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Cited by 54Global Health Workforce IssuesDental Health and Care UtilizationGlobal Health and Surgery

Oral health workforce in Africa: a scarce resource

Open access
Gallagher, Jennifer E., Mattos Savage, Grazielle C., Crummey, Sarah C., Sabbah, Wael, Varenne, Benoit, Makino, Yuka·2023·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph20032328PMC PMC9915704
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Abstract

The World Health Organization (WHO) African Region (AFR) has 47 countries. The aim of this research was to review the oral health workforce (OHWF) comprising dentists, dental assistants and therapists, and dental prosthetic technicians in the AFR. OHWF data from a survey of all 47 member states were triangulated with the National Health Workforce Accounts and population data. Descriptive analysis of workforce trends and densities per 10,000 population from 2000 to 2019 was performed, and perceived workforce challenges/possible solutions were suggested. Linear regression modelling used the Human Development Index (HDI), years of schooling, dental schools, and levels of urbanization as predictors of dentist density. Despite a growth of 63.6% since 2010, the current workforce density of dentists (per 10,000 population) in the AFR remains very low at 0.44, with marked intra-regional inequity (Seychelles, 4.297; South Sudan 0.003). The stock of dentists just exceeds that of dental assistants/therapists (1:0.91). Workforce density of dentists and the OHWF overall was strongly associated with the HDI and mean years of schooling. The dominant perceived challenge was identified as ‘mal-distribution of the workforce (urban/rural)’ and ‘oral health’ being ‘considered low priority’. Action to ‘strengthen oral health policy’ and provide ‘incentives to work in underserved areas’ were considered important solutions in the region. Whilst utilising workforce skill mix contributes to overall capacity, there is a stark deficit of human resources for oral health in the AFR. There is an urgent need to strengthen policy, health, and education systems to expand the OHWF using innovative workforce models to meet the needs of this region and achieve Universal Health Coverage (UHC).

AI snapshot

Written from the paper’s full text.

TL;DR

The WHO African Region has a critically scarce oral health workforce, with dentist density at 0.44 per 10,000 population in 2019 despite 63.6% growth since 2010. Workforce density is strongly associated with national development and schooling, and member states report maldistribution, low priority for oral health, and weak policy/financing as key challenges.

Key findings

  • In 2019, the AFR reported 36,222 dentists, 32,783 dental assistants/therapists, and 11,986 dental prosthetic technicians; average densities per 10,000 population were 0.44, 0.39, and 0.10, respectively.
  • Dentist density grew 63.6% from 0.28 per 10,000 in 2010 to 0.44 in 2019, but intra-regional inequity was marked: Seychelles had 4.297 dentists per 10,000, while South Sudan had 0.003.
  • The dentist-to-dental assistant/therapist ratio was almost equivalent at 1:0.91, while dentists-to-dental prosthetic technicians was 1:0.33.
  • Linear regression found HDI was associated with dentist density (increase of 6.53 per unit HDI) and combined OHWF density (increase of 12.07); mean years of schooling had a significant but weaker association, while number of dental schools and urbanization were not significant in the unadjusted model.
  • The dominant perceived challenges were “mal-distribution of the workforce (urban/rural),” “oral health considered low priority,” and “lack of financial support for oral health workforce training institutions”; leading solutions included strengthening oral health policy, improving workforce data, and providing incentives for underserved areas.

Methods

  • Cross-sectional WHO/King’s College London global OHWF service evaluation survey of all 47 AFR member states, conducted January–December 2019, combined with National Health Workforce Accounts data and population data.
  • Descriptive analysis of workforce trends and densities per 10,000 population from 2000 to 2019; linear regression modelled dentist and combined OHWF density using HDI, mean years of schooling, number of dental schools, and percentage urban population.
  • Qualitative survey responses on workforce challenges and solutions were examined descriptively and thematically.

Limitations

  • The paper states that for some countries, data on dental assistants/therapists and dental prosthetic technicians were over five years old; not every country provided auxiliary workforce information; only external validation was used; and there was no evidence on unregistered OHWF members, rural/urban distribution, training institution numbers/structure, working hours, or within-country coverage.
  • The paper also states that time lags in NHWA reporting make contemporary data difficult, particularly in the para-COVID environment.
  • Evident from the text: the analysis focuses mainly on dentists, with possible underreporting of mid-level personnel, and grouping distinct mid-level oral health professionals under “dental assistants and therapists” is described as not particularly helpful for the African context.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph20032328

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 53 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In 2019, the WHO African Region had 36,222 dentists.

    “There were 36,222 dentists, 32,783 dental assistants/therapists, and 11,986 dental prosthetics/technicians reported for the AFR in 2019.”
    Quote in the paperSubstantial claim
  • Findingown data

    The ratio of dentists to dental assistants/therapists in the WHO African Region was 1:0.91.

    “The ratio of dentists per dental assistants/therapist was almost equivalent at 1: 0.91, whilst dentists per dental prosthetics/technician was 1:0.33.”
    • Also stated in: § 4. Discussion · hedged
      “the AFR is ahead with almost a 1:1 ratio.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In 2019, the WHO African Region had 32,783 dental assistants/therapists.

    “There were 36,222 dentists, 32,783 dental assistants/therapists, and 11,986 dental prosthetics/technicians reported for the AFR in 2019.”
    Quote in the paperSubstantial claim
  • Findingown data

    In linear regression, each unit increase in HDI was associated with an increase in combined OHWF density of 12.07 per 10,000.

    “For each unit increase in HDI, there was an increase in density of dentists of 6.53 and in density of combined OHWF of 12.07.”
    Quote in the paperSubstantial claim
  • Findingown data

    Average dental prosthetic technician density in the WHO African Region in 2019 was 0.10 per 10,000 population.

    “Average density per 10,000 population was 0.44 for dentists, 0.39 for dental assistants/therapists, and 0.10 for dental prosthetics/technicians.”
    Quote in the paperSubstantial claim
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 28
  • The quote only partly states this claim. 2

  • May combine two claims.

    Findingown data

    Country-level HDI scores were associated with the density of dentists and the combined OHWF.

    “Linear regression analysis revealed that country-level HDI scores were associated with the density of dentists (Table 1) and the combined OHWF (Table 2).”
    • Also stated in: § 4. Discussion · boosted
      “HDI [19], was a good predictor of dentist density; and, to a lesser extent, average years of schooling.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Other reported challenges included issues relating to education and training programmes and numbers, lack of dental auxiliaries such as therapists and assistants, and landlocked areas not chosen by dentists.

    “Second, there were issues relating to education and training programmes and numbers, where the “lack of dental auxiliaries such as therapists and assistants” was identified and challenges regarding coverage given that there are “landlocked areas not chosen by dentists”.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Responding countries (n = 40) identified maldistribution of the workforce (urban/rural), oral health considered low priority, and lack of financial support for oral health workforce training institutions as the three biggest challenges.

    “When challenges (Figure 4) and possible solutions (Figure 5) were explored, responding countries (n = 40) identified “maldistribution of the workforce (urban/ rural)”, “oral health considered low priority”, and “lack of financial support for oral health workforce training institutions” as the three biggest challenges.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the unadjusted model, reported number of dental schools and level of urbanization were not associated with workforce densities.

    “Similarly, average years of schooling also showed a significant, but weaker, association with workforce densities but not with the reported number of dental schools and level of urbanization in this unadjusted model.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Nigeria had the highest growth for both dental assistants/therapists and dental prosthetic technicians.

    “Available data suggest a higher rate of growth of dental assistants/therapists (238%) and dental prosthetic technicians (250%), with Nigeria having the highest growth for both groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Average dentist density in countries with low HDI was 0.051 per 10,000, compared with 0.652 in countries with medium HDI or above.

    “The average density of dentists per 10,000 population in countries with low HDI is 0.051 against 0.652 for medium HDI or above, whilst for those of ‘high HDI or above’, it is 1.270.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Seventeen countries highlighted additional solutions.

    “Comparable themes were displayed by 17 countries in highlighting additional solutions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

    Findingown data

    Burkina Faso had the lowest dental prosthetic technician density in the WHO African Region, at 0.001 per 10,000 population.

    “Countries with the lowest densities were South Sudan for dentists (0.003), Ethiopia for dental assistants/therapists (0.007), and Burkina Faso and the Democratic Republic of Congo (DRC), for dental prosthetic technicians (both 0.001).”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The Democratic Republic of Congo had the lowest dental prosthetic technician density in the WHO African Region, at 0.001 per 10,000 population.

    “Countries with the lowest densities were South Sudan for dentists (0.003), Ethiopia for dental assistants/therapists (0.007), and Burkina Faso and the Democratic Republic of Congo (DRC), for dental prosthetic technicians (both 0.001).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    Multiple solutions were supported, led by strengthening oral health policy, improving health workforce data for planning, and providing workforce incentives to work in underserved areas.

    “Multiple solutions were supported, led by the need to “strengthen oral health policy”, “improve health workforce data for planning”, and provide “workforce incentives to work in underserved areas”.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The average density of the OHWF for the WHO African Region is 0.780 per 10,000 population, of which 0.44 relates to dentists.

    “The average density of the OHWF for the AFR is 0.780 per 10,000 population (0.44 of which relates to dentists).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Other reported challenges included lack of leadership at national level for oral health.

    “First there were concerns posed over the “lack of leadership at national level for oral health”.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The OHWF in the AFR is very scarce, representing a stark oral health workforce deficit.

    “The OHWF in the AFR is very scarce [5,8]; therefore, being able to plan their distribution and training with greater precision and tailoring their development according to the location needs would be an important step to minimise the burden of oral health diseases of the region.”
    • Also stated in: § 5. Conclusions · plain
      “There is a stark oral health workforce deficit in the AFR; thus, there is an urgent need for developmental action supported by capacity building to address oral health needs, with great potential to develop innovative models of care which further utilise the workforce skill mix and community health personnel.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] World Health Organization (2021, September 08). Promoting Oral Health in Africa: Prevention and Control of Oral Diseases and Noma as Part of Essential Noncommunicable Disease Interventions 2016 [Updated 3 August 2021. 126]. Available online: https://apps.who.int/iris/handle/10665/205886.

      Not checked in the free run.

    • cites [8] World Health Organization. Regional Office for Africa (2021, August 04). Regional Oral Health Strategy 2016–2025: Addressing Oral Diseases as Part of Noncommunicable Diseases: Report of the Secretariat Brazzaville. Available online: https://www.afro.who.int/publications/regional-oral-health-strategy-2016-2025-addressing-oral-diseases-part-noncommunicable.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingnone given

    The research team created the most comprehensive dataset on the OHWF in Africa.

    “Nonetheless, the research team created the most comprehensive dataset on the OHWF in Africa; data which need to be kept up-to-date and extended.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The focus of OHWF capacity data remains on dentists.

    “However, despite achievements in terms of highlighting OHWF capacity, the focus remains on dentists, and there may be underreporting of mid-level personnel.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    An AFR Regional Oral Health Strategy 2016-2025 was endorsed, guiding member states to integrate oral health into NCD prevention and control in the context of universal health coverage.

    “Thus, an AFR Regional Oral Health Strategy 2016–2025 [8] was endorsed, guiding member states to integrate oral health into NCD-prevention and control in the context of universal health coverage (UHC) [11].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] World Health Organization. Regional Office for Africa (2021, August 04). Regional Oral Health Strategy 2016–2025: Addressing Oral Diseases as Part of Noncommunicable Diseases: Report of the Secretariat Brazzaville. Available online: https://www.afro.who.int/publications/regional-oral-health-strategy-2016-2025-addressing-oral-diseases-part-noncommunicable.

      Not checked in the free run.

    • cites [11] World Health Organization (2022, January 11). Political Declaration of the Third High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases: World Health Organization. Available online: https://apps.who.int/gb/ebwha/pdf_files/EB150/B150_7-en.pdf.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    About half the population of the WHO African Region suffers from oral diseases, most notably dental caries, periodontal disease, and tooth loss.

    “with about half its population suffering from oral diseases, most notably dental caries, periodontal disease, and tooth loss [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Institute for Health Metrics and Evaluation (2022, July 27). GBD Results Tool. Available online: http://ghdx.healthdata.org/gbd-results-tool.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The age-standardized incidence rate of oral cavity cancer in the WHO African Region is 1.8 per 100,000 population.

    “variable levels of oral cancer (lip and oral cavity; age-standardized incidence rate of oral cavity cancer of 1.8 per 100,000 population) [5]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] World Health Organization (2021, September 08). Promoting Oral Health in Africa: Prevention and Control of Oral Diseases and Noma as Part of Essential Noncommunicable Disease Interventions 2016 [Updated 3 August 2021. 126]. Available online: https://apps.who.int/iris/handle/10665/205886.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cleft lip and/or palate are among the most frequent congenital disorders in the WHO African Region.

    “Cleft lip and/or palate are among the most frequent congenital disorders [1,2,5].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [1] Abid, 2015, Prevalence and Severity of Oral Diseases in the Africa and Middle East Region, Adv. Dent. Res. source

      Not checked in the free run.

    • cites [2] GBD 2017 Oral Disorders Collaborators, Bernabe, E., Marcenes, W., Hernandez, C.R., Bailey, J., Abreu, L.G., Alipour, V., Amini, S., Arabloo, J., and Arefi, Z. (2020). Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study. J. Dent. Res., 99, 362–373. source

      Not checked in the free run.

    • cites [5] World Health Organization (2021, September 08). Promoting Oral Health in Africa: Prevention and Control of Oral Diseases and Noma as Part of Essential Noncommunicable Disease Interventions 2016 [Updated 3 August 2021. 126]. Available online: https://apps.who.int/iris/handle/10665/205886.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is increasing prevalence of dental trauma in both primary and secondary dentitions in the WHO African Region.

    “there is increasing prevalence of dental trauma in both primary and secondary dentitions [1]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Abid, 2015, Prevalence and Severity of Oral Diseases in the Africa and Middle East Region, Adv. Dent. Res. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Shortages of high-skilled workers within fields such as medicine, engineering, and dentistry are a harsh reality.

    “shortages of high-skilled workers within certain fields, such as medicine, engineering, and dentistry, are a harsh reality [5,15,27].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] World Health Organization (2021, September 08). Promoting Oral Health in Africa: Prevention and Control of Oral Diseases and Noma as Part of Essential Noncommunicable Disease Interventions 2016 [Updated 3 August 2021. 126]. Available online: https://apps.who.int/iris/handle/10665/205886.

      Not checked in the free run.

    • cites [15] World Health Organization (2021, August 04). The African Regional Framework for the Implementation of the Global Strategy on Human Resources for Health: Workforce 2030: World Health Organization. 2020 [12p]. Available online: https://apps.who.int/iris/handle/10665/260238.

      Not checked in the free run.

    • cites [27] Majgaard, K., and Mingat, A. (2012). Education in Sub-Saharan Africa: A Comparative Analysis, World Bank Publications. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    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].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Ghotane, 2019, Fortitude and resilience in service of the population: A case study of dental professionals striving for health in Sierra Leone, BDJ Open source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Nutritional transition to a Western diet has been linked to an increased prevalence of caries in the WHO African Region.

    “nutritional transition to a Western diet has been linked to an increased prevalence of caries [6]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Folayan, 2020, Association between nutritional status and early childhood caries risk profile in a suburban Nigeria community, Int. J. Paediatr. Dent. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Oral health has a low priority, as demonstrated by the absence of oral health policies, resources, and technical capacity.

    “oral health has a low priority, as demonstrated by the absence of oral health policies, resources, and technical capacity [8,11].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [8] World Health Organization. Regional Office for Africa (2021, August 04). Regional Oral Health Strategy 2016–2025: Addressing Oral Diseases as Part of Noncommunicable Diseases: Report of the Secretariat Brazzaville. Available online: https://www.afro.who.int/publications/regional-oral-health-strategy-2016-2025-addressing-oral-diseases-part-noncommunicable.

      Not checked in the free run.

    • cites [11] World Health Organization (2022, January 11). Political Declaration of the Third High-Level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases: World Health Organization. Available online: https://apps.who.int/gb/ebwha/pdf_files/EB150/B150_7-en.pdf.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Europe has a 12-times larger oral health workforce than the WHO African Region despite having less than two-thirds of the population.

    “Europe, in contrast, with less than two-thirds of the population has a 12-times larger OHWF [17] and little predicted growth [18].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] World Health Organization (2021, March 10). National Health Workforce Accounts Data Portal: World Health Organization. Available online: https://apps.who.int/nhwaportal/Home/Index.

      Not checked in the free run.

    • cites [18] United Nations (2020, November 25). World Population Prospects 2019: Volume I: Comprehensive Tables: United Nations. Available online: https://population.un.org/wpp/publications/Files/WPP2019_Volume-I_Comprehensive-Tables.pdf.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A recent technical paper suggests that a seven-fold increase in dentists and dental assistants/therapists is required in the WHO African Region to achieve 70% UHC.

    “A recent technical paper suggests that a seven-fold increase in dentists and dental assistants/therapists is required in the AFR to achieve 70% UHC [32].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] World Health Organization Regional Office for Africa (2021). Health Workforce Thresholds for Supporting Attainment of Universal Health Coverage in the African Region, World Health Organization.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [5] World Health Organization (2021, September 08). Promoting Oral Health in Africa: Prevention and Control of Oral Diseases and Noma as Part of Essential Noncommunicable Disease Interventions 2016 [Updated 3 August 2021. 126]. Available online: https://apps.who.int/iris/handle/10665/205886.

      Not checked in the free run.

    • cites [29] Hackley, 2018, A Case Study Optimizing Human Resources in Rwanda’s First Dental School: Three Innovative Management Tools, J. Dent. Educ. source

      Not checked in the free run.

    • cites [30] Morgan, 2018, Building oral health research infrastructure: The first national oral health survey of Rwanda, Glob. Health Action source

      Not checked in the free run.

    • cites [7] Ghotane, 2019, Fortitude and resilience in service of the population: A case study of dental professionals striving for health in Sierra Leone, BDJ Open source

      Not checked in the free run.

    • cites [31] Ghotane, 2021, Needs-led human resource planning for Sierra Leone in support of oral health, Hum. Resour. Health source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Where workforce numbers were similar, NHWA data were used; where marked differences existed for the same year, WHO authors liaised with member states to identify the most reliable data for analysis.

    “Where workforce numbers were similar, the NHWA data were used. Where marked differences existed for the same year, the WHO authors liaised with the relevant member states to identify the most reliable data to include for analysis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The 74th and 75th World Health Assemblies recognized the immense burden created by oral diseases, especially for low-income settings, including developing innovative workforce models as a key strategic pillar.

    “the 74 [12], and 75th [13] World Health Assemblies have recognised the immense burden created by oral diseases, especially for low-income settings, including ‘to develop innovative workforce models to respond to population oral health needs’ as a key strategic pillar.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] World Health Organization (2021, September 08). 74th World Health Assembly, Resolution WHA74.5: World Health Organization, Geneva. Available online: https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_R5-en.pdf.

      Not checked in the free run.

    • cites [13] World Health Organization (2022, August 03). 75th World Health Assembly, Documents A75/10. Geneva: World Health Organization. Available online: https://apps.who.int/gb/Journal/e/WHA75/JRN-A75-3_en.html.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There is no consistent data on the number and structure of training institutions such as dental schools and training colleges.

    “Fifth, there is no consistent data on the number and structure of training institutions such as dental schools and training colleges.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The latest reports from member states ranged from 2002 to 2019.

    “The latest reports from member states ranged from 2002 to 2019.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Data on dental assistants/therapists and dental prosthetics/technicians tended to be older and updated less frequently (64% and 66%, respectively).

    “Whilst most African countries (n = 39, 83%) updated their dentist numbers during 2018 and 2019, data on dental assistants/therapists and dental prosthetics/technicians, tended to be older and updated less frequently (64% of dental assistant/therapists; 66% dental prosthetics/technicians).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    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].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] Abid, 2015, Prevalence and Severity of Oral Diseases in the Africa and Middle East Region, Adv. Dent. Res. source

      Not checked in the free run.

    • cites [5] World Health Organization (2021, September 08). Promoting Oral Health in Africa: Prevention and Control of Oral Diseases and Noma as Part of Essential Noncommunicable Disease Interventions 2016 [Updated 3 August 2021. 126]. Available online: https://apps.who.int/iris/handle/10665/205886.

      Not checked in the free run.

    • cites [7] Ghotane, 2019, Fortitude and resilience in service of the population: A case study of dental professionals striving for health in Sierra Leone, BDJ Open source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The WHO African Region is recognized as the most challenged region globally, with limited health workforce capacity.

    “is recognised as the most challenged region globally, with limited health workforce capacity [15].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] World Health Organization (2021, August 04). The African Regional Framework for the Implementation of the Global Strategy on Human Resources for Health: Workforce 2030: World Health Organization. 2020 [12p]. Available online: https://apps.who.int/iris/handle/10665/260238.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    The absence of data on auxiliary members does not mean that type of workforce is not available or provide insight to their scope of practice.

    “Second, not every country provided information on auxiliary members, and the absence of data does not mean that type of workforce is not available or provide insight to their scope of practice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    For some countries, the latest available data on dental assistants and therapists and dental prosthetic technicians are over five years old.

    “First, for some countries, the latest available data on dental assistants and therapists and dental prosthetic technicians are over five years old.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Given the time lag in reporting data to the NHWA, obtaining contemporary data remains a challenge, particularly in this para-COVID environment.

    “Eighth, and finally, given the time lag in reporting data to the NHWA, obtaining contemporary data remains a challenge, particularly in this para-COVID environment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Only external validation of data was employed during the development of this research.

    “Third, only external validation of data [45] was employed during the development of this research.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Bukten, 2021, Exploring the external validity of survey data with triangulation: A case study from the Norwegian Offender Mental Health and Addiction (NorMA) Study, Res. Methods Med. Health Sci.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Levels of urbanization are related to the presence of developed infrastructure and opportunities for employment after graduation.

    “Levels of urbanization are related to the presence of developed infrastructure and opportunities for employment after graduation [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] World Health Organization (2021, September 08). Promoting Oral Health in Africa: Prevention and Control of Oral Diseases and Noma as Part of Essential Noncommunicable Disease Interventions 2016 [Updated 3 August 2021. 126]. Available online: https://apps.who.int/iris/handle/10665/205886.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The WHO African Region largely comprises low- and middle-income states.

    “The region largely comprises low- and middle-income states [14]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] The World Bank (2021, March 17). Countries Income Status 2020–2021: The World Bank. Available online: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There is no evidence on the working hours for the OHWF (part-time or full-time workers).

    “Sixth, there is no evidence on the working hours for the OHWF (part-time or full-time workers).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There is no evidence on the number of unregistered OHWF members.

    “Fourth, there is no evidence on the number of unregistered OHWF members and no data on the distribution of the workforce across rural and urban settings.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The study had a good response of member states to the survey, which together with the NHWA provided good data for the AFR.

    “One of the main strengths of this study was the good response of member states to the survey which, together with the NHWA, provided good data for the AFR.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    There may be underreporting of mid-level personnel in OHWF data.

    “However, despite achievements in terms of highlighting OHWF capacity, the focus remains on dentists, and there may be underreporting of mid-level personnel.”
    Quote in the paperSubstantial claim
44 of 44

  • The paper relies on this without support.

    Most oral and dental conditions are preventable and/or treatable, particularly early in the disease process.

    “Most oral and dental conditions are preventable, and/or treatable, particularly early in the disease process and should be identified and managed in primary care settings.”

  • The paper relies on this without support.

    The WHO survey responses from 40 countries are representative of all 47 WHO African Region member states for perceived workforce challenges and solutions.

    “responding countries (n = 40) identified “maldistribution of the workforce (urban/ rural)”, “oral health considered low priority”, and “lack of financial support for oral health workforce training institutions” as the three biggest challenges.”

  • The paper relies on this without support.

    The NHWA and WHO survey data are comparable enough to be triangulated into a single integrated database.

    “This integrated study database was created through triangulation of data obtained from the above two sources for the 47 countries of the AFR.”

  • The paper relies on this without support.

    The latest available workforce reports from member states (2002–2019) are sufficiently current to describe the 2019 oral health workforce.

    “The latest reports from member states ranged from 2002 to 2019.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Dentist-to-population ratios across African countries were just 0.44 per 10,000 population, ranging from as low as 0.003 in South Sudan to about 4.29 in Seychelles.

    “Dentist-to-population ratios across countries were just 0.44 per 10,000 population, ranging from as low as 0.003 in South Sudan to about 4.29 in Seychelles, while the availability of dental assistants and technicians varies considerably across regions (14).”

    From Oral health in Africa: a neglected public health priority (2026) · cites this paper as [14]

  • The oral health workforce across Africa is significantly under-resourced.

    “Moreover, the oral health workforce across Africa is significantly under-resourced.”

    From Oral health in Africa: a neglected public health priority (2026) · cites this paper as [14]

  • Academia is a key stakeholder as the research and evidence-based policy development pipeline are synergistic.

    “Academia is a key stakeholder as the research and evidence-based policy development pipeline are synergistic.15,16”

    From Oral Health Policy and Research Capacity: Perspectives From Dental Schools in Africa (2024) · cites this paper as [15]

    The Results (§3) mention dental schools and planning and operational research, while the Discussion (§4) calls for evidence-informed care and the Conclusions (§5) call for oral health policy. None of these passages identifies academia as a key stakeholder or describes a synergistic pipeline between research and evidence-based policy development. Searches for those terms and close paraphrases found no passage addressing that relationship. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

Cites

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Cited by

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Related

Authors
Gallagher, J. E., Mattos Savage, G. C., Crummey, S. C., Sabbah, W., Varenne, B., & Makino, Y.
Affiliations
  • King's College London (GB)
  • Dental Public Health, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London SE5 9RS, UK
  • Dental Office, WHO Oral Health Programme NCD Department, Division of UHC/Communicable and NCDs, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
  • World Health Organization Regional Office for Africa (CG)
Corresponding author
Gallagher, Jennifer E.
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2023-01-28
Volume
20
Issue
3
Pages
2328
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph20032328
PMC
PMC9915704
OpenAlex
W4318475706
Semantic Scholar
f8c7742543ebcbca8050421c91accc802c1adc8f
Cited by
54
References
35
Citations by year
2026: 12 · 2025: 18 · 2024: 18 · 2023: 6
FWCI
18.14
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by)
Funders
  • World Health Organization
  • University of the Western Cape
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
Keywords
dental workforce, workforce distribution, Human Development Index, years of schooling, dental schools, oral health policy, universal health coverage, Africa
MeSH terms
Workforce, Africa, Dentists, Health Workforce, Health Policy, Humans, Oral Health

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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