Questions/Answers

The main objective is to improve the oral health status of Phuduhudu community and offer the oral health team and community a platform to act and help reduce disease burden. That is involving the community in the planning and the implementation of their oral disease preventive programmes. This entailed consultation with the community and other stakeholders, the oral health team pitching up in the community for members to come up for screening,the team following up community members(house to house campaign) and identification of needy situations, programme design targeting identified groups (early childhood,Maternal and under fives,people with special needs/challenged individuals,school health programme) organization of workshops,stakeholders symposium,forming and resuscitation of village committees,oral health team voluntary and social responsibility activities(primary school signage, fire assembly point and new main gate installation), provision of oral health services(oral health education,tooth fillings,tooth cleaning,tooth extraction,provision of artificial teeth) and commemoration of World Oral Health Days.The community was given focused attention with the aim of reaching every community member(young and old) for oral health services( living no one behind).

This initiative targets the whole population in this identified village, the old,young,physically and mentally challenged.The village is geographically disadvantaged in terms of access to services in general.Phuduhudu village is situated some one hundred and twenty four kilometers (124kms) east of Maun (nearest regional oral health facility). It is a small rural settlement.The initiative has never been implemented anywhere in the region and or nation,it is therefore distinctively new,innovative and unique in Botswana. The village is inhabited mainly by khoisan tribe ,nomadic with unique traditional practices,high risk behaviors (tobacco smoking and alcohol abuse)they are economically disadvantaged from national main stream.

This initiative addresses the health and well being SDG.It focuses on continuous service provision. Through oral health services, the initiative reduces pain and suffering, among geographically disadvantaged settlements at very minimal cost.The initiative empowers the community to seek health services by raising their level of knowledge .The Initiative also empowers the community to plan and implement their own oral health services hence increases ownership and sustainability of the initiative. Oral health education is shared with children and expectant mothers to raise awareness on child development and growth,including growth of oral tissues (teeth,gums,soft tissue ) and their nutrition.

In Botswana we have various programmes tailor made for vulnerable groups.The initiative identifies gaps within some of the programmes e.g food basket to people with disabilities does not come with a package of helper to provide cleaning,cooking and washing services to the disabled.The initiative through consultation with stakeholders is raising awareness for such services to be provided for them,through engaging existing community structures e.g village authority (kgosi) Village Development Committee,Village Health Committee,Home Based Care Committee and Social Worker.The initiative brings in other public service departments to address relevant identified needs/service to their departments e.g provision of sanitary pads for the girl child not to miss school.During the course of the initiative local and regional governance in public administration is informed and support sort through stake holder symposium.The initiative uses the RECM (Reach Every Community Member) strategy,to provide needed or identified services at individual level irrespective of age,gender,race or economical status.The Initiative brings harmony and peace ,by engaging the whole community to work together towards achieving their common goal.The initiative impacts the whole community positively by providing a disease free and healthy community.The initiative brings a number of people during workshops,commemorations and other activities hence economically empowers small businesses.

This was the first time in history of oral health services in Botswana for such services to be taken to communities in such a manner and approach.Never before have oral disease preventive programmes being designed in such an inclusive manner.It engaged the community in the planning and implementation of their health services.This called for establishment of good rapport and trust with the community.This lead to better understanding of the community needs and situations.Screening for oral diseases and conditions,and oral health education is done in individual homes to reach every member and appreciate their environments and living conditions.

As mentioned above this initiative is an original idea,which came as a result of a situation the Ngami oral health team found themselves in.There was a need for a strategy that could improve accessibility of oral health services to small remote settlements.The only regional oral health facility in Maun serving 150 000 people, was overwhelmed by patients numbers and disease burden.This resulted in Phuduhudu Community Oral Health Project initiation. This also lead to re-organization of the oral health team and assign oral disease preventive programme coordinators.Designed programmes are as follows;Early Childhood,Maternal and Under Fives; School Oral Health Programme;Special Needs;Project Village.

Because of the good results yielded from this initiative,the Project Village concept was replicated in two other regions in Botswana (Okavango and Chobe regions). The initiative is still relatively young (three years). Our organization is not aware of any replication in other countries. The concept has however been presented before the Public Service Day Convection, University of Botswana Primary Health Care Conference and Ministry of Health and Wellness Work Improvement Teams (WITs) convection.The project was highly applauded but has never competed for awards .A recommendation was made to Ministry of Health and Wellness to roll out the initiative nationally.

The initiative is implemented through Ministry of Health and Wellness manpower,financial and equipment material resource.The team was composed of the following; Project Executive, Project Sponsor, Project Manager working with six team members.The Ngami District Health Management Team (DHMT) provided all the needed transport,dental equipment and materials, office equipment and stationery .The project is operating under normal institutional expenses/budget.The Ministry of Health and Wellness allocates funds to its institutions in different regions on yearly basis countrywide.

The initiative is sustainable.Socially, It is sustained by oral health team making scheduled visits to monitor implementation of health promoting habits and behaviors by community members.The team reinforces oral health messages (oral health education) and hold regular meetings with front line activists(village committees, village authorities, civil servants,traditional doctors) and student marshals(primary pupils). These front-line activists and student marshals provide feedback to visiting health teams. The feedback is used to re-orientate health services and programmes.The oral health team provide updated information,education and communication (IEC) materials .Economically this initiative is sustainable because its running within the budgeted expenses.There are no extra financial costs beyond budget furthermore the involvement of other stakeholders/sectors (multi sector approach and multi disciplinary approach) reduces the expenses even further as they play a part. On the environmental aspect, the initiative has not interfered with the natural environment setup, as it is a human behavior change initiative. However, the Ministry of Environment, Natural Resources Conservation and Tourism through their department of Forestry is fully involved in the project as one of our stakeholders. They provide advise.

Yes

The project was evaluated in three ways. 1. Continuous monitoring and evaluation: The team evaluated the initiative as the project is running through observations and meeting with relevant stakeholders 2.After two years of project implementation: The project was evaluated now using a structured evaluation tool.(see Annex 3, Evaluation report March 2018). 3. External evaluation; This evaluation was carried out externally by Directorate on Public Service Management.

1. Distance to the targeted village from the Oral health facility ( the intention is to reach out to all). 2. Total population to be reached( population <1500 people). 3. Percentage level of knowledge( random sampling Oral health education). 4. Total percentage of population provided with Oral health education. 5. Total percentage population screened for oral diseases and conditions. 6. Total percentage population identified with oral diseases and/or conditions. 7. Total percentage population treated for oral diseases and/or conditions. 8. Total Percentage level of reduced disease burden. 9. Total Percentage level of improved oral health status.

Reaching out to the Phuduhudu community village increased accessibility and raised awareness and coverage in oral health issues. Essential Health Service Package (EHSP) i.e. screening, health education and treatment were provided. 92% of community members were screened out of total population of 600.from which baseline information was derived. Disease burden was reduced by 45.7%. Community knowledge and awareness was raised by 25.2% through engagement of Village Health Committees, front line activists and students marshals who helped to spread the message. Expecting mothers and caregivers were enrolled into series of health education and demonstrations on good oral hygiene practices.

The stakeholder collaboration played a key role in both the design and implementation of the initiative. They consisted of the following: Phuduhudu community leaders( Chief, chief advisors Village elders)- for authority to conduct initiative Tribal office- for communication and secretariat Water utilities cooperation- for water purification and fluoridation Mogolokwane Primary school- school Oral health programme Phuduhudu health post- drugs, consultaion and counselling Traditional doctor- Traditional beliefs on oral health issues Village Development Committee-Community mobilization and engagement Village Health Committee-Community mobilization and engagement Village choir- Edutainment Village football club- social interaction, entertainment fitness and peace Traditional guitarist- Edutainment Parents and Teachers’ Association (Mogolokwane Primary School)-Committee-Community mobilization and engagement Community Trust-Community mobilization and engagement Community Home Based Care-Community mobilization and engagement Botswana Police - peace, protection and security Botswana Defence Force- peace, protection and security Central Transport Organisation (CTO)-transport services Fire Department-safety and service provision Tebelopele (HIV testing and counselling centre) Emergency Medical Services (EMS) Supplies Office- procurement Social worker- Guidance and counselling Physiotherapy unit- service provision Dietetics- service provision Public Relations Office-communication and publicity Member of Parliament- value addition Ministry of health and wellness- resource provider

Public servants hardly reach out to communities hence loose touch with real community needs.The results are; ineffective use of available resources and services. Health promotion strategies(advocacy,mediating and enabling) in community context will fade away.The purpose of the Ottawa Charter health promotion action areas will be defeated, thus resulting in loss of confidence and trust on the health system,increased disease burden. We learnt; its possible for civil servants to take services to communities as a team through the multi sectoral and multi disciplinary approach. Its possible providing health services despite challenges, through community participation, unity and botho. Enhance service provider skills.