The New Idea

Good dental health in Nigeria is a privilege of the wealthy few who can afford expensive private dental care provided by the small number of qualified dentists. Sherifat Quadri, a public health officer and a trained dental hygienist, is trying to change this by introducing preventive dental services into Nigeria. Departing radically from the prevailing public health model of education campaigns aimed at adults coupled with free but temporary public services, Sherifat's approach targets children and charges for private services from the outset.

To spread her approach, Sherifat is training the country's underutilized dental hygienists to be self-employed "barefoot dentists." Using her own successful practice as a model, she shows them both how to provide the greatest preventive dental care benefit for the majority of Nigerians, who would ordinarily only resort to dentists, doctors or traditional healers in dental emergencies. Perhaps more importantly, she teaches them how to develop this market and to make a reasonable living doing so. In so doing she is heading off a mass exodus from the profession due to a lack of formal employment opportunities and, by example is transforming the model for dental care in Nigeria.

The Problem

Millions of Nigerians suffer from poor oral health, which has negative consequences for overall nutritional and developmental well-being. A survey Sherifat conducted among the school-aged population in her home city of Abeokuta revealed that nine out of ten children examined required dental treatment for tooth decay, gum disease or orthodontic problems.

Because of a general lack of health care and education, many Nigerians seek medical attention only in the most dire situations, often when the illness can no longer be cured. When dental problems occur, people choose to visit traditional healers rather than certified dental professionals. The healers extract teeth that might have been saved if basic cleaning and prevention had started at an early age.

The problem is compounded by the fact that most Nigerians believe that the government should provide free services (and most international organizations and donors implicitly favor the government model, even when their ideology and rhetoric indicate otherwise). Government efforts to implement a preventive dental health care model have been ineffective because they focus on incorporating dental health directly into an already overburdened and underfunded primary health care system.

Although several cohorts of dental hygienists were trained through a World Health Organization program, the government made no provisions to employ these skilled hygienists after the training course ended. In the absence of jobs with the relatively few private dentists, many of these hygienists have left the dental profession altogether. The situation illustrates a difficult dilemma: Few people enter the dental profession because there is no developed client system for their services, while the low number of dental professionals perpetuates the general ignorance and lack of dental hygiene.

The Strategy

Sherifat is solving this dilemma. First, she has demonstrated that through thoughtful and diligent marketing and a creative set of services, it is possible to earn a living providing preventive primary dental care to ordinary Nigerians. Second, she is training other dental hygienists throughout Nigeria in her methods.

To get started, Sherifat started the nonprofit Preventive Dentistry Demonstration Center in her home city of Abeokuta, and sought and found local sponsorship for primary dental treatment (and education) for children. She garnered support from individuals and commercial sponsors, including a toothbrush manufacturing company and the producers of Crest toothpaste, who donate posters and samples of their products. The German Embassy donated a mobile dental unit, a local philanthropist donated a site for the center and a retired dentist donated a dental chair.

She chose to target children because in so doing she was preparing for the future and, quite simply, because they are accessible through the school system. In cooperation with the school authorities, Sherifat offered free screening services to new school entrants in many of the public and private schools in Abeokuta and its environs. She also trains teachers and school authorities on the use of oral hygiene educational materials, which she provides, in the classroom.

The free screening leads to a stream of follow-ups to the Center on a fee basis for topical fluoride, diet regulation, plaque control, dental health education, diagnostic treatment and repeat periodic screening. When appropriate, she refers those who need additional treatment to dental clinics. She solicits support and cooperation from parents, and works out compassionate fee schedules to help them afford needed treatment. But she insisted from the outset that the client must pay, as much to engrave a value to the service as to ensure its sustainability.

To enhance the experience for kids, Sherifat has created a clean, fun and educational environment at the Center. She has designed engaging educational materials using donated audio-visual equipment and books, and a mix of games and leisure reading is also on hand. Children frequently drop in after school to participate in regular activities organized at the Center.

In order to increase the geographic reach, Sherifat operates a mobile dental care center from her car. In this way, she has been able to serve surrounding rural areas, some of which have never before had access to dental care.

In order to increase the supply of primary dental care providers available through the Center, she trains interested community members to assist her with cleaning teeth and running demonstrations.

Sherifat periodically conducts surveys to track changes in the general oral health of the children and community awareness of dental care and oral health. The surveys show that her program has succeeded in improving oral hygiene and awareness among children in Abeokuta and its environs. Sherifat is beginning to see a greater demand for dental care by adults in the area as well.

To spread her model, Sherifat conducts seminars for other trained dental hygienists around the country. Based on her experiences in Abeokuta, she shows them how to implement her program with a minimum amount of capital investment, and has developed a manual that explains how to set up community-based dental health care facilities using locally available skills and equipment.

The Person

Sherifat first trained as a public health officer, and then as a dental hygienist under a World Health Organization-sponsored program. With more than twenty years in government and public health service, she has observed the dental health needs of the community and knows how to fill the gaps in government programs. Over the years in the public health service, she proposed many models for improved dental health care to the government, with no success. As her children grew older and family demands essened, she took the difficult decision to step out and establish her own preventive primary dental care service as a private practice. She cites the strong support from her husband, a progressive Muslim (as she is), and her father, a well-connected civil servant, as critical to her early success. Her father, in particular, helped her to obtain equipment donations from various companies and embassies, giving her confidence in the all-important area of fundraising. Sherifat took a leave without pay to establish her pilot project, initially running it part-time on evenings and weekends, with the help of volunteers.