COMPREHENSIVE SCHOOL ORAL HEALTH PROGRAMME - GHANA

This document is Version 6.0 of the Comprehensive School Oral Health Programme (CSOHP–SHEP), a modular national programme design for Ghana, delivered through the existing School Health Education Programme. The architecture is base-plus-increment: a fixed Foundation of reinforced oral health and dietary education, representative-sample baseline survey, screening, actively-tracked referral, and trauma prevention, with three discrete costed options layered above — targeted task-shifted professional prevention (recommended), universal supervised toothbrushing with provision structured for co-financing, and the full integrated optimum. The design rests on three deliberate distinctions. First, cost-effectiveness is separated from affordability: the most cost-effective single intervention, supervised toothbrushing with fluoride toothpaste, is placed in a discrete co-fundable option because universal consumable provision constitutes a perpetual recurrent commitment of a kind that per-child value alone cannot resolve. Second, the binding workforce constraint is addressed through proposed task-shifting of fluoride varnish and silver diamine fluoride to trained community health nurses and community health officers under dental standing order, drawing on randomised school-trial evidence and World Health Organization guidance; the absence of an enabling national scope-of-practice instrument is named as a formal precondition. Third, systematic-review evidence carries the load-bearing intervention claims, with the closest available African school-based cost-effectiveness analysis read as directional rather than determinative, filtered through feasibility constraints specific to the Ghanaian workforce. The design is contributed pro bono. The authors retain copyright as originators and grant a perpetual, non-exclusive, royalty-free licence to the Government of Ghana for implementation. The intended decision-making audience is the Ministry of Health (lead accountable owner), the Ministry of Education and Ghana Education Service (co-delivery through the school platform), and the Ministry of Finance (financing). Cost figures are illustrative pending local validation; the structural relationships between options are independent of final unit costs.