In 2004, four Health Workers were trained in emergency dental care on the first ever Bridge2Aid training programme. Ten years on, more than 50 Health Workers are being trained every year by Bridge2Aid volunteers. Impressive development, though how sustainable is the training programme?
The question of sustainability is a widely-debated issue within the field of development; it is generally agreed that “Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs” . Translated into terms of the Bridge2Aid dental training programme; Health Workers are being trained, and people are being treated during the training, but are Health Workers who were trained several years ago still using their dental skills? Are people in the rural areas accessing the dental treatment necessary in order to take them out of pain? Some might look at it differently and ask whether the training itself is sustainable; is using volunteers to train, a sustainable method?
Bridge2Aid recently carried out a survey of Health Workers who had been trained since 2004 in Tanzania. Ten years on, 89% of those Health Workers are still in post [as Clinical Officers]. Very few Health Workers move on from their posts. Those that have done so have moved on to administrative posts, posts outside the government or have decided to undergo further training. Some of the Health Workers who were trained on the very first training programme have indeed progressed through the Government health system, though they are still using their Bridge2Aid training to treat patients in dental pain, 10 years on.
For the 89% of Health Workers who remain treating from the rural clinics and dispensaries, best practice figures show that, with the proper support and supervision, a Bridge2Aid-trained Health Worker can see over 200 patients a year and treat up to 84% of them with an extraction, immediately taking patients out of pain.
Dental pain in the rural areas of Tanzania is destructive to lives and livelihoods. With 289 trained Health Workers still in post each able to see 200 dental patients per year, that’s 60,000 rural people per year whose livelihoods, education and ability to care for their families will not be compromised because they are fortunate enough to have access to safe treatment to relieve their dental pain.
During a single training programme, up to 500 people receive free treatment. The training provides Health Workers with a skill that is missing from their current training; these outcomes demonstrate the success of the programme in meeting the needs of the present. Other dental aid organisations focus on this aspect and this aspect alone; they treat, and then depart, leaving behind them a void. Yes, a community has been treated safely, but what happens tomorrow, when someone’s child, friend or parent is also in pain and needs treatment? They are back to square one, often in a worse place; local Health Workers’ skills can be seriously undermined, and the trust in them by their communities, damaged, as a result of outside ‘help’.
Training local Health Workers who are already established and trusted by the local community, whilst treating patients, does tick both boxes; it meets the needs of the present, and far from compromising the needs of future generations, it ensures instead that needs of future generations are met and catered for. It leaves behind a legacy; skills, experience and knowledge.
Training using volunteers is Phase 1 of a three-phase dental training programme. Bridge2Aid recognises that the use of volunteers is not sustainable in the long-term, nor, in some locations, is it appropriate or safe to bring in large volunteer teams. 
Phase 2 increases local ownership of the programme. The Phase 2 approach is ‘Train the trainers’ where urban-based local dental personnel are trained by one volunteer dentist and a Bridge2Aid Clinician in how to train their own rural Health Workers in emergency dental care. The goal: in-country dental personnel are provided with skills necessary to train their rural-based Health Worker colleagues in how to provide emergency dental treatment to their communities.
The final stage, Phase 3, is where the training of rural Health Workers is built into the country’s health system with Bridge2Aid playing a distant role facilitating the procurement of equipment.
How far along is Bridge2Aid in developing the final two phases of the dental training programme? In February 2013, Bridge2Aid ran a pilot Phase 2 programme. Since then, Phase 2 has been repeated and in total seven District Dental Officers (DDOs) have been trained as trainers and in doing so, 21 Health Workers were trained in emergency dental care. 1,891 patients have benefited from free treatment on Phase 2 programmes. The challenge now is to facilitate Phase 3 training, where the DDOs train their own Health Workers. Conversations at national Government level are looking to facilitate this and is something that Bridge2Aid hope to see rolled out in the near future.
For Bridge2Aid, ‘Sustainability’ is not just a buzz word, thrown in because it sounds good and ticks boxes. One of Bridge2Aid’s core values is to be sustainable; it is the foundation of all operations; all programmes are funded in part by the profits of Hope Dental Centre, an established, private dental clinic in Mwanza, Tanzania. In Tanzania the team is composed of 80% local employees. The training programme does just that; it trains people, Health Workers who are established members of society, caring for their rural communities, Health Workers who remain in the health care system and who are there for future generations.
