Community dental clinics: providers' perspectives.

OBJECTIVES: Not-for-profit community dental clinics attempt to address the inequities of oral health care for disadvantaged communities, but there is little information about how they operate. The objective of this article is to explain from the perspective of senior staff how five community dental clinics in British Columbia, Canada, provide services. METHODS: The mixed-methods case study included the five not-for-profit dental clinics with full-time staff who provided a wide range of dental services. We conducted open-ended interviews to saturation with eight senior administrative staff selected purposefully because of their comprehensive knowledge of the development and operation of the clinics and supplemented their information with a year's aggregated data on patients, treatments, and operating costs. RESULTS: The interview participants described the benefits of integrating dentistry with other health and social services usually within community health centres, although they doubted the sustainability of the clinics without reliable financial support from public funds. Aggregated data showed that 75% of the patients had either publically funded or no coverage for dental services, while the others had employer-sponsored dental insurance. Financial subsidies from regional health authorities allowed two of the clinics to treat only patients who are economically vulnerable and provide all services at reduced costs. Clinics without government subsidies used the fees paid by some patients to subsidize treatment for others who could not afford treatment. CONCLUSIONS: Not-for-profit dental clinics provide dental services beyond pain relief for underserved communities. Dental services are integrated with other health and community services and located in accessible locations. However, all of the participants expressed concerns about the sustainability of the clinics without reliable public revenues.

Is international volunteer surgery for cleft lip and cleft palate a cost-effective and justifiable intervention? A case study from East Asia.

BACKGROUND: Although surgery provided by international volunteers is increasingly common in the developing world, there have been few assessments of the cost-effectiveness of these activities. In this context, this study covered 15 years of experience of one international nongovernmental organization, Smile for Children, in providing cleft lip (CL) and cleft palate (CP) surgical services in Vietnam. METHODS: We analyzed the cost-effectiveness of the program and its contributions to building local capacity. To assess the cost-effectiveness of CL/CP surgery performed during Smile for Children's missions in Vietnam, we analyzed the data from four annual missions, from 2007 to 2010. According to the 2003 World Health Organization Guide to Cost-Effectiveness Analysis, we calculated cost per disability-adjusted life years (DALYs) averted with and without age weighting. For the data from the 2010 mission, we repeated the same calculation but with and without considering opportunity cost for labor. RESULTS: The discounted cost per DALY averted averaged $68, ranging from $52 to $79 depending on the year of the mission. The average discounted cost per DALY averted with age weighting was $56 (range $43-$65). For the calculation that takes into account the volunteers' possible income loss as the labor cost of the mission in 2010, the cost per DALY averted without age weighting increased by 28%, from $76 to $97; and the cost per DALY averted with age weighting increased by 27%, from $63 to $80. Under all of these varying assumptions, the CL/CP program operated by Smile for Children is a cost-effective intervention using international criteria for cost-effectiveness. CONCLUSIONS: The contribution of the international volunteer surgical team to building in-country capacity is notable. It was achieved primarily through training Vietnamese surgeons during the mission trips and through sending these surgeons to Korea for training. Other staff, including anesthesiologists, were also trained; and equipment and supplies were provided.

Volunteer orthopedic surgical trips in Nicaragua: a cost-effectiveness evaluation.

BACKGROUND: Injuries account for a substantial portion of the world's burden of disease and require effective surgical care. Volunteer surgical teams that form partnerships with hospitals help build local surgical capacity while providing immediate care. The purpose of the present study was to evaluate the cost-effectiveness of short orthopedic surgical volunteer trips as a method of reducing the global burden of surgical disease through both surgical and educational interventions. METHODS: Data were collected from a scheduled volunteer trip to Leon, Nicaragua, in January 2011 as part of the Cooperación Ortopédica Americano Nicaraguense (COAN), a 501c3 nonprofit organization established in 2002. Costs are from the COAN provider prospective with an additional analysis to include the Nicaraguan provider variable costs. The total burden of musculoskeletal disease averted from the patients receiving surgical intervention was derived using the disability-adjusted-life-years (DALYs) framework and disability weights from the disease control priority project. The cost-effectiveness ratio was calculated by dividing the total costs by the total DALYs averted. RESULTS: A total of 44.78 DALYs were averted in this study, amounting to an average of 1.49 DALYs averted per patient. The average cost per patient from the COAN provider perspective was $525.64, and from both the COAN and Nicaraguan provider perspective it was $710.97. In the base case, cost-effectiveness was $352.15 per DALY averted, which is below twice the Nicaraguan per capita gross national income ($652.40). CONCLUSIONS: Volunteer orthopedic surgical trips are cost-effective in Nicaragua. Further research should be conducted with multiple trips and with different patient populations to test the generalizability of the results.

Removing obstacles one patient at a time: the importance of faith based health care in the community.

Samaritan Clinic, a faith-based, safety-net clinic in Albany, Georgia is an outreach ministry of Mt. Zion and Second Mt. Zion Baptist Church. Through volunteerism, Samaritan Clinic has served 3,335 patients representing 7,092 visits; this is a story of faith made possible by a grant to Samaritan Clinic from Morehouse School of Medicine.

Politicizing women's choices--again.

Why the commotion over Planned Parenthood and Ann Romney matters.