United Nations Public Service Awards Case Studies

Since disabilities can be caused not only by congenital factors but also by acquired factors such as various diseases and accidents, it is expected that the number of disabled persons will gradually increase. Also, most people with disabilities are unable to receive medical benefits and proper treatment due to social discrimination including difficult economic conditions and mental and physical disabilities.
This situation shows that the provision of medical benefits for the disabled has become a priority issue. Accordingly, government agencies and various medical organizations have been acting to improve the situation; however, the result has not yet been quite satisfactory.
In particular, oral health benefits for the severely congenitally disabled require the most attention. Most congenitally disabled people have not had the ability to care for their teeth by themselves since childhood. As a result, oral diseases like cavities develop faster in this population and are usually not treated until adulthood. The weak teeth that result from long-term neglect and lack of care cause pain while chewing and often prevent the sufferer from knowing the taste of food for the rest of his life. This raises the issue of the necessity of systematic dental care from early childhood.
Moreover, treating severely disabled people (e.g., the mentally challenged) requires more time, workforce, and special equipment since patients often have difficulty communicating and can be prone to seizures. Therefore, local dental clinics have difficulty providing treatment to this population. As basic treatments are provided mostly through religious organizations, offering professional treatments to this group has become a critical task.
Due to the many requirements such as special equipment, a specially trained workforce and treatment spaces and limitations, dental clinics for the disabled had not been established as of 1996. Local dental clinics recognized that this particular population was hard for them to treat and facilities and workforce for this purpose did not exist. This made the participation of public organizations imminent.
The Korean Dental Association, the Seoul Metropolitan Government and many other organizations attempted to implement a dental clinic for the disabled in the early 1990s, but they failed without achieving any results due to difficulties securing a professional medical workforce, expensive medical equipment, high operation expenses, and dentists' lack of understanding of the disabled.
However, since 1996 qualitative changes in oral healthcare for the disabled created the opportunity for new medical policies to expand and develop. This began with the opening of the dental clinic for the disabled by Seocho-gu Community Health Center in collaboration with voluntary professional dentist groups.
September 1996, at the suggestion of the renowned doctor of dental surgery, late Chang-Deok Ki, marked the starting point of the establishment of Korea's first dental clinic for the disabled in collaboration with the Seocho-gu Community Health Center and voluntary dentist groups (dentists, dental hygienists, dental technicians, etc.) to address the inconvenience of disabled dental patients, opening a new chapter in the oral health project

What is the initiative about? (the solution)
Seocho-gu dental clinic for the disabled has provided treatment to improve the oral health of the disabled since its opening on September 23, 1996 with voluntary dentist groups including dentists and dental hygienists. In its beginning, the disabled who were suffering from oral diseases flowed in from all over the country for treatment. In 1997, the dental clinic adopted prosthetic treatment; in 2003, it started dental implant treatment. In addition, the clinic was the first to provide treatment in connection with the volunteer work system as a local self-governing organization in Korea. Organizations in and out of Korea have benchmarked and introduced similar projects. The main benefits and effects of the project are as follows. First, contributed to improving the society where people live together. The dental clinic for the disabled project allowed people to see that the disabled population plays an important role as members of society by helping people to pay more attention to the disabled’s difficulties and inconveniences and by providing opportunities to volunteer more in social activities for the disabled. - No. of volunteer dentists (man-days): Total 2,175 Second, improved quality of life of the disabled and gave them hope. By providing various dental treatment services to the disabled who felt left out and isolated from their basic rights due to their mental and physical challenges, the project improved their quality of life and gave hope and courage for a more active life. - Dental treatments (September 1996-November 2010): Total 21,734 people (Tooth extractions 2,348, amalgam restoration 4,064, prosthetic treatment 1,135, other treatments 13,647) Third, evaluated as a main policy which suggested new roles and directions for public health organizations. Public health organizations have to play a role in areas that private health organizations have difficulty handling for the medically marginalized in the society rather than competing with the private sector. The dental clinic for the disabled project is a welfare policy which emphasizes providing continuous management and consideration to the socially isolated class, and the project has been evaluated as an excellent health policy which suggested new directions for medical welfare. - Establishment of the Oral Health for the Disabled Department, the Korean Government, enactment of the Oral Health Act, announcement of the plan to establish 13 dental centers for the disabled, etc. Fourth, expert volunteer activity is established in the society and a reliable benchmark of this practice was established thanks to the participation of professional dentist groups in the project. The clinic provided an opportunity for experts to participate in volunteer work rather than cursory volunteer activity. In addition, it has been expanded to 1) free volunteer treatment in the evening by the Seocho-gu Medical Association and 2) Saturday volunteer work by the Association of Seocho-gu Korean Oriental Medicine. These practices have had a huge influence on public organizations’ operation of dental clinics for the disabled such as the establishment of the Seoul Dental Hospital for the Disabled and treatment of disabled patients at 355 general dental clinics.

Who proposed the solution, who implemented it and who were the stakeholders?
The Seocho-gu Dental Clinic for the Disabled began with a suggestion from the now late dentist, Chang-Deok Ki. In 1983, at the building completion ceremony of Seoul Seongbundo Education Center for the Disabled, located at Gwangju-gun Gyeonggi-do, Chang-Deok Ki who was then a professor of Catholic College of Medicine met the first elected mayor of Seocho-gu, Nam-Ho Jo, then director of the Seoul metropolitan city director for bureau of health welfare. In 1996, the Seocho-gu Community Health Center first opened due to the suggestion by doctor Ki. Much interested in the dental treatment of lepers and needy neighbors, Doctor Chang-Deok Ki found it difficult and inconvenient to provide dental treatment to the disabled and asked then mayor Nam-Ho Jo of Seocho-gu to open a dental clinic for the disabled. Then Mayor Jo authorized the Seocho-gu Health Center to open a dental clinic for the disabled on its first floor. Employees of relevant departments such as the head of the medicine department Young-Hyun Kwon and team manager Chil-Soo Jeon drafted execution plans and led cooperation with relevant organizations for its systematic operation. In particular, the most important and difficult matter in medical treatment is securing professional dentists and a medical team. Thus, cooperation of the Seocho-gu Dentist Association was a pressing matter. Several meetings and discussions were held regarding details about the participation methods. During the establishment process of the dental clinic for the disabled, there was undivided support and cooperation from noted authorities of the time in the dental area including Professor Jae-Ho Lee of Yonsei University and Professor Geong-Ho Lee of Gyeonghee University and professional dental clinics such as Gangnam Ye Dental Clinic. Therefore, the Seocho-gu Dentist Association played an important role in opening the Seocho-gu Dental Clinic for the Disabled and became a volunteer group which practices noblesse oblige for needy neighbors by treating the disabled as family in volunteer activities. Currently, the number of registered volunteer dentists to the dental clinic for the disabled is 278 and they treat patients from Monday through Friday 09:00 - 18:00. The treatment services include amalgam restoration, tooth extraction, curettage of periodontitis, operative treatment and scaling. In particular, they offer prosthetic treatment and implant treatments free of charge to disabled welfare recipients who live in Seocho-gu. Graduates from Seoul National University Dental School who are moved by Doctor Ki's love for the disabled participate in the volunteer work. On December 27, 2005, Doctor Ki received an award at the 22nd Korean Catholic Social Volunteer Award held at the Seoul Myeongdong Catholic Hall.

Describe how and when the initiative was implemented by answering these questions
a. What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
The dental clinic for the disabled project is a humanist welfare health project that aims to address the difficulties of disabled people who can't get proper or timely dental treatment due to the absence of dental clinics in Korea which can provide dental treatment to severely disabled people such as autistic children and people with cerebral palsy. Doctor Ki, who felt sorry for the pain of severely disabled people while participating in dental volunteer work at a social welfare facility for the disabled, felt the urgency to have a dental clinic for the disabled in Korea and suggested establishing one to large scale universities and public organizations. But it was not accepted due to the conditions in Korea. In 1996, Doctor Ki’s encounter with then mayor of Seocho-gu, Nam-Ho Jo, became an opportunity to make the suggestion a reality. Finally, in July 1996, Seocho-gu Community Health center established a plan to open a dental clinic for the disabled for the first time in Korea, and implemented the plan in cooperation with the volunteer work system by securing special equipment and a medical workforce which genuinely understood severely disabled people’s difficulties to create a space where severely disabled people could get treatment with confidence. First, the clinic encouraged local community participation through volunteer work as a strategy to secure a professional medical workforce. We visited local dental clinics in Seocho-gu and explained the purpose of the project in detail. Moreover, we encouraged the Seocho-gu Dentist Association to participate in the project by sending a letter of cooperation at the same time. In particular, active participation of the association led to the implementation of special treatment of the disabled training for the volunteer workers and the creation of a completely volunteer medical team composed of dentists, dental hygienists, dental technicians and nurses who completed the training program. In the beginning, the team had only 5 volunteer dentists. There are currently 278 dentists participating not only from Seocho-gu, but also from other districts as of November 2010. Up to now a total of 2,175 man-days have been volunteered at the clinic. Next, at that time there were no domestic medical equipment manufacturers companies which produced special dental equipment for the disabled making it difficult to acquire the special unit chairs matching the requirements of Seocho-gu. However, to overcome this difficult situation, we visited a general medical equipment manufacturer and explained the equipment needs and participated in the manufacturing processes. As a result, we succeeded in developing new special unit chair equipment, and our request created an opportunity for the company to manufacture special equipment of an advanced country level. The project started as completely private sector volunteer work but expanded to the public sector with the establishment of a dental clinic for the disabled, compulsory establishment of oral health policies by the Disabled Oral Association and the government. The Seocho-gu volunteer dentist group takes pride in being the catalyst to all this.

b. What were the key development and implementation steps and the chronology? No more than 500 words
The dental clinic for the disabled was suggested by an expert and reviewed by the Seocho-gu Community Health Center, and its implementation plan was established in May 1996. In July of the same year, Seocho-gu Council secured the required budget and the volunteer group of professional dentists was composed. Finally, on September 23, 1996, the dental clinic for the disabled was opened for the first time in Korea on the first floor of the Health Center. What is all the more meaningful is that thanks to the medical group of volunteer workers, the clinic can be operated on an annual material expense of 5 million KRW. Famous Korean singer Taiji Seo donated 10 million KRW for the purchase of medical equipment and 'Guwahata Tsuneyaki' a member of the International Dentists Association, donated 100,000 Yen. At the beginning in 1996 treatment services included amalgam restoration, tooth extraction, periodontal disease treatment and scaling and were offeredon every Tuesday and Thursday. Beginning in 1997, the number of days for treatment increased from 2 to 3, and, in 1998, prosthetic treatment and basic dental treatment were introduced. In 1999, the number of treatment days was increased to 6 days a week. In early 2003, the implant treatment, the latest dental treatment to implant teeth for severely disabled low-income people, was started, establishing itself as a dental clinic for the disabled. It began with 10 types of treatment equipment for the disabled including 2 dental unit chairs for the disabled, a blood pressure unit and pulse measuring equipment for general anesthesia and an ultrasonic scaler in 1996. But, it has been equipped with Pos Vision through which a patient’s guardian can observe the treatment procedure, a respiratory anesthesia system and a vehicle equipped with a wheelchair lift in 2000, implant equipment in 2002 and a panorama x-ray in 2003. The fifth-elected mayor, Ik-Cheol Jin puts forth a lot of effort to expand equipment for the disabled to get the best treatment. He purchased digital x-ray equipment by utilizing the incentive budget, which was received through the Seoul Health Center Incentive Project Evaluation in 2010. The number of patients was 116 in 1996, 1,158 in 1997 and 1,375 in 2005 and totaled 21,734 as of November 30, 2010. The users came more from other districts and other cities (58.3%) than from Seocho-gu (41.7%), which demonstrates that the dental clinic for the disabled project is not only for the severely disabled in Seocho-gu but also for the severely disabled from other areas. A continuous increase in the number of users is indicative of increasing satisfaction and confidence in the professional services offered at the clinic. At a meeting commemorating the 14th anniversary of the opening of the Seocho-gu Dental Clinic for the Disabled in September, 2010, the fifth-elected mayor of Seocho-gu, Ik-Cheol Jin, asked for continuing efforts in promoting the first clinic for the disabled in cooperation with professional volunteers not only in Korea but also around the world and bought medical malpractice liability insurance for the volunteer dentists in order to enable them to treat the disabled without the fear of being sued.

c. What were the main obstacles encountered? How were they overcome? No more than 500 words
In 1996, there was no medical organization where the disabled could receive professional treatment in Korea. Due to the lack of social recognition that society needed a dental clinic for the disabled, there was no social infrastructure that served this purpose. Therefore, there have been many difficulties from the preparation stage to the establishment of a dental clinic for the disabled because of poor conditions and systems. In a nutshell, the initiative faced three main challenges: securing 1) a professional medical team; 2) proper medical equipment; and 3) supportive organizations. First, it was hard to find medical professionals who could treat severely disabled people, the most difficult population for dentists to treat. What was important was to secure a medical team that was full of a sense of duty and commitment and that could warmly care for the disabled, whose treatment is several times harder than that of the average patient. To address this problem, in-charge public officers of the Seocho-gu Health Center visited dentists’ offices one by one to explain the purpose of the project and encouraged them to participate in the project. Also, with the active cooperation of the Seocho-gu Dentist Association and the late Doctor Chang-Deok Ki, we were able to provide training for the treatment of the disabled. Dentists, dental hygienists, nurses and dental technicians who completed the program compose the volunteer medical team. Second, there was no company in Korea which could manufacture the special equipment needed for reliable dental treatment of the severely disabled. Purchasing equipment overseas entailed a huge expense, which was also the main cause for other public organizations not being open to a dental clinic for the disabled. To solve this problem, we researched special dental equipment for the disabled at 'Tokyo Oral Health Center for the Mentally and Physically Disabled, but failed to gain anything from this. To address this issue, in-charge public officers of Seocho-gu visited a medical equipment manufacturer and explained the situation. They finally developed a special unit after many trials and errors in cooperation with the employees of the manufacturer. The unit is an advanced-country level piece of equipment and it can be separated into a set and chair. Its revolving panel and handle make it easy for the patient to step on and off. Third, it was difficult to acquire the funds for the equipment purchase. The budget was to be approved through the district council prior to the implementation of the project, but most of the district councilmen were against the project due to their lack of recognition about the necessity of a dental clinic for the disabled. At that time, the director and team manager of the health center met with councilmen in person to explain the purpose of the project and secured the budget to purchase the necessary dental equipment. We were also able to secure equipment through donations from Korea's famous singer 'Taiji Seo' who was associated with Seocho-gu and cooperation from a Japanese volunteer dentist group for the disabled.

d. What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
Financial resources for Seocho-gu Dental Clinic for the Disabled: In 1996, the finances of Seocho-gu were secured for the purchase of special equipment along with donations and rewards in evaluations from outside organizations. In 1997, Korea Lions Club donated 10 million KRW In 2000, Seocho-gu received 100 million KRW for its selection as an exemplary gu (district) in health and medical services in Seoul In 2005, Seocho-gu received 3 million KRW at the Catholic Awards; In 2010, Seocho-Forum donated unit chairs for the disabled In 2010, Seocho-gu received 23 million KRW in incentive rewards for being selected the best gu in the health center project evaluation. Technology resources for Seocho-gu Dental Clinic for the Disabled: The knowhow of Doctor Chang-Deok Ki who had rich experience in treating the disabled and professional knowledge and the experiences of the medical team of the Seocho-gu Dentist Association has been a great help to the project. There was also help from a professional medical equipment manufacturer in developing the equipment which fulfills the disabled requirements. Human resources for Seocho-gu Dental Clinic for the Disabled: The clinic has been 100% operated by volunteer dentist groups. The Seocho-gu Community Health Center holds meetings frequently to listen to their difficulties and provides all the necessary support. Also, the Seocho-gu Dentist Association has provided continuous cooperation and support for the development of the project as it mandated that dentists who open new offices are required to participate in the volunteer work at the dental clinic for the disabled every Thursday. The project was a collaboration masterpiece by committed volunteer workers, donors, the mayor of Seocho-gu and relevant public officers. It has provided positive motivation for the disabled and their families who suffer from social discrimination.

Is the initiative sustainable and transferable?
Operation of the dental clinic for the disabled requires consideration and recognition about the pain of disabled people, who are a weaker part in the society, and strong institutional support by the central government. Therefore, the dental treatment and oral health support project for the severely disabled is a representative project for medical equality which can help the disabled to live happier lives. The dental clinic for the disabled should be settled through a sustainable welfare system for the disabled with the government-level integrated promotion system and facilitation of citizens' governance. To make it a sustainable policy: Institutionally, the Ministry of Health and Welfare started to pay attention and support disabled people's oral health by establishing the Oral Health Department in 1997. The enactment of the Oral Health Act found legal grounds for the oral health project for the disabled in 2000. Socially and culturally, the volunteer dentists of the Seocho-gu Dental Clinic for the Disabled launched the Korea Dentist Volunteer Association for the Disabled in December 1996, and dentists around the country declared 'the Dentist's Moral Code, the Disabled First' in 2002. Dentists, figures in academia and society established 'Smile Welfare Foundation' for the treatment of the severely disabled in 2003, and, in 2004, Korea Dentist Association for the Disabled was established. Also, the Seocho-gu Dental Clinic for the Disabled, as Korea's first policy to improve the oral health and dental treatment of severely disabled people and a byword for a dental clinic for the disabled, received the Catholic Award and was selected as an exemplary gu (“district”) in health and medicine. The in-charge public officers received Best community service award for their efforts. The project has been widely benchmarked. In September 2005, then chairman of the Korea Dentist Association, Doctor Su-Gu Lee suggested that the mayor of Seoul (the current president of Korea) establish a dental clinic for the disabled (located at Hongik-dong, Seongdong-gu, the old site of the Police Hospital) and 25 health centers including Gumi-si Health Center of Gyeongbuk. At his suggestion, 355 general dentists began dental treatment for the disabled. In 2009, the central government announced that 9 oral treatment centers for the disabled would be established between then and 2013 and selected Jeonnam University Dental Hospital for the Disabled in 2009 and Dankook University Hospital in 2010 for the announcement. Currently, these oral treatment centers for the disabled are under construction. In 2011, it plans to support the establishment of the centers by selecting Jeonbuk University Hospital and Jeju Rehabilitation Hospital. In addition, in the private sector, the project has established a general medical welfare policy with the establishment of the university hospital's dental clinic center for the disabled and the opening of a dental clinic for the disabled. It may also be an appropriate model for developing countries which do not have many medical benefits for the disabled to benchmark as a medical welfare policy.

What are the impact of your initiative and the lessons learned?
The project's influence on the country is that it laid the cornerstone to develop oral health projects for the disabled in Korea as a humanist welfare policy which recognizes that the disabled people are also integral members of our society and provides courage and opportunities to live in a sharing society. Also, the key success factor of the project was the implementation of a medical welfare policy based on volunteer work and the determination of the heads of organizations and committed volunteer activity and cooperation of local health organizations, promoting strong wills and mature citizens' participation in the local community. In addition, the biggest change and lesson from the project is that establishment of the dental clinic for the disabled for all the disabled people in the country was not done by the central government but by the Seocho-gu Health Center. This became an opportunity to raise awareness about the importance of oral health for the disabled nationally and socially and develop a government policy related to this. The project is recognized as a starting point of citizen governance which is operated by dentists, public officers and social groups all together. In particular, the dental clinic for the disabled finds a way for severely disabled people who are largely isolated from oral health area to receive professional dental treatment and a structured oral management system such as education about the importance of caring for their teeth from childhood. It also presents a lesson that a public health organization and community health centers can have a leading role in the area. Also, the participation of medical teams and social leaders in volunteer work helps establish the volunteer work system as a means of realizing noblesse oblige and is a huge motivation to organizations at home and abroad.


Institution Name:		Seocho City Office (Seocho-gu)
Institution Type:		Government Department
Contact Person:		GYESUN LEE
Title:		assistant manager
Telephone/ Fax:		82-2-2155-6378
Institution's / Project's Website:		82-2-2155-6409
E-mail:		catherine120@seocho.go.kr
Address:		Seocho city office,2584 Nambusunwhanno(1376-3, Seocho-dong),Seocho-gu, Seoul, South Korea
Postal Code:		137-043
City:		Seocho
State/Province:		Seoul
Country:

The Problem

Solution and Key Benefits

Actors and Stakeholders

(a) Strategies

(b) Implementation

(c) Overcoming Obstacles

(d) Use of Resources

Sustainability and Transferability

Lessons Learned

Contact Information