Intersectoral collaboration and coordination mechanisms for implementing water fluoridation: Challenges from a case study in Brazil. (9th December 2021)

• Record Type: Journal Article
• Authors: Bomfim, Rafael Aiello; Watt, Richard G.; Frazão, Paulo
• Is Part Of: Journal of public health dentistry. Volume 82:Number 4(2022)
• Page Start: 468
• Page End: 477
• Publication Date: 2021-12-09
• Subjects: health care coordination and monitoring -- intersectoral collaboration -- oral health -- public health -- water fluoridation; Dental public health -- Periodicals; 362.1976
• DOI: 10.1111/jphd.12492
• Languages: English
• ISSNs: 0022-4006

Abstract

Abstract: Objectives: Community water fluoridation has been associated with better oral health conditions globally and reduced dental caries. While oral health policies are governed by the health sector agenda, water fluoridation is undertaken by public, private, and mixed public/private companies of the sanitation sector. The first aim of this study was to investigate the degree of intersectoral collaboration, and the second was to investigate how the coordination mechanisms are perceived by the sanitation agents of the sectors involved in water quality management, for the potential establishment of water fluoridation in a central‐west state in Brazil. Methods: Semi‐structured interviews were conducted with chief sanitation agents from nonprofit, profit, and mixed public/private companies responsible for water quality and fluoridation in a purposive sample. Theoretical frameworks of intersectoral collaboration and coordination mechanisms were used for analysis. Results: Twelve interviews were conducted. Informal collaboration was identified in the sanitation sector within companies involved in water provision. The main coordination mechanisms were network‐type mechanisms, which involve consultations and knowledge sharing, and market‐type mechanisms, which explore new job opportunities and cost‐effectiveness, especially in water quality measures. Enabling themes (enablers) were identified, such as positive attitude toward including water quality and fluoridation in a collaborative health and sanitation common agenda. Moreover, fluoridation did not meet the regulatory and surveillance agenda at the state level, and until that moment, there was no proposal of the health sector for water fluoridation. Conclusions: Partnership creation, consolidation, and shared mission, especially between health and sanitation sectors, were identified as main challenges for implementing water fluoridation policy.