A PILOT TRIAL OF THE IMPACT OF FINANCIAL INCENTIVE ON THE UTILIZATION OF DENTAL SERVICES AMONG CIVIL SERVANTS IN IBADAN, NIGERIA


O.T. Alade1 and F.B. Lawal2

  1. Department of Preventive Dentistry, College of Medicine University of Lagos, Lagos.
  2. Department of Periodontology and Community Dentistry, University of Ibadan and University College Hospital, Ibadan.

Abstract

Background: Financial constraints have been reported as major barriers to utilization of dental services in developing countries. It is however unknown if financial incentives will improve dental service utilization among civil servants in Nigeria.

Objective: To evaluate the effect of financial incentive on the utilization of dental services among civil servants in Ibadan, Nigeria.

Methods: This was a pilot trial among two clusters of civil servants in Ibadan, Nigeria. In both groups, the civil servants participated in an oral health education programme, a dental screening exercise and referral for dental treatment. In addition to this, the experimental group got a financial incentive
to present for treatment. The two groups were followed up for a period of twelve weeks. Data were analysed using SPSS.

Results: A total of 109 civil servants participated in the study. There were 62 in the control group and 47 in the experimental group. The mean age of the study participants in the control group was 42.1 8.75 years, mean DMFT was 0.95 and 94% of them had an unmet dental need. Similarly, in the experimental group the mean age was 44.7 11.68 years, mean DMFT was 0.45 0.95 and 98% of them had an unmet need. There was no significant difference between the two groups at baseline. At twelve weeks, none of those referred for treatment in the control group presented for treatment while only 3 (6.4%) experimental group presented for dental treatment. No statistical difference was observed (p=0.077).

Conclusion: In this study financial incentive did not result in significant increased utilization of dental care services among adults.

Keywords: Dental service utilization, Civil servants, Financial incentive

Correspondence:
Dr. O.T. Alade
Department of Preventive Dentistry,
College of Medicine,
University of Lagos,
Lagos, Nigeria.
E-mail: lolaalade@live.com

Introduction

Predisposing factors, enabling factors and need predict the utilization of healthcare services.4 Studies show that the best predictor of dental service use is patient need. In Nigeria, many of the studied populations have been noted to have unmet dental needs.2 Despite this, many do not seek dental care until complications have set in.5 Other contributing factors such as financial constraints may be important in view of the economic challenges in the country. In addition, payment schemes for financing dental care such as insurance is limited.6

Out of pocket expenditure is the major type of dental care financing in Nigeria.6, 7 Therefore, the Nigerian citizen bears the brunt of health care costs with over 95% of private expenditure on health being out of pocket. Furthermore, the National Health Insurance Scheme in the country serves only about 3% of Nigerians8 and somewhat predictably, dental services are secondary level services in this insurance scheme. Therefore, non-life threatening dental need may be overshadowed by more pressing demands such as need for food, housing, transport and medical care.

In view of these, financial constraint may be an important factor affecting dental care seeking behavior in our environment. As such, financial incentive is expected to remove one of the barriers to accessing dental care and enable people with dental need demand for care.9 The aim of this study was to evaluate the impact of financial incentive on the utilization of dental services among civil servants in Ibadan, Nigeria.