Oral diseases constitute a global public health crisis, affecting nearly 3.5 billion people worldwide [1]. They cause pain, disability, and economic loss, with their highest burden falling on vulnerable and marginalized populations [1,2]. This crisis is exacerbated by a widespread systemic failure: c [3]. This exclusion frames oral health as a discretionary rather than an essential service, rendering cost a primary barrier to access [4]. Africa exemplifies the severe consequences of this global neglect. The continent is projected to experience the largest relative increase in oral diseases by 2030, driven by urbanization, dietary changes, and the persistent low prioritization of oral health [3,5,6]. The prevailing clinic-centric, curative model is not only misaligned with regional demographics, resource constraints, and cultural contexts [7] but also replicates a global paradigm that uses high cost as a rationale for exclusion rather than as an impetus for innovating equitable, preventive solutions. Therefore, the challenge in Africa is a pressing demonstration of the need for a paradigm shift in how oral health is valued and delivered.The persistent inadequacy of oral health care in Africa is a deeply entrenched structural problem, rooted in systemic and self-perpetuating deficiencies that are more than a simple shortfall of resources or logistics. This structural failing is evident in the severe maldistribution and shortage of the oral health workforce, where the low dentist-to-population ratio, frequently reaching 1:100,000, stands in stark contrast to ratios around 1:2,000 in high-income countries [2,6]. This scarcity is exacerbated by a maldistribution of care providers, with most dental facilities concentrated in urban centers [8]. Consequently, rural populations, which constitute the majority in many African countries [9], face geographic barriers to accessing care [10]. Compounding this is the policy and financing neglect, as oral health remains excluded from most UHC schemes and primary care policies [11], resulting in catastrophic out-of-pocket expenditures for many households [12]. In the absence of political will and dedicated preventive funding, the oral health burden is normalized for marginalized populations due to a lack of [11][12][13].In the absence of accessible and affordable professional care, populations often resort to traditional or complementary remedies [14]. While these remedies are often effective for basic hygiene, they lack an evidence base for managing acute conditions, potentially leading to delayed presentation and health complications [15]. Yet, the prevailing clinic-centric model, derived from Western biomedical frameworks, creates a systemic cultural and institutional disconnect by overlooking and not strengthening indigenous health practices and community-based oral health care traditions, thereby widening the access gap [15,16]. The cumulative effect is a situation where a preventable condition like dental caries can progress to a life-threatening infection and chronic oral pain [17]. This disconnect is exacerbated by infrastructural and technological inequities, where limited preventive public health infrastructure and uneven digital access reinforce disparities rather than resolve them [18]. The cycle is perpetuated by dental education curricula that remain focused on curative, clinical care, offering minimal training in community-based prevention, cultural competence, or the integration of traditional knowledge systems [16]. Collectively, these intertwined factors create a system in which oral diseases are treated late [19][20][21], and late access to treatment is systematically sustained by the very structures designed to combat them.While it is known that prevention remains the most viable option to address oral disease [1] and a strategic necessity to achieve health equity, reduce healthcare costs, and improve overall quality of life [22]. The critical question is how to implement it effectively within the African socio-economic and cultural landscape. Mitigating the oral health crisis in Africa requires fundamental structural reorientation toward community-embedded, preventive, and culturally intelligent models of care. The aim of the study is to advocate for a shift away from the current prevailing model of oral healthcare in Africa, and to propose a new, community-embedded, home-based primary preventive model.The conventional oral healthcare model, which relies on encouraging clinic attendance for preventive check-ups and education, is rooted in a Western biomedical framework and fails to account for the geographic, financial, and cultural barriers that limit clinic access, thereby exacerbating health inequities. It is ill-suited to the infrastructure, economic realities, and cultural practices of many lowresource settings in Africa as it inherently places the onus of cost, time, and travel on the individual, thereby disproportionately disadvantaging rural and low-income communities. This raises a pivotal question: in settings where transportation costs are significant considerations, and where cultural beliefs often prioritize home-based and community-advocated remedies [15,16], is a clinic-based model for prevention justifiable?For Africa, where a more equitable, efficient, and culturally intelligent model of delivering oral health care is needed, alternative(s) must be explored. A viable path forward is a reorientation towards home-based and community-driven primary prevention. This is a call to re-engineer the ecosystem, positioning the household as the primary locus of prevention, supported by a strengthened public health infrastructure that actively incorporates indigenous knowledge and hands the responsibility of prevention to empowered communities. This model aligns with the WHO's building blocks approach by focusing on community ownership and integrating oral health into broader health initiatives [23].Advocating for a home-based, community-embedded model of oral health prevention does not diminish the fundamental responsibility of governments and health systems to ensure population health. Rather, this paradigm shift represents a strategic reorientation toward primary prevention, anchored by robust public health infrastructure, targeted professional development, and equitable distribution of tools and knowledge. The model's success wholly depends on this systemic support; without it, responsibility is devolved onto individuals and communities, exacerbating the very inequities it seeks to address. The proposed model, therefore, envisions a synergistic partnership, positioning the household and community as the frontline of daily prevention-actively fortified by the state through funded preventive programs, subsidized access to essentials like fluoride toothpaste, and culturally sensitive training curricula [24]. Ultimately, the goal is to avoid making people responsible for outcomes beyond their control due to inadequate support. Instead, the model empowers them within a framework of shared responsibility, where public health infrastructure enables effective self-care and community action, thereby transforming the locus of care without abandoning the population.This proposed model offers several distinct advantages, with an emphasis on cultural leverage. First, a preventive approach is economically prudent. Evidence indicates that population-based preventive programs yield a high return on investment: for every USD invested in community-based oral disease prevention, up to USD 50 in treatment costs can be saved [25]. Empowering individuals, households, and communities with the knowledge and tools for effective self-care, including the use of affordable fluoride toothpaste, sugar consumption limitation, and other dietary strategies, can prevent a significant proportion of oral diseases, thereby alleviating financial pressure on both households and the overstretched public health systems.Second, a key, yet underutilized, strategy is the respectful engagement with and leverage of culturally resonant health promotion, often embodied by community-based actors like traditional healers. As demonstrated in Yorùbá culture, songs, proverbs, and folklore are powerful tools for embedding health messages [15,16]. Public health campaigns can leverage these existing oral traditions to disseminate messages about oral hygiene, reframing modern practices like fluoride toothpaste use within the context of cultural values such as spiritual balance, personal dignity (iyi), and social respectability [16].Although the integration of culturally resonant health promotion is often promoted through the integration of traditional healers into formal health systems [26], this integration approach remains unresolved, facing challenges related to training standardization, regulatory frameworks, and scope of practice [27,28]. Our proposal does not suggest that traditional healers can or should replace absent dentists or solve systemic human resource shortages in isolation. Rather, it advocates for a complementary and collaborative model. Community Health Workers (CHWs) and respected community figures, including some traditional healers who share a language and worldview with the community, can be trained as oral health promoters. Their role would be to champion the complementary use of evidence-based prevention alongside trusted cultural practices, such as the use of chewing sticks with known antimicrobial properties [29,30]. This can bridge the trust gap and transform cultural barriers into facilitators. The proposed model is not an alternative to building a robust health workforce but a necessary, parallel investment to extend its reach and impact sustainably. It seeks to 'task-share' health promotion and simple prevention, not 'task-shift' the full burden of clinical care. This strategy needs to use a dual approach: 1) Strengthening the economic, human, and physician resources of the formal oral health system remains a non-negotiable priority for managing disease and handling referrals. 2) Simultaneously, empowering community-based networks to deliver primary prevention. This decolonizes the approach by valuing indigenous knowledge systems while anchoring them within a strengthened public health infrastructure that can provide oversight, training, and a clear referral pathway.Third, the environmental impact of health care delivery is an emerging concern. Clinic-based models necessitate frequent patient travel, consuming fuel, and generating carbon emissions [31]. Furthermore, complex restorative treatments for advanced disease consume more materials and energy, contributing to medical waste [32]. A home-based prevention model inherently reduces the carbon footprint of oral health care by minimizing unnecessary travel, reducing disease incidence, and diminishing the demand for resource-intensive curative procedures [33].Fourth, digital health technologies present a transformative opportunity to overcome geographic barriers. The proliferation of mobile phone networks enables the use of tele-dentistry, allowing CHWs to perform basic screenings and receive remote guidance from dental professionals [34]. Smartphone penetration in Africa is growing rapidly, increasing from 64% in Sub-Saharan Africa in 2024 to 75% in 2025 [35]. Mobile health (mHealth) applications can deliver standardized oral hygiene instruction, including culturally tailored animations using local music and proverbs, dietary advice, and preventive reminders in local languages. This task-shifting and tele-guidance approach, validated in programs for oral health [36], can expand the reach of oral healthcare systems without requiring more dentists [37].Table I provides a summary of the argument presented in the paper by systematically contrasting the limitations of a clinic-centric model with the proposed household-focused, community-supported alternative preventive model. The paradigm shift is a move from a clinic-centric model to one that relocates the primary locus of preventive oral healthcare by empowering and enhancing self-care at the individual household level, which is reinforced by a network of support within the community. This is achieved through several key changes outlined in the table, including the shift from the professional dental clinic to the household, establishing it as the frontline for daily prevention, while the community becomes the supportive ecosystem. Key actors are expanded beyond oral healthcare professionals to include individuals, caregivers, CHWs, teachers, and traditional healers. This creates a multi-layered support system that guides, educates, and reinforces positive self-care practices within everyday life. The approach becomes culturally intelligent, leveraging indigenous knowledge, oral traditions, and technology to make evidence-based self-care practices more resonant, sustainable, and responsive to local resources. The proposed model transforms prevention from a periodic clinical event focused on managing disease by an external authority (the dentist) into a continuous, community-embedded practice for sustained health and well-being managed by empowered individuals. Implementing this paradigm shift faces significant systemic challenges that demand strategic and context-sensitive solutions to prevent the inadvertent perpetuation of health inequities. First is the need for sustained political will to reorient national health budgets from a curative to a preventive focus, including the integration of oral health into UHC schemes and primary care policies [11].Innovative financing, such as earmarked taxes on sugar-sweetened beverages shown to be effective in Africa [38], alignment of donor investments with frameworks like the African Union's Agenda 2063 through domestication into national development plans, coordinated partnerships, and leveraging various financing mechanisms [39], and the reallocation of funds from high-cost tertiary procedures to community-based prevention can yield a high return on investment for this program.Second, addressing workforce gaps requires scaling training for CHWs and traditional healers without compromising quality. This necessitates a standardized, accredited curriculum focused on core preventive competencies (identifying early signs of caries and gingivitis, delivering motivational interviewing for fluoride toothpaste use and sugar reduction, using a validated mobile app for risk assessment and capturing images for tele-consultation, and applying a simple referral algorithm based on symptoms to designated primary care dental units), supported by ongoing supervision and telementorship from dental professionals [37], alongside continuous professional development and clear scope-of-practice guidelines to ensure safety and clarity [27,28]. The digital divide presents another barrier; although smartphone penetration is rising [35], uneven access and literacy risk widening disparities [18]. A hybrid approach combining mHealth apps for connected users [36] with low-tech solutions like SMS reminders, interactive voice response, and community radio in local languages, shown to be effective [40], is essential for inclusive reach.Furthermore, tele-dentistry and community screening must be formally linked to clinical care through structured referral protocols. Clear guidelines, supported by mobile diagnostic tools for CHWs [34], should define urgent red-flag conditions, establish feedback loops for follow-up, and integrate seamlessly with existing primary care networks to avoid siloed systems. Finally, cultural and logistical sensitivities must be navigated with care. Potential resistance from professional associations can be mitigated through the co-creation of guidelines and evidence-sharing. Respect for the intellectual property of traditional knowledge, credited inclusion of cultural custodians in program design [16], and transparent, long-term community engagement are all vital to building trust and reinforcing the complementary, not replacement, role of cultural practices within an evidencebased prevention framework. The goal is to establish every household as its own first line of defense, supported by the consistent practice of evidence-based prevention, such as twice-daily use of fluoride toothpaste and reduction in sugar consumption, which remains one of the most effective public health interventions for dental caries [41,42], while respecting and incorporating culturally validated selfcare practices.To realize this vision, a phased, adaptive implementation strategy is essential to pilot, refine, and scale the model effectively as outlined in Table 2. By deeply embedding prevention into community and primary care structures, a resilient oral health ecosystem capable of enduring with reduced reliance on external funding can be fostered. Successful implementation requires multisectoral governance, actively involving Ministries of Health, Education, Local Government, and Finance. National Oral Health Prevention Guidelines must be co-developed with communities and strategically aligned with overarching frameworks such as the WHO's Framework for Integrated People-Centred Health Services [43] and the African Union's Health Strategy 2016-2023 [44]. A robust monitoring and evaluation framework is needed to track progress through key indicators like the reduction in early childhood caries incidence, coverage metrics such as the proportion of households with access to affordable fluoride toothpaste, workforce data on the number of trained CHWs and traditional healers per district, and perceived quality measures of patient satisfaction and cultural relevance. Further strengthening resilience would require promoting the local production of affordable fluoride toothpaste to ensure a reliable supply, create economic opportunities, and reduce import dependence [45,46]. It is time to move beyond attempting to retrofit a Western, clinic-centric model onto the complex realities of Africa. The future of oral health in Africa lies in decentralizing prevention, democratizing care, leveraging technology, integrating with primary care, and, most importantly, empowering communities by drawing upon their immense cultural and human capital. This model reimagines health systems as enablers of prevention. It calls for governments, professionals, and communities to co-create a cost-effective, sustainable, and scalable oral health ecosystem where prevention is accessible, culturally resonant, and systematically supported as an ethical and practical imperative to mitigate the growing epidemic of oral disease on the continent. Ultimately, the sustainability of this paradigm shift hinges on parallel reforms in dental education, producing graduates who are as proficient in cultural humility and community partnership as they are in clinical science.
Tin Htet Oo, Sukanya Tianviwat, Songchai Thitasomakul
INTRODUCTION The health system is one of the essential parts to promote the population’s quality of life. Currently, there are oral health system analyses with various specific focuses, for example, stewardship, service delivery, improvement of oral health outcomes through research, and continued education and overviews of the framework, from some countries such as India, Iran, Uganda, and the European Union countries..[12345] Myanmar has 135 different ethnic groups living in 14 states/regions of the country, with about 54.13 million in 2019.[67] There are around 111 spoken languages in Myanmar with eight significant languages, and Burmese as the official national language.[7] Therefore, there are many impediments to providing adequate health services to the whole nation, such as lack of personnel, language barriers, different cultures and beliefs, and inadequate transportation infrastructure. Myanmar government recently started the NHP covering four years (2017–2021), which is a part of a long-term NHP of achieving UHC by 2030.[8] Nevertheless, the oral health policy has been neglected in most NHPs.[59] This study aims at reviewing the oral health system in Myanmar, with the WHO’s six building blocks of the health system.[10] Scientific articles about oral diseases and oral health in Myanmar had already been published.[1112131415161718192021] Although information about the health system and human resources for health in Myanmar were found in some articles,[67,22] items related to the oral health system have not yet been mentioned. Therefore, this article reports the current conditions and challenges of Myanmar’s oral health system based on the published articles and the reliable local documents that are inaccessible by non-native speakers and non-health professionals added value to the academic world in the overview of the oral health system. MATERIALS AND METHODS The oral health system analysis was conducted based on the WHO’s six building blocks of the health system: health service delivery, health workforce, health information systems, access to essential medicines, health financing, and leadership and governance.[10] For inclusion in the review, articles and documents dealing with oral health and the health system in Myanmar based on the WHO’s six building blocks of the health system and oral health status were considered: dental caries, gingival diseases, periodontal diseases, dental fluorosis, cleft lip and palate, and oral cancer in Myanmar. Articles were searched from PubMed and Google Scholar. The search terms used were Myanmar, oral health system, health system, oral health services, health resources, health financing, health information, essential medicine, and leadership and governance for oral health and health system-related information. The terms: oral health status, Myanmar, dental caries, gingival diseases, periodontal diseases, dental fluorosis, cleft lip and palate, and oral cancer were used to inform oral health status. Moreover, related information on dental health from reliable websites of governmental and nongovernmental sectors was also searched. Articles published until August 2020 were explored. All electronic records were imported into Endnote X7. Titles, abstracts, keywords, and contents of articles and documents were scanned to meet the eligibility criteria and eliminate irrelevant items. Articles with information unrelated to the standards were excluded. Potentially relevant articles were selected and collected as full-text records. Selected full-text journals were appraised for their meeting the eligibility criteria. A total of twenty-nine articles and documents matching these criteria were used as included articles in this review. ORAL HEALTH STATUS IN MYANMAR Dental caries and periodontal disease are the most common oral diseases in Myanmar. Two studies of Thwin et al.[1112] showed that the prevalence of dental caries in 3-year-, 4-year-, and 20- to 45-year-olds were 78.9%, 87%, and 90.8%, respectively. In the Pathfinder survey of different regions,[1314] dental caries’ prevalence was high (above 50%) in the 5-year, 12-year, and 35–44 age groups. According to the national oral health survey, the untreated caries level is very high among 6-year-old children (84.1%).[1415] The prevalence was lower than 50% in other studies, such as in those by Chu et al.,[16] Aung et al.,[17] and Mon et al.[18] The National Oral Health Survey (2016)[1415] showed that the percentages of bleeding on probing in the 12-, 15–18-, 35–44-, and 60- to 74-year age groups were higher than 60%. The prevalence of dental caries, as shown in Table 1, and that of gingival and periodontal diseases was high among Myanmar people and was followed by an upward trend with age.Table 1: Prevalence of dental caries and decayed, missing, filled teeth (DMFT/dmft) by age groups in MyanmarOther common oral health problems in Myanmar are oral cancer, dental fluorosis, cleft lip, and palate.[1415,192021] According to a review of oral cancer in Myanmar, oral cancer is the fifth most common cancer[19] in Myanmar. Betel quid chewing has been considered one of the important risk factors for oral cancer.[1920] Moreover, based on the statistical report of representative cancer referral hospitals in Myanmar, oral cancer accounted for 3.5% of all cancer cases. It ranked at the sixth position in males (5.3%) and the 10th position in females (2.2%).[20] The National Oral Health Survey also reported that the prevalence of dental fluorosis was high (13.3%–21.67%) in the areas of Central Myanmar.[1415] According to the Annual Hospital Statistics Report (2013), cleft lip and palate is the third most common congenital disability in Myanmar and it accounted for 18.5% of all congenital malformations.[1421] ORAL HEALTH SERVICE DELIVERY There are two sectors for oral health service delivery: governmental and nongovernmental. In the governmental sector, departments under the Ministry of Health and Sports (MOHS) are shown in Chart 1.[23]Chart 1. Organization chart of departments under the Ministry of Health and Sports (MOHS)Public dental clinics in state and region hospitals, district hospitals, township hospitals, station hospitals, and health centers under the Department of Medical Service and the Department of Public Health take the primary responsibility to deliver oral health-care services to the Myanmar population.[7] Universities of Dental Medicine (Yangon and Mandalay) under the Department of Health Professional and Resource Development also provide dental care services to the community.[7] Among the nongovernmental organizations, Myanmar Dental Association (MDA) gives continuous educational training programs for Myanmar dental professionals and also provides dental care services to the population in both urban and some rural areas.[24] Moreover, community-based organizations provide public dental health-care services on a nonprofit basis. Private dental clinics offer services to the population for which the people have to pay for out-of-pocket. Oral health promotion activities The following oral health promotion programs were established in Myanmar for different targeted groups:[1425] Early Childhood Caries Prevention Program for younger than five-year-old children, including toothbrushing and oral health education to caregivers Institution-based School Oral Health-care Activity for school children, including toothbrushing, oral examination, oral health education, and essential dental treatment Maternal Oral Health Education Program, including oral health services for pregnant women, improved maternal and child health Feasible Effective and Affordable Fluoride Program for the whole population Oral Cancer Awareness Program by screening among tobacco and betel quid consumers in suburban and rural areas The primary prevention of oral health is to prevent diseases from occurring; the secondary prevention is to get an early diagnosis and prompt treatment; and the tertiary prevention is to restore oral health functions.[26] In Myanmar, most dentists are extensively involved in the parts of secondary prevention and tertiary prevention.[27] However, the role of Myanmar dentists in primary prevention is currently limited.[27] Accessibility for oral health-care services Dental clinics under the government sectors, including the two universities, implement free-of-charge services for necessary dental treatments such as dental checkups, tooth extraction, restoration, and sedative dressing. Other services such as endodontics treatment, minor or major oral surgery, fixed or removable prosthetic treatment, and orthodontics treatment can be fulfilled with some contribution fees.[7] Dentists involved in school health teams administer the oral health examination, dental health education, tooth extraction, sedative dressing, and atraumatic restorative treatment for free-of-charge to appropriate cases among school children.[7] Coverage of percentage of the population with selected oral health-care services in Myanmar Although Myanmar people can access dental services from both public and private sectors, reported data of services coverage were available only from the public sector, as follows. According to reports of the South East Asia region, 2008,[28] the coverage percentage of the regular oral examination in 12-year-old children was 73%, and emergency dental care in adults and elderly was 35% and 34.5%, respectively. Also, the percentage of fluoride toothpaste use was 100%. DENTAL WORKFORCE There are insufficient numbers of dentists and dental nurses, and there are no dental therapists or dental hygienists in Myanmar.[2228] Dental professionals educated from two dental universities (Yangon and Mandalay) provide oral health-care services in the public and private sectors for the whole population in Myanmar.[29] In addition, there are limited numbers of army-dentists trained under the Defense Services Medical Academy (DSMA) to serve.[29] The latest total number of registered dentists under the Myanmar Dental Council till 2018 was 4,539,[29] where the dental nurses’ number was 503,[22] as shown in Figure 1. The dentist to population ratio is approximately 1:16,000,[29] fewer than the WHO recommended proportion of 1:7500.Figure 1: Number of dentists and dental nurses working in the public and private sectorDentists working in the public sector are under the Department of Medical Service and the Department of Public Health of MOHS, Myanmar, whereas private dentists work in private dental clinics or private hospitals. According to Figure 1, the number of dentists working in the public sector was decreased, and private dentists were increased based on 2016 data compared with 2014 data.[622] However, the number of dental nurses working in the public sector has increased since 2009. Figure 2 shows the number of dentists working in the public sector in 14 states/regions of the country according to the data of 2016.[22] The numbers of dentists working in the public sector are higher, approximately around 100 in big cities: Yangon and Mandalay Divisions, and Shan State.[22]Figure 2: Number of dentists working in the public sector by 14 states/regions and Nay Pyi Taw Union territoryORAL HEALTH INFORMATION SYSTEM The National Health Information System is an organized system of keeping the records, processing, analysis, reporting, usage, and feedback of information based on systematic data collection, community surveys, clinical studies, health system research, and census data. It is used to make decisions and formulate policies for health programs.[30] Data are collected manually by trained basic health staff using standardized forms (monthly, quarterly, and annually) in the current information system.[7] To strengthen the current information system, an electronic information system has been introduced and its robustness identified.[7] The current system comprises hospital information and public-health information. All the data are sent through the Township Health Department and the respective Region or State Health Department to the Department of Health Planning.[7] The Central Statistical Organization under the Ministry of National Planning and Economic Development takes responsibility for analyzing statistics for the country according to the Central Statistical Authority Act 1952.[7] Oral health status, risk factors, utilization of dental services, and service coverage are constituents of the oral health information system.[31] The dentists working in the public sector report monthly dental patients’ data from their hospitals or fields through the current health information system. ACCESS TO ESSENTIAL MEDICINE Myanmar Essential Medicines Project has been implemented in collaboration with the WHO since 1988 and has developed a National List of Essential Medicines (NLEM) to follow the concepts of essential medicine use.[32] For dental use, the dental cartridge (local anesthesia) and anti-bacterial drugs for oral diseases shown in Table 2 are included in the new edition of the National List of Essential Medicines (2016), which contains 486 items of medicine.[32] Drugs, including essential medications, are mainly supplied by the Central Medical Store Department (CMSD) under the MOHS to all hospitals under governmental sectors.[32] The crucial medicines, equipment, and materials required for dental use are also distributed by the CMSD to dental clinics under government sectors periodically.[732]Table 2: Local anesthesia and anti-bacterial drugs for dental use Category A = for any doctor, B= Alternative to A, C = for experienced doctors, D, E1 =Trained personnel with expert qualifications (drugs to be used in the specialized center)HEALTH FINANCING Health financing is one of the critical issues that Myanmar is currently facing. The primary sources of finance for health-care services are the government, private households, social security systems, community contributions, and external aid.[3033] Total health expenditure as a share of GDP was reported as approximately 4.7% (Myanmar MOHS, 2017), which in absolute terms of health spending per capita was 70,100 kyat, or about US$54.[34] The government share of total health expenditure, including government budgetary and social insurance, was 23% (Myanmar MOHS, 2017).[34] Governmental health expenditure increased from 647 million USD in 2014 to 1048 million USD in 2019,[35] as shown in Figure 3. This expenditure is for medical, dental, and other medical-related fields, including the funding of medical equipment, electro-surgical technology, the provision of free medical treatment for government employees, and medical professionals’ training.[3536] According to the WHO, Myanmar has the highest out-of-pocket-payment rates of health-care spending in the Association of Southeast Asian Nations (ASEAN) (73.9%).[3435]Figure 3: Government expenditure on health care (2014–2022f), USD millionsThe MOHS primarily grants funds for dental equipment and materials required in public dental sectors. Around 1,100 million kyats (715,786.50 USD) for 125 dental health units with an average of about 5,726 USD for each dental unit was provided in the last NHP (2006–2011).[37] One study[38] reported that the percentage of household expenditure spent on dental care in Myanmar was 1.5%. LEADERSHIP AND GOVERNANCE Health legislation plays a crucial role in the governance and leadership components of the health system. They are described next.[30] The National Health Committee (NHC) The NHC was founded on 28 December 1989. It takes the leadership role as a compositional committee with the MOHS and other ministries’ collaboration. It gives guidance for implementing the health programs systematically and efficiently. The NHC sets the policies for the whole nation and makes decisions to guide the health-care sectors based on the It the long-term NHP the of achieving UHC by which covering four The of the NHP to public health problems and promote the health status of the to coverage of health services for the whole nation, to and human resources for to medical to and to of essential Nevertheless, the of for oral health is in the is the to health service to and human resources for all It gives to on each and decisions working in the public hospitals and clinics under the government the policy health coverage The long-term NHP aims at the the Health Coverage The is to provide health-care services, including essential dental services, to of social status, and from The current which four years in the UHC framework, was to access primary health-care services, essential services, and at the township level and the The secondary and tertiary health-care services be in the NHP and Nevertheless, it has been that there is no specific or for the coverage of oral health care services to the Myanmar health sector committee is the health sector and in Myanmar. The specific of the the MOHS on the health providing a on as a for the health sector in the of improved health care health status, medical education, and health of the of health and and a in through information, education, and Nevertheless, the role of in the of oral health issues is Health The primary of is to and to the of implementing different It is essential to the health of the It also health such as factors, factors, social and community living and working and which health and oral It can be that the oral health status of Myanmar is which access to dental services in Essential oral health care service delivery, necessary to strengthen the oral health system, is one of its significant The MOHS is the primary for public health and dental care Therefore, the government take responsibility for it by both governmental and nongovernmental Nevertheless, dental services for some areas in Myanmar to transportation are among the challenges by government and dental the Myanmar dental in primary prevention and oral health promotion including oral health education, oral examination, toothbrushing, fluoride and specific for be since primary prevention is a to strengthen oral health in Myanmar as a of the registered dentists and dental nurses are working in the public It is that the dental for oral health is and there is public and private oral health sectors for dental services in Myanmar. This be some dentists from government to various or working and working recently dentists not to the MOHS continued their There is also no oral health such as dental hygienists and dental in some other countries in the South East Asia India, and there is no to the health-care since the with the to deliver the health-care services to the people in the is a Nevertheless, one study an to this are It can be described as a from both and of the health-care in terms of the based on factors, factors, and services utilization rates and from and However, it be to implement in Myanmar as it is a country with limited where data are required to the Therefore, a of this review about the oral health-care is to training dental health-care to provide services and to dental personnel to in the and of the national level of oral health policy for policies and oral health care services based on available dental the essential medicine was developed by collaboration with the WHO, Myanmar be included in the countries that than necessary of the WHO Although local anesthesia and some anti-bacterial drugs used in dental care were included in the Myanmar National List of Essential Medicine items and supplied by the current of dental materials and equipment is insufficient for the public dental the other the oral health information system not a to the collected data the dentists working in the public sector report monthly dental through the current information system. This be to the to related information from private dental clinics and Other for of the current health information system are the of and the limited of services for the electronic information system, as as data in where security are Myanmar’s health spending as a share of GDP was average and the government share of total health spending was also average compared with other countries at a The percentage of the household expenditure on dental care in Myanmar was the among and which was the as Myanmar is a country, and around of Myanmar people in and rural people living in rural areas are considered to have status, and people are to education and health According to one health-care utilization was with household there are no data for dental services utilization in Myanmar. it was that those with dental treatment not to to private dental clinics to their of for dental services utilization also the of the diseases and treatment and the financing governmental funding for the dental role is not oral health expenditure data for dental dental professionals and public oral health care programs are not Moreover, funding for dental materials and equipment was only reported in the last NHP and this was considered the other current spending is not Public spending on health in Myanmar is lower than that in other countries of with a level of and health a in years is a major of spending and there is a lack of health Therefore, a specific in oral health be a for the In as a country of Myanmar, its policy on UHC has since and is to access essential and health Also, it is that the primary health care system from basic health care to and care with a national for its UHC oral health was a part of UHC with a through a services to access to services and oral health status in In the of Myanmar’s UHC by has a to the current NHP in UHC policy on primary care This is of very in the coverage of health services the UHC of high risk to and in services the and and urban and rural Moreover, oral health in Myanmar’s UHC is and there are no specific for oral Therefore, to this one study to the coverage of health services and risk for and at in important decisions for in In the of oral the of essential oral health care services in hospitals or health centers level also be considered in the UHC a Myanmar dental professionals be in specific and oral health policy for oral health in The current oral health-care system in Myanmar is such as oral health status and dental services utilization be using all oral health human resources the public and private dental Moreover, the of dental in primary programs be be with a public to an oral health information system. A prompt and appropriate to the insufficient of dental equipment and materials be issues be with the MOHS and the Therefore, the Myanmar government to a oral health policy for an oral health system and specific for specific challenges to promote oral health-care coverage for the whole AND The of There are no of AND