Global mapping of oral health plans, programmes and policies in countries with universal health coverage: a scoping review protocol

Abstract

Introduction

This review aims to map oral health plans, programmes and policies worldwide in countries with universal health coverage.

Methods and analysis

This protocol describes a scoping review that will follow the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review checklist, guided by the PCC framework: Population—countries with universal health coverage (78 globally recognised); Concept—oral health plans, programmes and policies; Context—integration into health systems. Searches will be conducted in MEDLINE (PubMed), Scopus, Web of Science, Embase, Health System Evidence and Epistemonikos, with no restrictions on date, language or study type. Grey literature will be accessed through Google Scholar, OpenThesis and the Brazilian Digital Library of Theses and Dissertations. Official documents from ministries of health and international bodies, including the WHO and the International Monetary Fund, will also be reviewed. Two independent reviewers will screen titles and abstracts; a third will resolve disagreements. Eligible records will undergo full-text review. Data will be extracted into predefined categories reflecting health system components: population, structure, services, governance and oral health indicators. Results will be presented using tables, charts and figures to illustrate strategies and innovations.

Ethics and dissemination

This review does not involve primary data collection and does not require ethical approval. Results will be disseminated through a peer-reviewed publication and presentations at academic conferences and scientific events.

Study registration

Open Science Framework (DOI 10.17605/OSF.IO/RCP8N).

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The research question of this review addresses a topic of great importance for global public health, especially considering the growing emphasis on universal health coverage (UHC).

• Results may inform managers, policymakers and professionals by mapping facilitators and barriers.

• Focuses on identifying policies, not evaluating their impact.

• The countries present distinct models of UHC, with differences in financing systems, dental services offered and governance structure, which may make it difficult to standardise data and make direct comparisons.

Introduction

Universal health coverage (UHC) is characterised by the possibility of all individuals and communities receiving the health services they need, ranging from prevention to rehabilitation or palliative care, without being exposed to financial difficulties.¹

UHC is a topic that has gained prominence on the world stage, being mentioned for the first time at the 58th General Conference of the WHO in 2005.² In 2010, the WHO revisited the topic with greater definition with the publication of the report on financing health systems, with an emphasis on the path that governments around the world can take to ensure the health of the population and achieve universal coverage.¹ With the increase in international debate, in 2015, UHC was incorporated into the 2030 agenda for sustainable development as a goal of one of the health and well-being objectives.³

The inclusion of oral health in UHC was recently highlighted by the UN General Assembly in 2019, which emphasised oral health as an essential part of UHC.⁴ Access to dental services is fundamental for the health and well-being of the population, considering that oral diseases are the most prevalent chronic non-communicable conditions in the world, as recognised by the WHO.⁵

Oral health has often been neglected in national and global strategies, considered non-essential in health systems, and often left as an individual responsibility, which negatively impacts health outcomes and access to dental care.⁶

Furthermore, dental coverage in many contexts is partial and based on business models, where the cost and quantity of treatment are directly linked to remuneration. Access is predominantly for those who can afford it, through private insurance that fully or partially covers services or through publicly funded social programmes, which often prioritise subgroups such as children and low-income individuals.⁷

Between 2020 and 2021, global initiatives by the Lancet Commission, WHO and the International Dental Federation have driven the integration of oral health into UHC. They have highlighted the need to expand access, especially for vulnerable populations, and to include dental care in general health systems, strengthening prevention and effective disease management.⁸

Given this reality and the growing recognition of the importance of oral health, the ‘Global Strategy and Action Plan for Oral Health 2023–2030’⁹ was launched this year, establishing six strategic objectives that aim to strengthen global oral health: (1) improve governance and political commitment; (2) promote oral health and prevent diseases; (3) develop innovative workforce models; (4) integrate essential oral healthcare into primary care; (5) improve oral health information systems and (6) advance the research agenda focused on public health in dentistry.

Currently, approximately 78 countries¹⁰ have UHC, but there is little information on the inclusion of oral health in this context. There is a lack of evidence on the current status of these systems, as well as on the organisation and preparation of health systems to incorporate oral health.

Because of the above, a scoping review will be carried out, which will seek to map oral health plans, programmes and policies in countries with UHC around the world.

Methods and analysis

This scoping review will be conducted following the Joanna Briggs Institute (JBI) methodology¹¹ and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR)¹² checklist. This protocol was registered in the Open Science Framework (DOI 10.17605/OSF.IO/RCP8N) to allow other researchers to follow the process.

Review question

The guiding question will be ‘What public oral health plans, programmes or policies have been implemented in different countries with UHC around the world?’. The acronym PCC (Population, Concept and Context) was used to develop the research question, where:

• Population (P): Country with UHC. The 78 countries recognised as having health systems that guarantee universal access to healthcare will be included. They are India, China, Indonesia, Pakistan, Brazil, Russia, Mexico, Japan, Egypt, Philippines, Turkey, Germany, Thailand, United Kingdom, France, Italy, Colombia, South Korea, South Africa, Spain, Algeria, Argentina, Canada, Morocco, Malaysia, Ghana, Peru, Saudi Arabia, Australia, North Korea, Burkina Faso, Taiwan, Sri Lanka, Chile, Romania, Netherlands, Rwanda, Tunisia, Belgium, United Arab Emirates, Cuba, Czech Republic, Sweden, Portugal, Greece, Israel, Austria, Switzerland, Hong Kong, Bulgaria, Serbia, Denmark, Singapore, Finland, Norway, Ireland, New Zealand, Costa Rica, Kuwait, Croatia, Georgia, Albania, Botswana, Slovenia, Bahrain, Trinidad and Tobago, Cyprus, Mauritius, Bhutan, Macau, Luxembourg, Suriname, Maldives, Brunei, Bahamas, Iceland, Seychelles and Liechtenstein.

• Concept (C): Oral health plans, programmes and policies, including strategic actions, governance, structure and services related to public oral health.

• Context (C): The context of UHC, with a focus on the inclusion of oral health in the health systems of these countries.

Search strategy

The search strategy will consider terms from the Medical Subject Headings, synonyms and free terms relevant to the review, and Boolean operators OR and AND will be used to construct the search strategy, as shown in table 1.

Table 1. Search strategy (MeSH terms).

Acronym	Research question	MeSH terms
P—POPULATION	Country with public health policies or system	((India OR China OR Indonesia OR Pakistan OR Brazil OR Russia OR Mexico OR Japan OR Egypt OR Philippines OR Turkey OR Germany OR Thailand OR “United Kingdom” OR France OR “South Africa” OR Italy OR Colombia OR “South Korea” OR Spain OR Algeria OR Argentina OR Canada OR Morocco OR Malaysia OR Ghana OR Peru OR “Saudi Arabia” OR Australia OR “North Korea” OR “Burkina Faso” OR Taiwan OR “Sri Lanka” OR Chile OR Romania OR “Netherlands” OR Rwanda OR Tunisia OR Belgium OR “United Arab Emirates” OR Cuba OR “Czech Republic” OR Sweden OR Portugal OR Greece OR Israel OR Austria OR Switzerland OR “Hong Kong” OR Bulgaria OR Serbia OR Denmark OR Singapore OR Finland OR Norway OR Ireland OR “New Zealand” OR " Costa Rica” OR Kuwait OR Croatia OR Georgia OR Albania OR Botswana OR Slovenia OR Bahrain OR “Trinidad and Tobago” OR Cyprus OR Mauritius OR Bhutan OR Macau OR Luxembourg OR Suriname OR Maldives OR Brunei OR Bahamas OR Iceland OR Seychelles OR Liechtenstein))
C—CONCEPT	Public oral health plans, programmes and policies	((“Oral Health” OR “Dental Health Services” OR “Oral Health Programs” OR “Dental Care” OR “Public Health Dentistry” OR “Community Dentistry” OR “Dental Health Surveys”))
C—CONTEXT	Government strategies for universal health coverage	((“Universal Healthcare " OR “Universal Health Coverage " OR “Healthcare Systems” OR “Delivery of Healthcare " OR " Integrated Healthcare " OR " Government Programs " OR " National Health Programs " OR " Public Health Systems”))

MeSH, Medical Subject Headings.

Searches will be performed in the main electronic databases: PubMed/MEDLINE, LILACS, Embase, Web of Science, Scopus, Health System Evidence and Epistemonikos, in addition to grey literature, including Google Scholar, OpenThesis and the Brazilian Digital Library of Theses and Dissertations.

Documentary research will also be conducted on the official homepages of the Ministries of Health of the countries under investigation, supplemented by other public domain data from official bodies (WHO, IMF, among others). To locate these sites, we will use the official website of each country, as well as a Google search engine (such as documents and policy guidelines, publications and legislation). Three reviewers will be responsible for conducting the searches on the relevant websites, following the predefined search strategy.

Considering that the organisation of websites varies between countries, navigation for each portal will be carried out individually and described in a research field diary. When necessary, websites that do not have an English version will be translated into that language to facilitate interpretation. Documents not available in English will be screened using reliable machine translation tools and, when necessary for accurate interpretation, will be reviewed with the assistance of an external collaborator or professional translator.

The literature search started in April 2025 and is expected to be completed by October 2025.

Eligibility criteria

Inclusion criteria

This study will include exploratory research on national and international governance or strategies for oral health, as well as studies that map the characteristics of oral health systems, including coverage, financing and services.

In addition, national or international documents published by recognised organisations, such as ministries of health, government departments or international entities related to oral health, as well as documents related to public oral health plans, programmes, policies or strategies, with a focus on the organisation, financing, governance or results of these systems, will be considered.

Data or reports on oral health will be included when they are scientific articles published in peer-reviewed journals or produced by recognised national or international bodies, using the most current data available.

Exclusion criteria

Will be excluded studies that address only individual oral health or private clinics, with no connection to public policies, as well as those that evaluate individual clinical interventions, such as specific dental treatments, with no connection to the health system.

Policy or programme documents that have been superseded by more recent versions will be excluded, unless the earlier version is considered essential for understanding the historical development of the health system. Other types of documents will be included regardless of their publication date.

In addition, clinical case reports, clinical trials or experimental studies with no connection to public oral health, as well as commentaries, letters to the editor and opinions not based on data or scientific analyses, will not be considered.

Study selection and data extraction

The articles will initially be managed in Mendeley (Elsevier, London, UK) for listing, organisation and removal of duplicates. After this step, they will be imported into Rayyan (Qatar Computing Research Institute, Doha, Qatar), where two reviewers, blindly and independently, will screen the studies by title and abstract, classifying them as included and excluded. In the case of disagreement, a third reviewer will be consulted for the final decision.

After the initial selection by title and abstract, a second selection stage will be carried out, which will consist of reading the previously selected articles in full. The articles included will be analysed in full text to confirm their eligibility. In parallel, official documents found on the websites of health ministries and international organisations will be collected and analysed by two independent evaluators. The entire selection process will be described in a PRISMA-ScR flowchart (PRISMA, 2018).

Data collection will take place using a structured form developed by the research team, considering the characteristics of the works, such as title, author/organisation, year of publication, country, type of document (article, dissertation, thesis, official document, etc), objective, method used and results. In addition, the data will be extracted and organised into specific categories that allow the analysis of essential aspects of the health systems, including population characteristics (universality, whether it covers vulnerable populations, urban or rural areas), structure (financing and costs for the population), care (access in the last 12 months and number of professionals), governance (presence of a specific oral health plan or policy) and oral health indicators (dental caries, periodontal disease and edentulism). For documents with narrative content, such as policies, plans or programmes, an additional inductive thematic analysis will be undertaken to identify emerging themes not captured by the predefined categories, allowing a more comprehensive understanding of the context and nuances of each health system.

Data analysis and presentation

The results will be presented in tables, charts and figures, describing the public oral health plans, programmes and policies implemented in different countries, focusing on their characteristics, strategies and impact. As this is a scoping review, the risk of bias of the included studies will not be assessed.

By consolidating information on the strategies and characteristics of these systems, the review seeks to provide support for the formulation of more effective and equitable public policies.

Ethics and dissemination

This review will not use primary data, so ethical approval is not required. The PRISMA S-cR checklist will be used to guide the writing of the findings. The results will be disseminated through an article published in a peer-reviewed journal, in addition to presentations at conferences and scientific events.