Needs-led human resource planning for Sierra Leone in support of oral health
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Abstract Background In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. Methods A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the ‘International Caries Classification and Management System (ICCMS)’ tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. Results To meet the needs of a single year-group of childrens’ needs, an average of 163 DTs (range: 133–188) would be required to deliver Conventional care (CC); 39 DTs (range: 30–45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38–68); and 27 DTs (range: 25–32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565–6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255–1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590–2236) for more extended Surgical and Preventive care (S5&6P) (range 1590–2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016–1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251–488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586–1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. Conclusion The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.
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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 [31]
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Osadolor, O. O. (2022) · Janaki Medical College Journal of Medical Science · doi:10.3126/jmcjms.v10i03.55556 · Cited by 6 · see citing works
A policy option towards improving efficiencies in Victorian public oral healthcare
Nguyen, T. M., & Hall, M. (2024) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3824 · Cited by 5 · see citing works
Pictorial art for gaining informed consent in low-literacy settings
Ghotane, S., Holt, C., Challacombe, S., Don-Davis, P., Kamara, D. A. K., & Gallagher, J. E. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.108749 · Cited by 4 · see citing works
Human Resource Management (Human Resource Planning)
Chiara, C., Diego, V., & Mara, S. J. (2023) · Sharia Oikonomia Law Journal · doi:10.55849/solj.v1i1.69 · Cited by 3 · see citing works
Human Resource Management (Human Resource Planning)
Chiara, C., Diego, V., & Mara, S. J. (2023) · Journal Islamic Economic Minangkabau · doi:10.55849/jiem.v1i1.69 · Cited by 2 · see citing works
Structural changes and influencing factors of human resource allocation for oral health in China
Tan, H. (2025) · PLoS ONE · doi:10.1371/journal.pone.0324454 · Cited by 2 · see citing works
Do Good, Better: Making a Difference in Global Oral Health
Hackley, D. M., Colburn, C., & Creasey, J. L. (2024) · Journal of the California Dental Association · doi:10.1080/19424396.2024.2330507 · Cited by 1 · see citing works
Modelling the Future Malaysian Clinician Dental Workforce using System Dynamics
Musa, M. F. C., Jennifer, M., Paul, H., Bernabé, E., & Gallagher Jennifer, E. (2024) · Malaysian Journal of Medicine and Health Sciences · doi:10.47836/mjmhs.20.3.17 · Cited by 1 · see citing works
Human Resources for Oral Health and Dentistry: Time for Action
Gallagher, J. E. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-99967-0.00168-x · Cited by 1 · see citing works
Caries clusters at lesion‐severity thresholds: A Sierra Leone case study
Sibanda, L., Ghotane, S., Bernabé, E., Challacombe, S., Pitts, N. B., & Gallagher, J. E. (2023) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12903
Human Resources Needs for Medical Records Officers at the Mataram City Health Center
Syamsuriansyah, S., Hizriyansyah, H., Ariffin, N. A. N., & Putra, R. P. A. (2023) · Al-sihah The Public Health Science Journal · doi:10.24252/al-sihah.v15i2.37159
Perceived oral health and disease experience among adults in Sierra Leone: An exploratory study
Ghotane, S., Al-Baiyaa, A., Challacombe, S., Don-Davis, P., Kamara, D., & Gallagher, J. E. (2025) · Journal of Public Health in Africa · doi:10.4102/jphia.v16i1.1385
Luan, Y., Sardana, D., Jivraj, A., Liu, D., Abeyweera, N., Zhao, Y., Cellini, J., Bass, M. B., Wang, J., Lu, X., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26974492
Velázquez-Cayón, R. T., Spanemberg, J. C., Arencibia, A. D. T., Sirumal, E., & Parra-Rojas, S. (2026) · Healthcare · doi:10.3390/healthcare14060821
Actions for reforming oral healthcare to combat Noncommunicable disease: A workforce challenge
MacEntee, M. I., Kettratad‐Pruksapong, M., Wright, F. C., & Owen, C. P. (2026) · Journal of Dentistry · doi:10.1016/j.jdent.2026.106943
Zhou, X., Pan, L., Shi, B., Li, H., Zhang, L., Zheng, S., & Sun, X. (2026) · International Dental Journal · doi:10.1016/j.identj.2026.111280
- Authors
- Ghotane, S. G., Don-Davis, P., Kamara, D., Harper, P. R., Challacombe, S. J., & Gallagher, J. E.
- Affiliations
- King's College London (GB)
- Cardiff University (GB)
- Corresponding author
- Gallagher, Jennifer E.
- ORCID
- Venue
- Human Resources for Health
- Published
- 2021-09-01
- Volume
- 19
- Issue
- 1
- Pages
- 106-106
- ISSN
- 1478-4491 (ISSN-L)
- PMC
- PMC8411531
- OpenAlex
- W3197159479
- Cited by
- 22
- References
- 87
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 3
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Human Resources for Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- King's College London
- 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
- workforce planning, dental workforce, dental therapists, dental caries, tooth extraction, oral health promotion, capacity building, Sierra Leone, low-income countries, decision support system, children's oral health, National Oral Health Survey
- MeSH terms
- Workforce, Allied Health Personnel, Child, Humans, Operations Research, Oral Health, Sierra Leone
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