EDITORIAL
International Dental Journal 2014; 64: 59–61 doi: 10.1111/idj.12106
Developments in interprofessional education and collaborative practice: new opportunities and challenges for FDI and the dental profession AN INTERNATIONAL FORUM ON UNIVERSAL HEALTH COVERAGE The World Health Organisation (WHO) Human Resources for Health Forum: Foundation for Universal Health Coverage and the Post-2015 Development Agenda (10–13 November 2013 Recife, Brazil) assembled numerous participants from a variety of backgrounds. They included country delegations, members of various governmental and non-governmental institutions, academicians, researchers, policy makers, members of many health-related organisations, institutions and professions, and others. It took place in Recife, Brazil, from 10 to 13 November 2013, under the theme Human Resources for Health: Foundation for Universal Health Coverage and the Post-2015 Development Agenda. According to WHO, universal health coverage (UHC) means that all people can use health services, while being protected against financial hardship associated with paying for them. UHC is considered to have a direct impact on a population’s health. UHC is considered as a critical component of sustainable development and poverty reduction, and a key element of any effort to reduce social inequities and the hallmark of a government’s commitment to improve the wellbeing of all its citizens1. UHC is firmly based on the WHO constitution of 1948 declaring health a fundamental human right and on the Health for All agenda set by the Alma-Ata declaration in 1978. Equity is paramount2. Various sessions discussed the barriers and challenges to UHC and the essential elements for policy making and programming for UHC at different health care settings. Other sessions discussed the scaling up
The link between interprofessional education and collaborative practice was discussed at the recent World Health Organisation (WHO) Human Resources for Health Forum in Recife. The perspectives, debated issues and declarations are briefly presented here, so that leaders in the field of oral health are familiarised with the potential impact of these discussions on the dental profession. © 2014 FDI World Dental Federation
of health workers, team approaches for success, partnership for effective strategies for UHC, effective use of resources, and mobility and recruitment of health workers in remote or rural areas. Further sessions focused on country models/experiences/best practices (e.g. collaboration of midwives and nurses at various settings), financial aspects of health care delivery, and other health and health-care related topics in association with UHC. MORE LINKAGES BETWEEN ORAL HEALTH AND GENERAL HEALTH AND A BROADENED ROLE FOR DENTISTS: AN OPPORTUNITY FOR FDI AND ORAL HEALTH FDI’s interest in the event stems from opportunities, within the context of UHC, to further develop elements of its FDI Vision 2020: shaping the future of oral health, in particular ongoing Vision 2020 projects within the fields of intra- and inter-professional collaborative practice. FDI Councillor Professor Nermin Yamalik, as cochair of the FDI Task Team on Collaborative Practice, represented FDI at the event. She made a presentation during a special session organised by World Health Professions Alliance WHPA3, of which FDI is a member, on the theme ‘Building collaborations and synergies between health professions: practice within the full scope of education and training’. The WHPA session focused on needed collaborations and synergies between different professional associations to achieve the objectives of UHC. The session highlighted the principle of health workers’ ability to practise within their full scope of education and training. It discussed the required skill mix of clinical, nonclinical and social professionals and needed collaborations and synergies between them to better achieve health strategies within an UHC context. The session essentially considered medical health care delivery and general health as most of the speakers were involved in medical and/or institutionalised care. 59
Editorial For FDI, the WHPA session was another opportunity to underline the inseparability of oral health from general health, undertake oral health advocacy and highlight the significant contribution of dentistry to UHC, systemic health, well-being and the quality of life of individual patients and the public at large. Furthermore, it was an opportunity to place a particular emphasis on why more collaboration is required between dentistry and other health professions such as medicine, nursery, pharmacy, and others. In her presentation, Professor Yamalik highlighted: • Better clarification of the bilateral relationship between oral health and general health • Oral signs/symptoms of many systemic diseases/disorders, the positive impact of good oral health and oral health care on improved systemic health and quality of life • Advances in science and technology related to all health professions, including both medicine and dentistry • Changing needs and demands from health professionals, ageing populations and new life styles • Common causes of certain oral and systemic disease and disorders (e.g. non-communicable diseases (NCDs) and tobacco, unhealthy nutrition, etc.) as some of the reasons behind the need for further improvement to collaboration between dentistry and other health professions. The presentation emphasised the significant contribution of dentistry to patients’ general health and quality of life. As a global matter, NCDs are a good example of all health professions coming to work together and it is clear that there is a message to be given and some measures to be taken by each health profession. Each profession, on its own, and also professions together and more effectively may combat NCDs globally. NCDs demonstrate that collaborative practice is not just a need for developed countries; it is in fact a global need and demand. Even more emphasis may be needed to be placed on collaborative practice and the joint activities and more communication and more projects of health professions related to UHC in developing countries as this issue may be rather more immature in these countries. The WHPA session also reminded of the need for collaboration between health organisations and the academic world as this is an important step for developing a collaborative-practice ready workforce through interprofessional education, and the analysis of the challenges brought out by the fragmented health systems. Barriers to effective collaborative practice raised by the audience included leadership and professional borders, the classical ‘silo’ model of professional education, fragmented systems, and limited distribution of policy statements. However, it was generally agreed 60
that efforts in the field of interprofessional education and collaboration need to stay on the agenda of all health professions. The significant role which the health associations could play at national and international level was also an important part of the session and the subsequent discussions. CONCLUSIONS The UHC Forum addressed the importance of teamwork, multiprofessional and multidisciplinary approaches and collaboration and partnerships both at the education and practice levels among the many partners involved in health care provision, e.g. nongovernmental organisations, governmental structures, health professions, professional organisations, the academic world, researchers, educators, policy makers, health service payers, patients, and others. Without doubt, health professions, and in particular dentists, need to be at the core of any discussions, negotiations or planning regarding health issues, provision of care, workforce planning and interprofessional education and collaborative practice in a given country and local conditions clearly need to be taken into consideration. Within the context of UHC, optimal models of provision of care – with the necessary funding and human resources – should be the goal of all parties involved in planning of health care. Interim/transient/suboptimal models of collaborative practice which do not comply with defined standards and quality of care and do not improve patient and public benefits cannot be accepted as permanent models of delivery of care. The FDI Istanbul Declaration (2013)4 entitled ‘Oral health and general health: a call for collaborative approach’ strongly defends oral health as a fundamental human right and an integrated part of general health and well-being, highlights the significant association of oral diseases with systemic diseases or disorders. It calls national, regional and global health leaders to recognise oral health as an essential component of global health and promote a reinforced interprofessional collaborative approach in the development of global and national policies. FDI Vision 20205 identifies the broadening role of dentists and collaborative practice as one of the five transversal themes with specific priority. The FDI Task Team on Collaborative Practice is working on defining how the dental profession can take a leading role in this important topic, working with WHO, policy makers, academicians and ministers of health. This underlines the significant emphasis FDI places on effective and quality care delivery and the UHC and total health care context through collaborative practice as well as the importance of correct planning of the future by health professions. © 2014 FDI World Dental Federation
Editorial Acknowledgement The author wishes to thank Tea Collins for kindly preparing and for her input regarding the goals and messages of the WHPA Session. Nermin Yamalik FDI Councillor
2. WHO. Alma Ata Declaration. Available from: http://www.who. int/publications/almaata_declaration_en.pdf?ua=1. [Accessed February 24 2014]. 3. World Health Professions Alliance WHPA: FDI World Dental Federation, World Medical Association (WMA), International Council of Nurses (ICN), World Confederation for Physical Therapy (WCPT), International Pharmaceutical Federation (FIP). WHPA represents more than 26 million healthcare professionals —doctors, dentists, nurses, physical therapists and pharmacists— in 130 countries.
REFERENCES
4. FDI. 101st FDI Annual World Dental Congress (Istanbul, Turkey, 28–31 August 2013). Available from: http://www.fdiworldental. org/publications/declarations/istanbul-declaration.aspx. [Accessed September 16 2013].
1. WHO. Universal Health Coverage. Available from: http://www. who.int/universal_health_coverage/en/. [Accessed November 4 2013].
5. Glick M, Monteiro da Silva O, Seeberger GK et al. FDI Vision 2020: shaping the future of oral health. Int Den J 2012 62: 278– 291.
© 2014 FDI World Dental Federation
61
International Dental Journal 2014; 64: 59–61 doi: 10.1111/idj.12106
Developments in interprofessional education and collaborative practice: new opportunities and challenges for FDI and the dental profession AN INTERNATIONAL FORUM ON UNIVERSAL HEALTH COVERAGE The World Health Organisation (WHO) Human Resources for Health Forum: Foundation for Universal Health Coverage and the Post-2015 Development Agenda (10–13 November 2013 Recife, Brazil) assembled numerous participants from a variety of backgrounds. They included country delegations, members of various governmental and non-governmental institutions, academicians, researchers, policy makers, members of many health-related organisations, institutions and professions, and others. It took place in Recife, Brazil, from 10 to 13 November 2013, under the theme Human Resources for Health: Foundation for Universal Health Coverage and the Post-2015 Development Agenda. According to WHO, universal health coverage (UHC) means that all people can use health services, while being protected against financial hardship associated with paying for them. UHC is considered to have a direct impact on a population’s health. UHC is considered as a critical component of sustainable development and poverty reduction, and a key element of any effort to reduce social inequities and the hallmark of a government’s commitment to improve the wellbeing of all its citizens1. UHC is firmly based on the WHO constitution of 1948 declaring health a fundamental human right and on the Health for All agenda set by the Alma-Ata declaration in 1978. Equity is paramount2. Various sessions discussed the barriers and challenges to UHC and the essential elements for policy making and programming for UHC at different health care settings. Other sessions discussed the scaling up
The link between interprofessional education and collaborative practice was discussed at the recent World Health Organisation (WHO) Human Resources for Health Forum in Recife. The perspectives, debated issues and declarations are briefly presented here, so that leaders in the field of oral health are familiarised with the potential impact of these discussions on the dental profession. © 2014 FDI World Dental Federation
of health workers, team approaches for success, partnership for effective strategies for UHC, effective use of resources, and mobility and recruitment of health workers in remote or rural areas. Further sessions focused on country models/experiences/best practices (e.g. collaboration of midwives and nurses at various settings), financial aspects of health care delivery, and other health and health-care related topics in association with UHC. MORE LINKAGES BETWEEN ORAL HEALTH AND GENERAL HEALTH AND A BROADENED ROLE FOR DENTISTS: AN OPPORTUNITY FOR FDI AND ORAL HEALTH FDI’s interest in the event stems from opportunities, within the context of UHC, to further develop elements of its FDI Vision 2020: shaping the future of oral health, in particular ongoing Vision 2020 projects within the fields of intra- and inter-professional collaborative practice. FDI Councillor Professor Nermin Yamalik, as cochair of the FDI Task Team on Collaborative Practice, represented FDI at the event. She made a presentation during a special session organised by World Health Professions Alliance WHPA3, of which FDI is a member, on the theme ‘Building collaborations and synergies between health professions: practice within the full scope of education and training’. The WHPA session focused on needed collaborations and synergies between different professional associations to achieve the objectives of UHC. The session highlighted the principle of health workers’ ability to practise within their full scope of education and training. It discussed the required skill mix of clinical, nonclinical and social professionals and needed collaborations and synergies between them to better achieve health strategies within an UHC context. The session essentially considered medical health care delivery and general health as most of the speakers were involved in medical and/or institutionalised care. 59
Editorial For FDI, the WHPA session was another opportunity to underline the inseparability of oral health from general health, undertake oral health advocacy and highlight the significant contribution of dentistry to UHC, systemic health, well-being and the quality of life of individual patients and the public at large. Furthermore, it was an opportunity to place a particular emphasis on why more collaboration is required between dentistry and other health professions such as medicine, nursery, pharmacy, and others. In her presentation, Professor Yamalik highlighted: • Better clarification of the bilateral relationship between oral health and general health • Oral signs/symptoms of many systemic diseases/disorders, the positive impact of good oral health and oral health care on improved systemic health and quality of life • Advances in science and technology related to all health professions, including both medicine and dentistry • Changing needs and demands from health professionals, ageing populations and new life styles • Common causes of certain oral and systemic disease and disorders (e.g. non-communicable diseases (NCDs) and tobacco, unhealthy nutrition, etc.) as some of the reasons behind the need for further improvement to collaboration between dentistry and other health professions. The presentation emphasised the significant contribution of dentistry to patients’ general health and quality of life. As a global matter, NCDs are a good example of all health professions coming to work together and it is clear that there is a message to be given and some measures to be taken by each health profession. Each profession, on its own, and also professions together and more effectively may combat NCDs globally. NCDs demonstrate that collaborative practice is not just a need for developed countries; it is in fact a global need and demand. Even more emphasis may be needed to be placed on collaborative practice and the joint activities and more communication and more projects of health professions related to UHC in developing countries as this issue may be rather more immature in these countries. The WHPA session also reminded of the need for collaboration between health organisations and the academic world as this is an important step for developing a collaborative-practice ready workforce through interprofessional education, and the analysis of the challenges brought out by the fragmented health systems. Barriers to effective collaborative practice raised by the audience included leadership and professional borders, the classical ‘silo’ model of professional education, fragmented systems, and limited distribution of policy statements. However, it was generally agreed 60
that efforts in the field of interprofessional education and collaboration need to stay on the agenda of all health professions. The significant role which the health associations could play at national and international level was also an important part of the session and the subsequent discussions. CONCLUSIONS The UHC Forum addressed the importance of teamwork, multiprofessional and multidisciplinary approaches and collaboration and partnerships both at the education and practice levels among the many partners involved in health care provision, e.g. nongovernmental organisations, governmental structures, health professions, professional organisations, the academic world, researchers, educators, policy makers, health service payers, patients, and others. Without doubt, health professions, and in particular dentists, need to be at the core of any discussions, negotiations or planning regarding health issues, provision of care, workforce planning and interprofessional education and collaborative practice in a given country and local conditions clearly need to be taken into consideration. Within the context of UHC, optimal models of provision of care – with the necessary funding and human resources – should be the goal of all parties involved in planning of health care. Interim/transient/suboptimal models of collaborative practice which do not comply with defined standards and quality of care and do not improve patient and public benefits cannot be accepted as permanent models of delivery of care. The FDI Istanbul Declaration (2013)4 entitled ‘Oral health and general health: a call for collaborative approach’ strongly defends oral health as a fundamental human right and an integrated part of general health and well-being, highlights the significant association of oral diseases with systemic diseases or disorders. It calls national, regional and global health leaders to recognise oral health as an essential component of global health and promote a reinforced interprofessional collaborative approach in the development of global and national policies. FDI Vision 20205 identifies the broadening role of dentists and collaborative practice as one of the five transversal themes with specific priority. The FDI Task Team on Collaborative Practice is working on defining how the dental profession can take a leading role in this important topic, working with WHO, policy makers, academicians and ministers of health. This underlines the significant emphasis FDI places on effective and quality care delivery and the UHC and total health care context through collaborative practice as well as the importance of correct planning of the future by health professions. © 2014 FDI World Dental Federation
Editorial Acknowledgement The author wishes to thank Tea Collins for kindly preparing and for her input regarding the goals and messages of the WHPA Session. Nermin Yamalik FDI Councillor
2. WHO. Alma Ata Declaration. Available from: http://www.who. int/publications/almaata_declaration_en.pdf?ua=1. [Accessed February 24 2014]. 3. World Health Professions Alliance WHPA: FDI World Dental Federation, World Medical Association (WMA), International Council of Nurses (ICN), World Confederation for Physical Therapy (WCPT), International Pharmaceutical Federation (FIP). WHPA represents more than 26 million healthcare professionals —doctors, dentists, nurses, physical therapists and pharmacists— in 130 countries.
REFERENCES
4. FDI. 101st FDI Annual World Dental Congress (Istanbul, Turkey, 28–31 August 2013). Available from: http://www.fdiworldental. org/publications/declarations/istanbul-declaration.aspx. [Accessed September 16 2013].
1. WHO. Universal Health Coverage. Available from: http://www. who.int/universal_health_coverage/en/. [Accessed November 4 2013].
5. Glick M, Monteiro da Silva O, Seeberger GK et al. FDI Vision 2020: shaping the future of oral health. Int Den J 2012 62: 278– 291.
© 2014 FDI World Dental Federation
61
