Fortitude and resilience in service of the population: A case study of dental professionals striving for health in Sierra Leone
Open accessAbstract
OBJECTIVE: Sierra Leone (SL), with a population of over 7 million people, has a critical health workforce shortage. This research explores the views of key players on population oral health needs and demands, the challenges of oral and dental care delivery, and professional careers in dentistry, in order to inform future capacity building. MATERIALS AND METHODS: Semi-structured interviews were conducted with a purposive sample of key players in dentistry and healthcare, both in-country and externally. An interpretive phenomenological approach was used in exploring views of key-players on the oral needs and demands of population, challenges in the delivery of oral and dental care, professional careers of dental professionals in SL, and future workforce capacity building based on a topic guide drawn from the available literature. Interviews were audio-recorded, transcribed verbatim, anonymised and analysed using QSR NVivo 10 for data management and reported in accordance to the consolidated criteria for reporting qualitative research. RESULTS: Twenty-one informants, of whom 18 were male, 17 were in-country and 16 were dental professionals, participated in the research. Dental professionals reported clear consensus on a considerable level of unmet oral health needs, most notably dental caries and periodontal disease, together with life threatening oral conditions such as osteomyelitis, Ludwig's Angina and Burkitt's Lymphoma. Challenges associated with the delivery of dental care revolved around five themes: patients' predisposition for traditional remedies and urgent care; practical hindrances to the delivery of care; professional isolation and weak governance; and place with pressing local crises and lack of political will. An emerging typology of dental professionals included: demonstrating loyalty to their nation and family; exhibiting resilience in challenging circumstances; embracing opportunity most notably amongst expatriates; and striving to serve the needs of the population. There was support for innovative future capacity building developments. CONCLUSION: This paper provides important insights to the delivery of dental care in a low-income country with significant oral health needs and multiple challenges in the delivery of dental care, whilst also providing a vision for developing, building and retaining future human resources for oral health.
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The role of mid-level providers in delivering healthcare generally has been advocated for the WHO African Region, embraced by Rwanda, and explored in Sierra Leone, Tanzania, and Malawi.
“The role of mid-level providers in delivering healthcare generally has been advocated for the AFR [5], embraced by countries such as Rwanda [29,30], and being explored in Sierra Leone [7,31], Tanzania [36], and Malawi [37] in line with workforce research and guidance [11,38].”
From Oral health workforce in Africa: a scarce resource (2023) · cites this paper as [7]
Several African states have started initiatives to shift the paradigm with successful examples of expansion and use of mid-level providers.
“several African states have started initiatives to shift the paradigm with successful examples of expansion and use of mid-level providers [7,28,29,30,31].”
From Oral health workforce in Africa: a scarce resource (2023) · cites this paper as [7]
Preventable fatalities associated with acute dental infections are of specific concern in the WHO African Region.
“Preventable fatalities associated with acute dental infections are of specific concern [7].”
From Oral health workforce in Africa: a scarce resource (2023) · cites this paper as [7]
Acute dental conditions cause pain, suffering, and even death.
“In summary, there is an urgent need to develop primary care services with an appropriate workforce to address the pain, suffering, and even death from acute dental conditions [1,5,7].”
From Oral health workforce in Africa: a scarce resource (2023) · cites this paper as [7]
In many settings, the OHWF is concentrated in urban areas, particularly the capital city.
“Seventh, there is no evidence on coverage within a country given that in many settings, the OHWF is concentrated in urban areas, particularly the capital city [7].”
From Oral health workforce in Africa: a scarce resource (2023) · cites this paper as [7]
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Oral health workforce in Africa: a scarce resource
Gallagher, J. E., Mattos Savage, G. C., Crummey, S. C., Sabbah, W., Varenne, B., & Makino, Y. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032328 · Cited by 54 · see citing works
Self-citationNeeds-led human resource planning for Sierra Leone in support of oral health
Ghotane, S. G., Don-Davis, P., Kamara, D., Harper, P. R., Challacombe, S. J., & Gallagher, J. E. (2021) · Human Resources for Health · doi:10.1186/s12960-021-00623-x · Cited by 22 · see citing works
- Authors
- Ghotane, S. G., Challacombe, S. J., & Gallagher, J. E.
- Affiliations
- King's College London (GB)
- Guy's Hospital (GB)
- Corresponding author
- Gallagher, Jennifer E.
- Venue
- BDJ Open
- Published
- 2019-05-13
- Volume
- 5
- Issue
- 1
- Pages
- 7-7
- ISSN
- 2056-807X (ISSN-L)
- PMC
- PMC6513870
- OpenAlex
- W2945024262
- Cited by
- 15
- References
- 73
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 1
- FWCI
- 2.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BDJ Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Topics
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Keywords
- dental professionals, oral health needs, unmet oral health needs, dental caries, periodontal disease, osteomyelitis, Ludwig's angina, Burkitt lymphoma, traditional remedies, political will, capacity building, resilience, Sierra Leone
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