Starting Of Evening Dental Clinic & Tele-Digital Dental Diagnostic Imaging Facilities

52 Pages·2016·1.36 MB·English

A Project Proposal For Undertaking Initiatives Under

The Capacity Building For Poverty Reduction (CBPR)
Program

“Starting Of Eveni n g Dental Clinic &

Tele-Digital Dental Diagnostic Imaging Facilities
In The Dental Colleges All Over The Country

(Specifically: Goa Dental College & Hospital)”
In Collaboration With Department Of Administrative Reforms &
Public Grievances (DARPG), Government Of India

Author : Dr. Ajit D. Dinkar
Professor & Head,
Oral Medicine, Diagnosis, & Radiology Dept.
Goa Dental College & Hospital,
Bambolim, Goa 403 202
Telephone (Office): 0832-2459812 to 815 Extn: 203, 201
Fax (Office): 0091-832-2459816 / 2458176
Mobile [phone]
E-Mail: [email protected]

January 2009
1. DETAILS OF THE ORIGIN OF THE PROPOSAL :
a) Name of the State : GOA
b) Name of the Host Organization: Oral Medicine, Diagnosis, & Radiology Dept.,
Goa Dental College & Hospital
c) Status of the Host Organization: Main Ministry / Department / Attached Office / Statutory
Body / Other – Please specify : A Department in a Govt.
run Dental Teaching Institute (College & Hospital)
d) Name of Contact person: Secretary Health,
Public Health Dept., Govt. of Goa
e) Contact Address: Secretary Health,
Public Health Dept., Govt. of Goa
Secretariat Complex,
Porvorim, Goa 403 205
f) Telephone / Fax No. : Telephone: [phone]
Fax: [phone]
Mobile:
E-Mail:
g) Nodal Contact Person: Dr. Ajit D. Dinkar
Professor & Head,
Oral Medicine, Diagnosis, & Radiology Dept.,
Goa Dental College & Hospital,
Bambolim, Goa 403 202
Telephone (Office): 0832-2459812 to 815 Extn: 203, 201
Fax (Office): 0091-832-2459816 / 2458176
Mobile: [phone]
E-Mail: [email protected]
h) Implementing Agency: Oral Medicine, Diagnosis, & Radiology Dept.,
Goa Dental College & Hospital, Bambolim, Goa 403 202
i) Account No. Of At State Bank Of India, Treasury Branch,
The Nodal Agency & Under The Control of the
To Which The Funds Are Directorate of Accounts (Govt. of Goa), Fazenda Bldg.
To Be Transferred Panaji, Goa 403 001

Demand No. 51

2210 Medical & Public Health
05 Medical Education Training & Research
105 Allopathy
01 Goa Dental College & Hospital (Plan)
02 Evening Dental Clinic (Plan: Centrally
Sponsored Scheme))

REVENUE OUTLAY(PLAN)
01 Salaries
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02 Wages
11 Domestic Travel
Account No. Of 13 Office Expenses
The Nodal Agency 21 Supplies & Materials
To Which The Funds Are 24 Petrol, Oil, & Lubricants
To Be Transferred 26 Advertising & Publicity
(Continued) 27 Minor Works
34 Scholarships & Stipend
50 Other Charges

CAPITAL OUTLAY (PLAN)
4210 Capital Outlay on Medical & Public Health
01 Urban Health Services
110 Hospital Dispensaries
04 Equipments
52 Machinery & Equipments

RECEIPTS WILL BE COLLECTED UNDER THE
FOLLOWING HEADS OF ACCOUNT:
0210 Medical & Public Health
01 Urban Health Services
020 Receipts from patients for Hospital &
Dispensary Services
04 Goa Dental College & Hospital
02 Evening Dental Clinic Service & Material
Charges
800 Other Receipts
81 Other Items
02 Evening Dental Clinic Tele-Accessing / E-
mail Charges for patients’ Diagnostic
Images & Tele Consultation Charges

11 PROPOSAL :

2a. PROPOSAL SUMMARY: -
The proposal summary should appear at the beginning of the proposal and outline the project. It
should be brief, no longer than two or three paragraphs. To include all the key points necessary to
communicate the objectives of the project.

State Governments as well as Private Organizations invest huge sums of money in
setting up the necessary infrastructure, i.e. the purchase of dead stock – equipments,
instruments, & materials, books and journals for the library, and the hiring of human
resources for the starting of Dental Colleges & Hospitals. Vast amounts of recurring
expenditure are incurred thereafter on maintenance as also on essential consumable
materials. This is done primarily as the State Govt.’s responsibility for catering to the
health needs and educational or employable-skill–acquisition aspirations of the citizens.
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Private Organizations step in when State Govt.’s efforts are not commensurate with the
demand and supply ratio on this score. In both cases, the Dental-Health-Care-Delivery-
System is tied up with the Timings of the Dental College – which are standard Office
hours viz. 9.00 a.m. to 4.30 p.m. on working days – or thereabouts with minor local
variations over the country. These timings invariably result in the Daily-Wage Laborers,
Below-Poverty-Line Persons, Contract-Laborers, Trainee-Employees, and such other
categories of individuals missing their Daily Wages as and when they seek dental
consultation and treatment for themselves or accompany a senior or child family
member for consulting and seeking treatment at the Specialist Dental O.P.D. or
Treatment Clinics at these Dental Colleges. Besides, of course school / college students
missing at least half a day of learning at their institutions / coaching classes etc.

As of 2009, there were 282 Dental Council of India recognized Dental Colleges in the
country. Almost every district in the country has one or more Dental College(s) today,
barring a few in the Northeast or in Jammu-Kashmir. Each Dental college on average
provides services to about 150 to 400 (Avg. 275) new cases (and between 1750 to 3500
(Avg. 2625) follow-up cases per day through their 9 Dental Specialty Departmental
Clinics.
These calculations are based on the fact that:-
(1) minimum required new-patient in flow as per DCI is 150 to 400 depending on BDS
or / & MDS Courses being taught in the College
(2) there are a minimum of 125 to 250 dental chairs (depending on 50 / 100 admissions)
in each college. Thus in a day of 7 working hours and a single dental appointment
lasting 30 minutes each; there would be at least 14 patients in a day per dental chair.
Thus 125-250 dental chairs would serve 125 x 14 = 1750 or 250 x 14 = 3500 follow-up
patients on an average in a day.
Averages for New Cases are: 150 + 400 = 550 = 275
2 2
Averages for Follow-up Cases are: 1750 + 3500 = 5250 = 2625
2 2
The 282 dental colleges would serve on an average 275 x 282 = 77,550 new cases to
2625 x 282 = 7,40,250 follow-up cases per day (!) at all of the 282 Dental Colleges!
Further, these patients are given appointments for the full range of their dental health
care needs; often necessitating over a dozen visits by each patient! Most often at Govt.
Dental Colleges, there exist long waiting lists for specialized Dental Treatment in the
various branches of Dentistry (e.g. At the Goa Dental College’s Orthodontia Dept
present waiting list is for over 2 years, at the Conservative Dentistry & Endodontics
Dept. the waiting list extends for over 6 months to a year). Over 70% of these patients
are such individuals who cannot afford the treatment charges of Private Dental
Practitioners. Most Govt. run Primary Health Centers & even District Health Centers
have limited or non–existent dental health care facilities / personnel!

Thus considerable loss of Human-Work-Hours (i.e. Man-Hours, without the gender
bias) occurs with consequent loss in production for the Nation and loss of earning
capacity to the individual in accessing the free / subsidized dental-health-care-services
available only during the morning & afternoon session when the Dental Colleges
functions. If essential dental-health-care-services are to be provided more effectively to
prevent loss both for the Nation, and for the Individual seeking these services, starting
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of Evening Dental Clinics coupled with that of Tele-Digital Imaging Services is a must.
While putting the existing infra-structure to greater use beyond normal day hours, such a
measure will help the services to be easily accessed by the Daily-Wage Laborers,
Below-Poverty-Line Persons, Contract-Laborers, Trainee-Employees, Students and
especially house-wives and other female workers for whom accessing Dental Health-
Care Services from 4.30 p.m. to 8.30 p.m. would be far more convenient. This small
measure in itself has the potential to not only prevent deficient usage of installed (or
proposed-to-be-installed) infrastructure far below its installed capacity but to also serve
as an effective step to build individual and organizational capacity to reduce poverty.
Convenience of availability-timings of these services for the needy coupled with
dedicated continuous delivery of these services is the unique feature underlying the
starting of Evening Dental Clinics in Dental Colleges throughout the country.

Promoting Medical-Tourism should go hand-hand with providing essential services to
the vast number of ordinary citizens. Failure to do so is akin to deliberately creating
another Nandigram / Anti Special-Economic-Zone / Goa Bachav Agitation type
situations and thus an invitation for public discontent, unrest, and a playground for
competitive hate politics of all sorts – disputed extent of health services provided,
economical class, regional, religion, caste, or language based.

2b. INTRODUCTION OF THE HOST ORGANIZATION

This may include: i) The Organizations key areas of operation and clientele ii) The service delivery
mandate it has. iii) The type of Central programs it handles. iv) Any multilateral / bilateral projects
it is handling at present.
It would be useful if the logic for the Organization undertaking the particular initiative were
provided.

i) The Goa Dental College & Hospital, a Govt. of Goa enterprise, is primarily engaged
in providing affordable, state of the art Dental-Health-Care-Services to the citizens
of Goa, citizens from adjoining border districts of the States of Maharashtra &
Karnataka, Emergency Dental-Health-Care-Services to the visiting Indian & Foreign
Tourists, and persons detained under various laws by the law & order maintaining
agencies in Goa.

ii) It is the premier and only Dental teaching Institute in Goa; it is recognized by the
Dental Council of India and affiliated to the Goa University. It operates dental
teaching courses leading to the award of the Bachelor of Dental Surgery / Master of
Dental Surgery courses in seven out of ten specialties. Admissions to these courses
are based purely on merit–cum-reservation criteria as enunciated by the Govt. of
Goa, the Govt. of India, and the Honorable Supreme Court of India from time to
time. Thus, it is engaged in providing Dental Health Care Delivery, Education,
Training, and Research.

iii) At present, there are no Central Programs, which the Goa Dental College & Hospital
is handling or receiving funds for.

iv) In the past (2004 - 2007) the Oral Medicine, Diagnosis, & Radiology Dept. of the
Goa Dental College & Hospital has collaborated with the M. S. Ramaiah School of
Advanced Imaging – a Central Govt. recognized TIFAC-CORE center (Technology
& Information Forecasting & Assessment Council Center of Relevance &
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Excellence) for the development of software for Chain Code Analysis, Image
Retrieval & Recognition of Lip Prints for applications in Forensic Dental Sciences.

v) Recently in 2010-2011 the Oral Medicine, Diagnosis, & Radiology Dept. of the Goa
Dental College & Hospital has collaborated with the Padre Conceicao College of
Engineering, Goa, to develop a software for recording and analyzing ear-prints for
person identification.

As the singular, Government of Goa operated and Dental Council of India
recognized, source of Dental Education, Training, Research and Dental Health Care
Delivery in the state of Goa; the Goa Dental College & Hospital is the tertiary
referral center for Dental Health Care Delivery systems in Goa. It also serves as one
of the Nodal Agencies for the referral of cases out of Goa under the Govt. of Goa’s
Medi-Claim schemes for its citizens. It was established in June 1980 and since its
inception has rendered valuable services in the Dental Health Care Delivery field in
Goa. Presented below is a graph of the number of patients attended & treated at the
Goa Dental College & Hospital over the last several years.
Fig. 1 Patient attended & treated at the Goa Dental College & Hospital in 2015
Number Of Patients Attended In The Goa
Dental College & Hospital
In The Year 2005
DE 19000,,000000 386,09
D
N 80,000
E
TT 70,000
A
S 60,000
T
NEITAP FO REBM 1234500000,,,,,000000000000000 672,23 419,42 755,9 585,8 477,4 763,6 012,4
U 0
N
R S O S O O O T T L
DMO FMO IREP NOC DEP HTRO HTSORP NED MOC AP LARO ATOT
DEPARTMENTS

Fig. 2 Patient and Work Output at the Oral Medicine, Diagnosis, & Radiology Dept of
the Goa Dental College & Hospital from August 1983 to December 2015.
WORK OUTPUT OF ORAL MEDICINE, DIAGNOSIS, & RADIOLOGY DEPT.,
GOA DENTAL COLLEGE & HOSPITAL
35,000
30,000 509,52 120,72 237,82 736,03 672,23 543,92 564,62 NPEOODAXUIRRATAM ATGIMLEBRN NEIEMONRTAESES TIODDSEFI &CDI I/NNE,
S 25,000 335,32 SECTION
TNEIT 839,02
APFO REBMUN 1125050,,,,0000000000000 175236,,11 707897898,,,427 752174696,0,,721 679412651,4,,951 132550231,,05,151 538890857,,04,131 824834823,,06,151 956944593,,26,141 835999427,,15,131 781352703,,16,141 857229263,,03,131 569788861,2,,841 606808174,2,,921 154747285,,16,151 385816019,5,,951 495788393,6,,961 625880,2,18 304986,3,19 417326,,5011 560128,,5111 934860,,5311 703097,,6311 153475,,6511 508657,,5311 695068,,4111 404615752,2,,661 NPEORSTOETODEAXOXRUAIRFRACT EAAMDTAAPGTIAMAMILALEBONITL TONEIIMLONNE IRTNNEOESDEES U NIODG DDSIMTFINY I/C&SBNIENRE,
3891 ceD oT guA672 4891 5891 6891 7891 8891 9891 0991 1991 2991 3991 4991 Y5991EAR6991 7991 8991 9991 0002 1002 2002 3002 4002 5002 6002 7002 8002 yaM otpU RDAEPDAIORLTOMGEYNT
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WORK OUTPUT OF ORAL RADIOLOGY SECTION,
ORAL MEDICINE, DIAGNOSIS, & RADIOLOGY DEPT.,
GOA DENTAL COLLEGE & HOSPITAL
30,000
SNOITAGITSEVNI CIHPARGOIDAR FO RE 112205055,,,,,000000000000000 276,4 981,4 325,7 597,6 828,5 511,8 362,6 691,5 693,6 786,5 709,5 482,3 216,7 467,7 633,8 352,01 824,21 485,41 279,51 731,61 183,91 570,42 064,12 190,81 407,9
B
M 9
U 34
N
0
3891 ceD 4891 5891 6891 7891 8891 9891 0991 1991 2991 3991 4991 5991 6991 7991 8991 9991 0002 1002 2002 3002 4002 5002 6002 7002 8002 yaM
oT gu YEAR otpU
A
Fig. 3 Number of Radiographic Investigations Carried Out at the Oral Medicine,
Diagnosis, & Radiology Dept of the Goa Dental College & Hospital from August
1983 to December 2015.
2c. PROBLEM STATEMENT
This is elucidation of the specific problem that is proposed to be solved or issue to be addressed
through an initiative supported by the CBPR Program and the expected outcomes.

The problem statement is a key element of the proposal. It should be clear, concise, well-supported
statement of the problem to be solved by undertaking the proposed initiative through support from
the CBPR Program. The information provided should be both factual and directly related to the
problem to be addressed by the proposal. The problem statement should clearly spell out the
connection between the issue pertinent to the problem statement and the proposed host organization.

Despite being the single largest Dental Health Care Service provider in their respective
geographical areas, the over 300 Dental Colleges & Hospitals operating all over the
country, at present, due to their operational work timings render the services provided
by them beyond the reach of the poor or at an unacceptably high collateral costs than
they are actually meant for. The loss of daily wages, inordinately long serpentine
waiting lists, long chain of appointments, shunting from department to department,
absence of all Dental Health Care Delivery Facilities at convenient timings and under a
single roof often puts off patients from accessing these facilities.

This not only adversely affects their general and oral health status but also often results
in absenteeism from work, with consequent loss of Human Work Hours for the
concerned production or service unit that employs the worker. When forced to avail the
services at specified timings during the day it entails loss of wages earned and therefore
deprivation to the family especially in case of daily wage earners.

Being the primary providers of Dental Health Care Services to the vast majority of the
lower and middle income group citizens of our country, it is incumbent on these Dental
Colleges & Hospitals to take due cognizance of the existing deficiencies in their
services and adopt measures to overcome such short comings. They should necessarily
go beyond meeting the infra-structure facility requirements as recommended by the
Dental Council of India and deliberate on ways and means to come up with
recommendations that highlight service delivery status and standards through the
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efficient use of existing infra-structure facilities or where required upgrading of such
facilities through innovative use of information technology.

Use of internet, Dental Appointment Kiosks, dedicated mobile / land line telephone
numbers for fixing appointments for dental treatment, viewing the patient’s dental
health status through Tele-Digital Dental Diagnostic Imaging Systems and
providing assistance and guiding consultations to the Dental Health care providers
right from the Primary Health Center level in the Govt. and private sector,
wherever required, will go a long way in reducing the serpentine waiting list
queues of patients at Govt. run Dental Colleges & Hospitals.

Private Dental Colleges are often located outside the main city / town due to the costs of
land acquisition (minimum 5 acres as per DCI) in the city limits. These institutions
therefore operate feeder satellite clinics in the cities & towns to enhance patient flow to
their main Hospital. The starting of Evening Dental Clinics & installation of Tele-
Digital Dental Diagnostic Imaging Systems would turn out to be a mutually beneficial
endeavor for their Institution as also to the patients availing their services.

With specific reference to the Goa Dental College & Hospital, the statistics of the
number and category of patients seeking treatment are provided below. The existing
wait-list of patients in various departments has been ascertained through data provided
by the concerned Professors & Heads of the respective departments. It is obvious that as
a responsible health care provider the Goa Dental College & Hospital, at the very least,
should be aware of this problem in its service delivery mechanism and gear up to take
corrective measures.

Fig. 3 Categories of Patients attending the Goa Dental College & Hospital

DATA NOT AVAILABLE

Fig 4 Table of number of patients on waiting list in various Departments at the Goa
Dental College & Hospital

DATA NOT AVAILABLE
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Fig 5 Table of extent of waiting-list time in various Departments at the Goa Dental
College & Hospital

DATA NOT AVAILABLE

2d. PROJECT OBJECTIVE
i) The project objectives should clearly spell what the initiative seeks to achieve.
ii) The expected results and benefits of each objective should be clearly defined.
iii) Should meet the guiding principles as specified in the guidelines and describe how the proposal
meets each criterion. (Refer section 5i, 5ii, 5iii)
2di) & 2dii) The initiative of starting the Evening Dental Clinics and installation of
Tele- Digital Dental Diagnostic Imaging Systems in the Dental Colleges
all over the country will achieve the following project objectives, with the
expected results and benefits from each such objective as mentioned in
bold italics there under:
1) Enable individuals from the economically weakest strata of society to
avail of quality dental health care delivery systems without entailing loss
of daily wages; which otherwise invariably occurs due to the clash of the timing
schedule of all Dental Colleges & Hospitals and the work timings of the Daily
wage Laborer.

2) Ensure that the Daily-Wage Laborers, Below-Poverty-Line Persons, Contract
Laborers, Trainee-Employees, Students, the senior and handicapped members of
the families of such categories of our compatriot citizens and especially house-
wives and other female workers are not deprived of Dental Health Care Services
at Dental Colleges & Hospitals by enabling these services to be accessed at a
time convenient to them viz. 4.00 p.m. to 8.30 p.m.

3) It would also curtail collateral costs like expenditure on travelling, eating
outside when required to remain at the Hospital for long periods
continuously or because of being required to visit / consult different
departments.

4) The patient would be more at ease receiving the prescribed dental
treatment vis-à-vis other family commitments like dropping / picking up
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a child from school, ensuring that there is someone at home when the child
returns from school, an elderly sick person at home is not left unattended etc.
5) To cut down on the criminally wasteful under-utilization of the existing
expensive and state of art installed capacities of Dental Health Care
Delivery Systems at the Dental Colleges & Hospitals.

Consequent to the Dental Council of India (DCI) specifying the list of
equipments, instruments, and materials to be available at the Dental Colleges &
Hospitals for availing DCI recognition to permit these institutes to start Dental
graduate & postgraduate courses, it is seen that there exists a very high quality of
Dental Health Care Delivery infra-structure at most if not all the Dental Colleges.

As of date a very high percentage of these equipments, instruments and materials
are still being imported due to the near absence or very low volumes or poor
quality of indigenous production / manufacture; with the possible exception of a
very few and limited number of items.

The after sales service, availability of spares, repairs & replacements, warranty
periods, compensation or replacement facilities during the idle down-time of
these equipments and instruments as and when required leave much to be desired.
This is possibly due to the absence of stringent guidelines regarding their import.
Most dealers, traders, agents, and local representatives of foreign dental
manufacturers are unreliable vendors. Reputed Private and Govt. Dental Colleges
are often caught between trying to comply with the DCI’s requirements of
essential equipments and the poor quality of services by these vendors. Frequent
reports of costly equipments lying uninstalled or not functioning for minor repairs
are all too frequently seen in the press to be ignored! A grace saving situation
would be to mandatorily put to use these equipments & instruments to their
maximum installed capacity from the beginning!!

6) Implementing the stated initiative would help strike some balance between the
demand and supply of Dental Health Care Services. This would ensure that
state of art Dental Health Care Services are affordable to all citizens and
thus assist in easily bringing these services under some sort of medical
reimbursement / insurance cover in the future. As of date, very elementary
dental health care services are covered under medical reimbursement. See
Swamy’s Compilation of Financial Rules Regulations 2015

7) Installing Tele-Digital Dental Diagnostic Imaging Systems at the Dental
Colleges will immensely assist treatment availability at a place and time
of the daily Wage Labourer’s choosing. Dental treatment is highly
sophisticated requiring extensive and advanced diagnostic imaging service back-
ups not only for treatment delivery but also for treatment planning.

Such advanced facilities are too expensive to be installed at every primary Health
Care Center or even District Level Health Centers. Nevertheless, these could be
easily accessed via the internet from the Dental Colleges & Hospitals and referred
to by the Dental Health Care Provider, who may be placed remotely from the
Dental College but in proximity to the patient seeking the dental treatment.

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