Revolutionising access to dental care in Sri Lanka

A dentistry simulation model led by Southampton has directly influenced government policy to improve dental outcomes and stabilise the country's dentistry sector.

Published: 14 February 2022

A Southampton management scientist together with Sri Lanka’s Ministry of Health have collaborated to develop a dentist simulation model that is improving access to dental care across the country. The research, which began in 2011 made recommendations that directly influenced government policy and reduced unemployment rates in the dentistry sector.

Now over 1.5 million people who’d previously had no access to state-funded healthcare, take annual visits to the dentist. A dramatic reduction in unemployment rates for qualified dentists has resulted in more dentists remaining in Sri Lanka to pursue their careers.

Creating the foundations to improve dental provision

Professor Sally Brailsford at Southampton and Dr Dileep de Silva from the Ministry of Health developed a model that identified demand for dentists in Sri Lanka. It made use of findings from Professor Brailsford’s previous research, including the:

need for clinician engagement
importance of human behaviour
introduction of clinical champions

After reviewing the model, the Sri Lankan government put in place a policy to:

fix the intake of dentistry students for 10 years
create 400 extra government-funded posts over 4 years

The model and its recommendations also helped the government understand the importance of creating a human resources division to plan the future healthcare workforce. The new HR division is headed up by Dr De Silva.

Assessing the impact of government policy

A 2015 oral health survey carried out nationally every 10 years found that:

“There has been a reduction in the oral disease burden and an improvement in oral health habits of the Sri Lankan population - regardless of age, sex, ethnicity and sector variations… and an improvement in dental service utilization patterns”.

Sri Lanka National Oral Health Survey 2015

Since the 1990s, Sri Lanka has suffered from a chronic oversupply of qualified dentists. By 2010 there were more than 250 dental surgeons awaiting government employment – 1 quarter of the total number of dentistry graduates. Many either left to work overseas or establish private practices.

In 2019 Dr De Silva conducted a survey of 455 dentists who had graduated since the implementation of the original recommendations in 2011. The survey respondents reported that:

87 per cent were in government employment within 1 year of graduation – reduced from an average wait of over 3 years
96 per cent were happy or very happy that, unlike their predecessors, they started their clinical careers immediately, and stayed in Sri Lanka
91 per cent reported job satisfaction levels of at least 7, on a scale of 1 to 10
78 per cent had been posted to rural areas - an important finding given the low level of rural provision in the past

The journal article describing the model and its early impact won Professor Brailsford her third Goodeve Medal, awarded annually for the best paper published in the Journal of the Operational Research Society.