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Dental Public Health Activities: Descriptive Summaries

Head Start Oral Health Forum and Action Plan

Practice Number: 58004
Submitted By: Ministry of Health, Republic of Marshall Islands
Submission Date: October 2005
Last Reviewed: October 2005
Last Updated: October 2005
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In the Republic of Marshall Islands (RMI), the Bureau of Primary Health Care began the first systematic collection of oral health data in the elementary schools, Head Start and pre-head start children in 2001. Data showed that the prevalence of early childhood caries was very high and that the children had received neither preventive nor curative services. Recognizing the high level of need in the RMI, the Ministry assigned a dentist for preventive services and implemented a nationwide program of oral health services. A major part of the challenge to this program is to break the isolation of the Head Start oral health services in order for it to meet mandated responsibilities.

A unique opportunity presented through a HRSA/ASTDD grant to hold a forum to develop an action plan for improving the oral health of children enrolled in the Head Start Programs of RMI. The grant provided $4,965.00 to support convening the forum. A Core Planning Group (CPG) was established comprising of representatives from the government agencies involved in Head Start and health programs that included: (1) Ministry of Health Preventive Services Dentist, (2) RMI Head Start Program Medical Coordinator, (3) Coordinator, Maternal and Child Health Program Coordinator, and (4) Chairperson, RMI Head Start Health Advisory Committee Chairperson (who is a parent). The CPG met 4 times before the forum to review oral health data and reports, identified the invitees and participants, and set the agenda. Throughout the planning process, the Preventive Services Dentist conferred with the Regional Dental Public Health Consultant in San Francisco and the Director of Northwest/ Alaska Center to Reduce Oral Health Disparity at the University of Washington.

The Head Start Oral Health Forum was held October 30 - November 1, 2002. Invitees included the Minister of Health, Minister of Education, Secretary of Health, Director of Dental Services, Director of Public Health/ MCH, and Chairman of Head Start Policy Council. Participants included the Director of Northwest/ Alaska Center to Reduce Oral Health Disparity, Ministry of Health Preventive Services Dentist, Director of RMI Head Start Program, Medical Coordinator, RMI Head Start Program, Dental Nurse, RMI Head Start Program, Nutritional Coordinator, Head Start Program, Head Start teachers from Arno, Kwajalein and Majuro Atolls, a representative from the Local Government, and a representative from Marshall Islands Women's Groups.

For the 2-day forum, the Minister of Health and the Director of Head Start Program provided special remarks. Then the Preventive Services Dentist and the consultant from the University of Washington presented statistics on current oral health status of Marshallese children and the etiology and prevention of Early Childhood Caries. Discussions were held with the participants that addressed: (1) The responsibilities of the Head Start Program, screening and referrals, (2) Education for teachers and staff on oral health care, healthy diet and snacking, (3) Community awareness and empowerment of parents and families, (4) Post-forum activities, time-lines and responsibilities, and (5) Development of an action plan to stimulate initiatives and expand efforts to improve oral health as part of total health.

The Head Start oral health action plan developed by the participants was considered a formal agreement between the government agencies with the specific detailed responsibilities stated in the MOA, which will bear the clear input of the professional staff that are required to carry out the work. Implementation of the Prevented Program will start with 3 atolls: Majuro, Kwajalein and Arno.

ASTDD follow-up funding was received to assist in the action plan activities. Three follow-up meetings were held on three atolls to strengthen the ECC Prevention Program implemented in 2003-04. Educational materials and training were provided, toothbrushes and fluoride toothpaste were provided for home use and fluoride varnish was applied on the children's teeth. It is the intent to expand the oral health activities to all 47 Head Start centers on 26 atolls.

The Action Plan has been implemented in a step-wise basis in the past 2 school years that includes:

  • Educating teachers and staff on oral health care, healthy diet and snacking at the Outer Pacific Cluster Training and Summer Trainings in the Marshall Islands,
  • Promoting community awareness and empowerment of parents and families at Parent Council Forums meetings in Majuro, and
  • Carrying out post-forum activities according to timelines and responsibilities stated in the Action Plan
The First Year (2003 -2004) provided: (1) tooth brushes and fluoride tooth paste for 550 Head Start enrolled children in 3 big atolls in the Marshall Islands, (2) fluoride varnish applied twice to 300 Majuro children and applied once to 250 Kwajalein and Arno children, (3) training for the teachers on effective tooth brushing at the centers visited, (4) screenings, referrals and treatment for enrollees with dental caries as needed, and (5) "Brush up on Health Teeth" CDC posters that are translated and formatted to meet the needs of the Marshall Islands and distributed to the Head Start centers and at other oral health workshops.

The Second Year (2004 -2005) provided: (1) tooth brushes and fluoride tooth paste for 550 Head Start children on 3 big atolls and for 100 children on 6 outer islands in the Marshall Islands, (2) fluoride varnish applied three times to 300 Majuro children, applied twice to 250 children on 2 other big atolls, and applied once for 100 children on 6 outer islands, (3) training for the teachers on effective tooth brushing during summer training program, (4) screenings, referrals and treatment for Head Start children with dental caries, and (5) "Oral Health" Colgate Posters translated and formatted to meet the needs of the Marshall Islands and distributed to all the Head Start centers and at other oral health workshops.

Follow-up activities included:

  • One meeting on Majuro with the Head Start Director on the future of the program, which would become the Kindergarten Program in the 2005 -2006 School Year.
  • A site visit to Ebeye with the UW consultant and a meeting with the Assistant Secretary of Health (Kwajalein Atoll) and Head Start personnel on program planning for the coming school year.
  • Site visit to Arno Atoll and meeting with the Head Start Coordinator and teachers.
All the activities in the past two years have been achieved with consultation from the Regional Oral Health Consultant and the UW Dental Public Health consultant. The activities have been supported by the Ministry of Health, Republic of the Marshall Islands, State Oral Health Collaborative Systems Grant 2003 and 2004 HRSA/MCHB, the Head Start Oral Health Forum Grant 2002 and Follow-up Grant 2004 ASTDD.

Contact Person(s) for Inquiries:

Dr. Ohnmar Tut, Ministry of Health, Republic of Marshall Islands, P.O. Box 16, Majuro, Marshall Islands, MH 96960, Phone: 011-692-625-3355 Ext 2101 or 2102, Fax: 011-692-625-4372, Email: ddsmohe@ntamar.net
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