Doing more than just restoring smiles to afflicted patients

Tim Theuri opted for dentistry after finishing his O-levels because he believed that was where he would be able to create his own niche. Almost a decade later, the Moi University graduate, is still passionate about oral care and works with the County Government of Muranga as a Dentist. Dr. Theuri also doubles up as the 21st President of the Kenya Dental Association (KDA), after previously serving the organization as assistant secretary, assistant national secretary, and the national secretary. He no longer focuses only on restoring smiles and peace to patients with dental problems. His assignment today also includes shaping the dentistry landscape in Kenya through policy, advocacy, and lobbying. As Chairman of KDA, Dr. Methu is the person mandated to enter into agreements on behalf of the association, look for partners and funding, as well as responding to member issues.

HCA: Kindly introduce KDA to us in terms of membership, structure, and the association’s mandates.

 Dr. Theuri: KDA was founded just before independence on the 27th of May 1960. We’ve enjoyed diverse leadership in terms of our chairpersons. We have also enjoyed largely good corporate governance over the years and that has worked for us in terms of continuity.

In terms of numbers, we don’t take joy in many dentists as a country, given the nature of our training, which is about 5 to 6 years, including the internship. Currently, we have about 726 general dentists and about 172 specialists. Out of that, the KDA boasts of a membership of about 300 to 400 in any given year.

On the structure front, we are organized into branches. We have a coast branch, a South Rift branch, a North Rift branch, a western branch, a Central branch, and on the national level, we have the National Governing council. Within the national governing council of 16 members, we have a national executive committee that comprises the president, the vice president, the national treasurer, and the secretary to the association.

Any profession has a welfare bit, and that is what KDA does largely. We take care of the welfare of our members; from their professional well-being to their social well-being and once in a while we get involved in personal matters like when death or sickness is involved.

When it comes to professional issues, will go all the way in terms of how you are bettering yourself as a dentist. In terms of continuous professional development, we bring key industry players to our members so that they can get the best rates in the market. For those who are interested in purchasing a dental product, we pull together our numbers so that we give them more purchasing power where certain things are involved.

The mandate of the association is widening now as the years move from what it was in 1960 to what it currently is. It takes my mind back to when the COVID-19 pandemic struck, and the association was involved in helping members evolve into that new space. We didn’t practice for a few months back and had to figure out how doctors will take care of themselves. We were able to hold their hands and now we’ve been able to walk with our dentists out of that and into the space where we are now.

HCA: How is the Association funded?

Dr. Theuri: How we sustain the association is basically through a membership subscription, that’s our biggest source of funding. Other sources include the events that we hold and support from partners. We have donations and grants that flow into the association, and we also do endorsements. If you have a product that you’d wish for us to endorse, you will present the same to us. The product has to be duly registered and be in conformance with local standards and with what is internationally accepted as well. We also do tests to ascertain quality before endorsing the product.

HCA: How many dentists are trained every year? Is there a structured curriculum by the government and are there any private universities that train dentists?

Dr. Theuri: Currently, only 2 universities offer the bachelor of dental sciences or dental surgery, in Kenya, namely The University of Nairobi (UON) and The Moi University. They each train about 20 students annually, thus the country annually releases about 40 graduates into the market and another 20 – 30 graduates coming from overseas.

We don’t have any private universities training dentists. However, we hope that in the next one or two years we should be able to see an institution that can be able to take up a role.

In terms of the curriculum, the co-curriculum is domiciled within the Kenya medical practitioners and dentist council, that’s our regulator. The universities pick the co-curriculum and add units that are perhaps peculiar to each of the universities, such as behavioral science courses and communication skills courses, among other relevant courses

We believe that dentistry is that field of medicine that sits in the middle of preventive and curative care as the procedures that we do are both preventive and curative.

Dr. Theuri- President, Kenya Dental Association

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HCA: Does the KDA lobby for the dentists to the government and is there any significant one that has happened that you can share?

 Dr. Theuri: We’ve been involved in various legislative efforts, the latest being the national hospital insurance fund (NHIF bill) that was trying to reconstitute the fund so that it’s able to deliver UHC.

In 2021, the health committee in the national assembly sought to find out why we have a rising cost of health care. We submitted to them our findings that doctor charges were incredibly high and recommended that doctors’ fees should be less than 12% of the total bill. Another key recommendation we gave was for the government to reduce taxation on medical equipment, instruments, and drugs to ease the cost of care. We noted that our medical products are attracting 16 percent VAT and some levies such as the railway development levy which, if removed, would result in an instant 16 percent reduction in health at the point of care.

We have also done various projects with various partners in terms of taking dental care of the general mass and the largely unreached people. In 2012, we partnered with the American Dental Association to deliver dental services in Kayole, Nairobi. For the 2017-2019 period, we did a project with the Mass Rebuild Foundation where we reached 20,000 children in 6 Kenyan counties namely Nairobi, Murang’a, Nakuru, Meru, Machakos, and Kajiado. To the public, we also conduct various dental camps in unreached areas. We have already done two dental medical camps in Lamu County involving different parts of the archipelago of Lamu islands.

HCA: What is the dentist-to-patient ratio in Kenya?

Dr. Theuri: The last population census that was conducted put the national population at about 50-52 million people. You’re easily looking at a ratio of about 1 dentist to about 50000 people. On average, out of those who are retained to practice, about 800, half of the dentists are in public service. Overall, we can easily say that we have less than 10 dentists on average per county.

In employability, there is a huge need for dentists, and we are not training enough despite the disease burden rising. We are having cancers of the head and neck coming up. The mouth is affected by cancer because of lifestyle choices like smoking and drinking and habits like the use of ‘betel’ and ‘kuber’, especially among the Asian population.

The most prevalent form of oral cancer is oral carcinoma affecting the tongue, the flow of the mouth, the lips, and the chic area. The thing is that cancer spreads quickly and before you know you can’t eat and need to have surgery. Sadly, we lose 50% of the people who come and get treated after five years.

HCA: Do dentists have any policy that’s coming up?

Dr. Theuri: We’ve been able to release the national oral health strategic plan (2022-2026) which is the second of its kind. The association was heavily involved in its development, and we are urging the Ministry of Health to look into operationalizing this policy. It requires about KES 1.5 billion to operationalize. Our current Health Permanent Secretary Madam Susan Mochache was gracious enough to say that she will look for those funds.

The other thing that we’ve been able to do is lobby for the adoption of the AMINAMATA Convention. Kenya is now a signatory to the convention, which is about the safe disposal of material used at the point of care by dentists.

HCA: What’s the health care financing framework in dental care to UHC?

Dr. Theuri: We believe that dentistry is that field of medicine that sits mark in the middle of preventive and curative care as the procedures that we do are both preventive and curative. If I’m giving you a filling, I’m not only curing a dental cavity, but I’m also preventing others from forming. Providers of healthcare financing, however, don’t look at dentistry this way and this explains why oral health care has not enjoyed good financing.

If you even look at third-party players, mainly insurance firms, dental care and optical will be an add-on as opposed to being the main feature in it. The National Hospital Insurance Fund (NHIF) has two types of schemes: we have the national scheme, and we have the managed scheme. Under the managed schemes, we have the civil servant schemes as well as the discipline forces, i.e. the police and the military who enjoy a good dental cover of about 50,000. In the national scheme, however, dental services are not strictly included, as we just have basic things like extractions and surgical services.

Also, what worries them is that if we say we are giving fillings to anyone, everyone will walk in and say they want a filling. We need to ask ourselves, what is the health-seeking behavior of Kenyans? Do we have data on that? Because if you have the data on the health-seeking behavior of Kenyans, then it will be possible to guide the providers.

HCA. What would you tell young people aspiring to take up a career in dentistry?

Dr. Theuri: To anyone who would like to do dentistry, it’s an excellent profession. It has provided me with experiences that I don’t think I’d have ever got elsewhere. I’ve been able to interact with people from all walks of life. I’ve been able to understand privilege and lack. I’ve been able to see people who are content with the little they have because they just enjoy good health, and that’s an experience that you can’t pick from anywhere else. For me, it has inspired and motivated me to be a good citizen because we don’t enjoy many of those in our country.

This feature appeared in the June 2022 issue of Healthcare Middle East & Africa. You can read this and the entire magazine HERE