, human relationship and the mind of ethical integrity and responsibility to public. The role of dental personnel should be consequently adjusted, notably in the highly overlap role between dentist and dental nurse which partly reflect to the low team work performance affecting the efficiency of dental service outcomes. Dentists, especially in public sector, tended to provide too high proportion of simple services which were the majority of demand, resulting the under provision of the needy complex dental services.  While the interchangable of majority dental services by two types of dental personnel was increasingly be questioned by people under the health insurance system.  In the other hand, dental nurse faced the struggled of career ladder progress.  The direction of the solution, concerning the whole complication of each alternatives, should focus on the improvement of the ‘dental team’ or ‘oral health team’ which had to be systematically defined and organized.  The dentist, the team leader, should mainly responsible in taking care of holistic oral health care, planning and monitoring the overall oral care system, clinical diagnosis and holistic treatment plan, quality control and provide the complex dental services with the sufficiently assisting by dental auxiliaries including dental nurse.  This oral health team approach should be more relevant and flexible for the wide gap situation of dental manpower in the country than the legalized regulation limiting the curative role of dental nurse or to provide the license to dental nurse to work independently.  This approach allowed the oral health team to adjust the borderline roles of dental personnel within the team with the administrative means according to relevant place and time. The supporting training for increasing the oral health team approach should be started from the educational and training period.The recruitment of dental personnel, particularly in the government sector, should involve the community role in the enrollment process of dental student.  The involvement might be in selection process, educational expenditures support, field work training and employment in the local health care unit.The dental education direction have to be balanced between the aim to meet the advancement of dental institutional knowledge and technology and to rightly response to the oral health problems and needs within the belonging social circumstances. The educational process should be developed under the concepts of social or community based, patient-centered, active learning through research and thinking skill enhancement, comprehensive ethical motivation and the extensive evaluation and quality assurance of educational outcomes.This administration of the changing process in dental education should be implemented by adjusting the policy, improving educational manpower as well as providing the appropriate supporting environments such as:  connecting the education institutional dental service with the national or regional health service system, providing the relevant infrastructure and social environment, or developing the curriculum under local community participation.  The distribution of dental personnel in public sector by national monitoring through the compulsory contract of dental students was still considered as necessary. However, the pattern of distribution process tended to be directly indicated by the need or outcome estimation rather than by the current frame of the Civil Servant Office.  The concept of the mentioned  “oral health team” should be taken as the guideline for dental manpower distribution.  The increasing production of dental nurse was clearly indicated as well as the extension of dental public service involving private sector. The distribution management should be run concurrently with the recruitment of dental students and should include the motivational and supporting measures for the remote or the unmet need areas.The capacity building and quality control of manpower should be continuing implemented through the professional standard regulation involving the institutional quality assurance ie. Hospital Accreditation system and individualistic quality control (such as. professional licensing/ relicensing and continuing education).Licensing  by central examination from The dental council was questioned for its difficulty in developing  the complicate and professionally acceptable examination representing the overall achievement of dental education. It was suggested to be implemented only in case of the dental education of Thailand were generated by numerous and  various types of dental schools where the standard control through educational programme monitoring was inconceivable.Even though the relicencing was widely accepted for the necessity, it was scrutinized for the ability of measuring essential competence, as well as its cost-benefit and its concomitance to the quality from the consumer point of view.  It was suggested that relicensing should aim for consumer protection and utilize various evaluative methods rather than rely only on the examination or formal training.The professional control by the public was also the simultaneous measure of quality control. Several approaches were recommended such as the participation of people sectors in the policy board in many levels of the health system, the patient/ people satisfaction evaluation as a part of Hospital Accreditation, the involvement of consumer/people representatives in professional council and the board of dental educational institutions. The progression in professional career in the governmental sector should be separate to the administrative career.  All health professions should be promoted equitably among each other as well as in comparable to the administrators.  The promotion in the public health administrative line should be opened to any competence persons regardless of their professional backgrounds.The planning of the general practitioner and the specialist proportion should be closely supervised to meet the actual need estimation.  The dental specialty branches should be reduced to provide the more comprehensive dental specialists. The recognition and support for general practitioner should be improved such as establishing the system of on-the-job training to enhance the all-round dental skills and knowledge to the general practitioner, leading to the namely the specialist in general practice or family dentistry.  The mechanism of the overall policy making and planning regarding dental manpower should be established as an integrated part of the health manpower system in