Constraints on the performance of school-based dental program in Yogyakarta, Indonesia: A qualitative study

Abstract

Background: A high prevalence of caries at ages ≥ 12 in Yogyakarta province (DMFT = 6.5), raises the question of the effectiveness of the school-based dental program (SBDP) which, as a national oral health program in schools, is organized by community health centers (CHCs). Purpose: The aim of this study is to explore the possible constraints on work processes which might affect the performance of SBDPs in controlling caries. Methods: In-depth interviews was conducted in twelve CHCs, covering all five districts both in urban and rural areas. Subjects were 41 dentists and dental nurses working in these CHCs. The interviews were structured according to the following themes: resources and logistics; program planning; target achievement; monitoring and evaluation; and suggestions for possible improvements. The data were analyzed using content analysis. Results: The main constraints identified were limited resources and inflexible regulations for resource allocation in the CHC, and inadequate program planning and program evaluation. Inadequate participation of parents was also identified. Another constraint is thatpolicy at the district level orientates oral health towards curative intervention rather than prevention. Suggestions from interviewees include encouraging a policy for oral health, task delegation, a funding program using school health insurance, and a reorientation towards prevention. Conclusion: The weakness of management processes and the unsupported policy of the SBDP at the local level result in a lack of effectiveness. The constraints identified and suggestions for improvements could constitute a basis for improving program quality.