Empowering communities to address Africa's dental crisis

Tell us about the WHO’s decision to endorse the mOral Health curriculum.

I was a part of the course development team that developed this oral health training curriculum, and I was tasked with leading the pilot implementation in Kenya and evaluating its impact. This project was supported by the WHO-AFRO regional office and through the pilot  program we trained community health workers on preventive care using a combination of the self-guided online mOral health course as well as on-ground training by designated trainers on topics like oral health promotion, oral health monitoring and data collection at the community level and school based care-so they can bring that knowledge back to their communities and help the county leadership with monitoring the oral health status of their communities. The strength of the self-guided course is that it is a competency based program developed in partnership with regional stakeholders with built in evaluation metrics and assessments.

Based on the success of the pilot implementation, the World Health Organization formally adopted it as part of the essential framework for strengthening oral health across sub-Saharan Africa at the recent 75th WHO Regional Meeting for Africa.

Now, if a country in the region is looking to improve oral health, WHO recommends using our course to train community health workers and build up their workforce.

What’s driving the surge in oral diseases in the sub-Sahara?

One of the big drivers is urbanization. As cities grow, we’ve seen a shift toward more non-communicable diseases, and oral diseases make up a significant portion of that. The key thing to recognize is that these conditions are preventable.

Unlike infectious diseases—where you can usually point to a single causative organism and treat it with antibiotics—oral diseases like cavities are multifactorial. They’re shaped by diet, lifestyle and even access to things like water fluoridation. With changing diets and lifestyles in sub-Saharan Africa, we’re seeing an increase in cavities and other oral health problems.

Can you paint a picture of what it means on the ground when someone in a rural African village has no access to a dentist?

In many areas, people have to travel miles—sometimes even overnight—to reach a county hospital for basic services. That’s where community health workers become so important. Each one is chosen from their own community and is responsible for about 100 households, not just individuals. Because of this, they’re deeply trusted and respected.

Kenya faces a major workforce shortage—there are only about 1,300 dentists for a population of 55 million. So the solution is to empower community health workers. They can provide preventive care, catch problems early, and make timely referrals, which eases the burden on an already overstretched system.

Our training program also gave these workers a real sense of pride and identity. When I visited, many shared how meaningful it was to wear the WHO vest as it gave them recognition and credibility. For people with only a few years of formal schooling, being part of a WHO-sponsored training not only boosted their confidence but also strengthened the trust their communities placed in them.

Are there ways to ensure that African member states will put the program into practice? 

I think the key to making this work is that it has to be community-led. In Kenya, what made the program successful was that it was truly collaborative. We worked closely with the Ministry of Health, with academic partners at the University of Nairobi, and with the county oral health officers who served as designated trainers.

It wasn’t something we just dropped in from the outside. We took time to build trust, to understand the culture, and to learn the real barriers people were facing. The only way to do that is by working with people who live there and know the community. They can tell you, “This won’t work here, and here’s why,” which is invaluable.

Equally important is securing leadership buy-in. Community members might be enthusiastic, but if national or county leaders aren’t willing to commit resources—whether financial or staffing—the program won’t be sustainable. So success really depends on having both: community support on the ground and leadership support at the top.

Was there a moment that made you realize this was urgent work?

I’m a dentist, and even during my MPH at Brown, I knew I wanted to focus on oral health because that’s the field I come from. Growing up in India, I saw how care is concentrated in cities while rural areas remain underserved, and I realized the same disparities exist around the world.

I was pursuing my post doctoral residency at Harvard where I worked with Dr. Brittany Seymour, who first introduced me to this project. It felt like the perfect fit: I already had experience in program evaluation, and my dental background allowed me to bridge both sides. I’m grateful for the opportunity to continue this work in my current faculty position. 

What motivates me is addressing workforce gaps in places where the need is greatest. I don’t believe in “voluntourism” or the helicopter model, where people fly in, deliver care and leave communities with little lasting impact. For me, it’s about sustainability—empowering local communities to meet their own needs.

That’s why I wanted to work on this project in Kenya: training front-line health workers who are rooted in their communities. They’re the first line of care, and by equipping them with skills, we can strengthen the system from the ground up. At the same time, building up dental schools and training more dentists is essential. But if we want real sustainability and to counter brain drain, the key is training people who are connected to and committed to serving their own communities while making sure they are appropriately compensated for their effort.

If this program succeeds, what might oral healthcare in Africa look like 10 years from now?

Ideally, my dream scenario would be for Kenya to have a thriving oral health workforce—no shortage of dentists, and a sustainable 1-to-7,500 dentist-to-population ratio. In that vision, the country’s needs are fully met by its own providers, without relying on outside support from higher-resourced countries.

Right now, there’s still a lot of dependence on external providers to step in, but true success would mean self-sufficiency. That way, if funding from outside sources is ever cut for reasons beyond their control, people wouldn’t suffer—because the system itself would be strong enough to take care of its own needs.