Zambia's first ever special care dentistry unit for children was opened by Professor Raman Bedi, Chair of the Global Child Dental Fund (GCDFund), in Lusaka this June 2022. This was the culmination of nearly a decade's hard work, planning and collaboration on oral health projects across the country, with the ongoing support and kindness of many passionate sponsors.

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The story in Zambia began between 2011-12 when the Chief Dental Officer, the Dean of the Dental Therapist School in Lusaka and the clinical dental director of one of the largest dental NGOs in Zambia attended the GCDFund's Senior Dental Leaders conference (SDL). SDL is an annual dental leadership programme for high-level dental leaders from every continent. It is led by Professor Bedi and the Global Child Dental Fund, a UK-based NGO, and alternately hosted by Harvard School of Dental Medicine and King's College London. This year's programme was its fourteenth; the programme has trained over 200 senior leaders from over 43 countries. SDL aims to further delegates' understanding of strategic change and oral health capacity building through collaborative approaches, with delegates strengthening their ability to deal with regional crisis and anticipate and plan for future demands of their country.1

SDL inspired the Zambian leaders to return home and forge a partnership between the Ministry of Health, the Lusaka Dental Training School and local and international NGOs. Together, they planned a model for how dental therapists could be trained to carry out dental prevention and treatment for underserved children across Zambia. This was desperately needed since around half of the population was under 18, and of those children, nearly 40% were both monetary-poor and lacking nutrition, water, sanitation, education or housing.2 At that time, there were only 250 dental professionals in Zambia to serve a population of around 15 million people. Of those, only around 40 were dentists.3 Accessing high-level care in urban areas was simply not an option for children.

The Global Child Dental Fund strove to expand its focus in Zambia by providing dental care for children with special needs or disabilities.

With the low dental workforce capacity in Zambia, government-run dental clinics were unable to promote oral health and prevention in a meaningful way.4 This was particularly concerning since dental caries is increasing with the growing availability of refined sugar across sub-Saharan Africa. Consequently, a three-year pilot programme ran successfully with Lusaka Dental Training School (funded by the Borrow Foundation) enabling 112 dental therapy students to deliver examinations, oral health education and dental treatment to over 11,500 children from 20 government and community-run primary schools in the rural Copperbelt Province of Ndola.

Following this successful outcome, the Global Child Dental Fund strove to expand its focus in Zambia by providing dental care for children with special needs or disabilities. It has been estimated that 4.4% of primary school-aged children live with a disability - estimated at up to 250,000 children.5 Disabled children in Zambia have severely restricted opportunities to access health care, especially if they live rurally. When they do seek care, they are often turned away because the country's dental therapists are not trained in special care dentistry and are therefore not confident in treating them. There was no curriculum in Zambia for dental therapists to learn about special care dentistry and how to successfully overcome the obstacles of disability to provide adequate care.

During the past few years, albeit with the delays that the COVID-19 pandemic invariably brought about, funds were raised with St James' Place and individual sponsors (including the greatly missed late Dr Tony Volpe) to upgrade the clinic at the Lusaka Dental Training School. Prior to funding, it was ill-equipped in poor condition with no sink or pipes for sanitation. The dental clinic was given a new lease of life with refurbishment including painting the room, removing an existing broken chair and installing a much-needed sink. A new paediatric chair was shipped from China; textbooks, dental materials and specially adapted dental equipment (including mirrors, bite blocks and lights) for children with disabilities also arrived. A part of the new clinic was dedicated as a Paediatric Education Centre with an area for children to brush their teeth and education materials and toothbrushes, toothpaste and educational resources that children and parents can use and take home. It is envisaged that at least 4,000 children will pass through the clinic annually.

Building upon the physical improvements to special care dentistry provision in Zambia, it was recognised that there was no curriculum in Zambia (or indeed most of Africa) for dental therapists to learn about how to successfully overcome the obstacles of disability and provide adequate care. A dental curriculum and training materials were developed to help dental therapists at the Lusaka Dental Training School to gain confidence in treating all children no matter what their needs. All dental professionals were also given free dental leadership training since leadership skills and health advocacy go hand in hand.

Working with partners to improve oral health overseas is an endeavour that requires leadership, teamwork, trust and time (in addition to the usual funding challenges). Rome was not, after all, built in a day. The endeavours over the past few years are only the beginning of the construction of something more substantial for dentistry in Zambia.