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Gudfala Tut Paste Development

For the Gudfala Tut Skul Program Date Activity 2017 June - August

Vanuatu National Oral Health Survey Dentalife Australia Pty Ltd is proud to have supported Medical Sailing Ministries Inc, PCV Health and Vanuatu Ministry of Health in the National Oral Health Survey 2017

2017 November

MSM Inc. approached Dentalife Australia with a proposal to develop fluoride toothpaste based on coconut oil suitable for trial in a supervised toothbrushing project in a school in Vanuatu. Pictured on the right is the first batch of paste based on coconut oil (30%) and calcium carbonate with 1000ppm sodium fluoride.

2018 February

First production at Dentalife Australia P/L Factory Specifications called for 500ml LDPE bottles for use in the classrooms; 125ml bottles for teachers and for an adult trial; simple mixing and filling equipment so that mixing could be undertaken in Port Vila to maintain supply of toothpaste for the trial project

2018 April

First production at PCV Health, Port Vila This is the first batch of toothpaste produced in 2018 at PCV Health, Port Vila, Vanuatu and was based on the original formula. This toothpaste, made with a simple hand mixer and sausage filler, was used in the Gudfala Tut Skul Projek undertaken at Central School, Port Vila

Three flavours: Mint; Bubble gum; Tropical

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2018 April to August

Trial Gudfala Tut Skul Projek – Vila Central Skul First day of the trial in class 1B comprising 40 excited children. Mean plaque scores in this cohort Week 1: 46.85 (4.23 Std Error) Week 20: 17.72 (2.09 Std Error) [Sigificant reduction P<0.001] Similar reductions in plaque scores in Grade 6 and 9 children

2018 November

National Oral Health Report and Vanuatu National Oral Health Policy

Official presentations to Vanautu Ministry of Health

Supervised toothbrushing program in schools was one of several key recommendations to reduce the burden of oral disease in Vanuatu

2019 February

Gudfala Tut Skul Projek Report Report released in early 2019. Policy, National Standards and Program Manual released

2019 May/June

Modifications to the toothpaste formula Based on feedback from the 20-week trial conducted April – August 2018 Dentalife Australia made minor modifications to the formula, including an increase in fluoride ion to 1350ppm. Also, to increase productivity, more robust bench mixers replaced the hand-held mixers using exactly the same models in Melbourne and Port Vila.

2019 July

Ministry of Health Endorsement Gudfala Tut Skul Program adopted by the Ministry of Health as a key oral health strategy described by the Public Health Director Len Tarivonda as a “Flagship Program”

2019 July

Begin Gudfala Tut Expansion Begin the implementation of Gudfala Tut in 5 schools, four in Port Vila and one in Luganville. Pictured is the consignment prepared in Port Vila and ready for despatch by Vanuatu Ferry to Luganville

Executive Committee Paper Accepted July 2019

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2019

Further Develop & Document Gudfala Tut Systems & Processes Continue to refine each element of the Gudfala Tut Skul Program, including: National POLICY Document National STANDARDS Document Gudfala Tut Abbreviated National Standards Gudfala Tut PROGRAM MANUAL for Kinder and Grade 1 Class Tooth Brushing Record Poster Child Brushing Record Book Class Brushing Instruction Poster Safe Toothbrush Storage Poster Gudfala Tut Fluoride Varnish Procedure Guidelines Gudfala Tut Skul Parent Consent Form Gudfala Tut Paediatric Medical History Form Gudfala Tut Evaluation & Monitoring Checklist Program Evaluation Form Toothpaste Mixing Instructions Gudfala Tut Skul Implementation Check List & Instructions Gudfala Tut Paste Branding, Marketing, labelling & Packaging

2019 Supporting Local Cooperative - ACTIV Began purchasing coconut oil from the women’s coop, ACTIV Assoc, which expressed interest in the retail distribution and sale of Gudfala Tut Paste in 125ml reusable containers. Offers of assistance with the sales and distribution of a retail version of the Gudfala Tut Paste – in Mint, Bubble-gum, and Tropical flavours from ACTIV – including offer of an introduction to P&O as a possible supporter

2019 Bamboo Toothbrushes Currently utilising donated plastic toothbrushes for the next 1-2 years, however, with the help of Dentalife Australia, investigating the importation of bamboo toothbrushes, with bristles in the 4 colours of the Vanuatu flag and including laser engraved Gudfala Tut message

2019 Toothbrush Holders Developing different types of locally manufactured bamboo toothbrush holders – to eventually replace plastic tubs

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2019 September

Facebook & Website Launched Gudfala Tut Facebook Page … https://www.facebook.com/Gudfala-Tut-112351113588259/?view_public_for=112351113588259 And website … http://msm.org.au/gudfala-tut/

2019 October

Second Consignment to Vanuatu Sent a further 2-pallet consignment of Ingredients and Gudfala Tut resources to Port Vila

2019 Enter Formal Manufacturing Agreement Entered into a formal toothpaste Supply/GMP Agreement with Dentalife Australia P/L to manufacture toothpaste in Vanuatu according to agreed protocols

2019 November

Gudfala Tut Business Plan 2020 Development of GTSP Business Plan 2020 During an MSM Team visit to Port Vila, assisted with development and approval of the GTSP Business and Budget Plan for 2020. This included:

• Schools 2020 Implementation Schedule • Implementation Challenges • Program Building Blocks • 2020 Budget Summary

2019 November

Program Funding Assurance Assurances from the Director of Public Health and Head of the Integrated Oral Health unit, to fund the roll-out of the Gudfala Tut Skul Program to more schools in 2020 and beyond, with MSM Inc (in association with PCV Health) supplying the necessary resources

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2019 December

World Dental Federation Grant Successful grant of 10,000 Swiss Francs ($AUS 14,500) received from the Geneve-based FDI World Dental Federation through the FDI World Dental Development Fund. Due to the quality of the submission, FDI requested permission to use the MSM Inc application as an example for future applicants:

Details Summarised as follows: https://www.fdiworlddental.org/fdi-at-work/world-dental-development-fund/overview-of-current-projects "Gudfala Tut Skul Projek (GFTSP)" in Vanuatu

Time Frame: January 2020 - December 2021

About: Implementing supervised tooth brushing in at least 15 schools in two main urban centres, Port Vila and Luganville, as trials to then expand the project into all urban and rural schools in Vanuatu.

Activities: 1. Adapting a well-established model (Childsmile, NHS Scotland) to the Vanuatu setting and offering:

• supervised tooth brushing with fluoride toothpaste in kindergartens and primary schools • free dental packs for children to brush at home • twice yearly applications of fluoride varnish

2. Introducing toothpaste manufacture in Vanuatu utilising local labour and resources on a not-for-profit basis as a sustainable source of fluoride toothpaste for the supervised tooth brushing program. (Note: The viscosity of the paste has been carefully formulated to enable dispensing a pea-sized quantity of paste without touching the toothbrushes, thereby reducing the risk of cross-contamination).

3. Developing the concept of “Brush in a Box”, which consists of all the resources necessary to introduce and run the “Gudfala Tut Skul” program in schools, especially in isolated islands. “Brush in a Box” is to be developed in consultation with the Vanuatu Department of Education.

2019 December

Gudfala Tut Pikinini Pak After discussions and market feedback, developed an oral health “Gudfala Tut Pikinini Pak” containing all the key components of the school-based oral health program, enabling ALL children to participate if desired. The Pikinini Pak to be available to all parents and guardians and promoted as a means of targeted fundraising. A total of 35 were sold over the Christmas period and to distribute to families in need in 2020

2020 Gudfala Tut Skul Implementation Plan (Efate; Luganville; Tanna) Implementation in:

1. 9 schools on Efate (including Port Vila = 8) 2. 6 schools/Kindys in Luganville (Santo) 3. 2 schools in Sulphur Bay (Tanna)

2020 March

Gudfala Tut Skul Implementation Stats Implementation stats as at mid-March 2020

Gudfala Tut Skul Program, 2020

Stats (March 13th, 2020) Port Vila Luganville Total schools implemented 4 6 Total number of kinder classes 18 17 Total number of kinder children 308 491 Total number of Grade 1 classes 6 11 Total number of Grade 1 children 234 387 Total number of children 542 878

Note: Gudfala Tut Skul has been implemented in seven more schools since March (five in Port Vila and two in Sulphur Bay, Tanna)

Dr Julianne Tevi, Senior Dental Registrar in Dental Public

Health with DSA Lylon Konali, Northern Provincial Hospital,

Luganville

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2020 March

Pikinini Wota Prior to the Covid-19 pandemic promising negotiations were undertaken with the General Manager, Vanuatu Beverages re-proposal to supply fluoridated drinking bottled drinking water in 19L containers for Kindy and Grade 1 classrooms; “Pikinini Wota” in 600ml and 1.5L bottles) for use in the home for infants and children up to 8 years of age. Note: Dentalife Australia is assisting with source of sodium fluoride

2020 March

Gudfala Tut Skul – STARTER PAK & TERM PAK Further refinement and costing of the many components of the program – some one-off such as the toothbrush holder, others recurrent such as the brushes and toothpaste – led to the sorting and supply of all elements into:

1. Starter Pak (for new classes), and 2. Term Pak (for supply of ongoing consumables, eg brushes & paste) In addition, a full costing of all program components was completed with the intention of promoting the program to independent and non-Government schools, Kindies and Play Groups

2020 July

Brush in a Box Further developing “Brush in A Box” supervised brushing program, based on the Vanuatu experience, for promotion and implementation in other countries – current interest from the Solomon Islands, Thailand, Cambodia, East Timor, and Hong Kong

2020 Manufacturing Calcium Carbonate from Coral Representing around 33% of the Gudfala Tut paste formulation, food-grade calcium carbonate is currently obtained in 20kg bags, sourced from Japan through Dentalife Australia.

To increase the percentage of locally sourced Vanuatu ingredients, investigation has begun on the economics and viability of establishing a small-scale coral powder-crushing plant in Port Vila.

Chemical assay facilitated by Dentalife Australia revealed that local coral is 99.8% pure calcium carbonate with no undesirable contaminants. When fully operational it is anticipated that Gudfala Tut Skul program will require around 1,500kg of calcium carbonate per year. At a cost of approx. $7/kg, this represents an input-cost (in the manufacture of the toothpaste) of $10,500pa.

In addition to supplying Gudfala Tut there is a possibility that locally produced calcium carbonate could be supplied for other purposes such as food products in Vanuatu and possibly overseas

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2020 Development of Training Resources Developed:

• Vanuatu College of Nursing Education, Bachelor of Nursing – Oral Health Module Curriculum • Oral Health Training Package – Oral Health and Fluoride Varnish Training • Oral Health Training Package – Assessment requirements for Oral Health and Fluoride Varnish Training • Revised classroom instructions for GTSP based on experience in 2019 and early 2020 implementations

2020 July

Funding to Modify Prosthetics Lab Agreement obtained from Dr David Goldsmith/West Ballarat Rotary to modify the PCV Health dental laboratory to facilitate toothpaste mixing

2020 August

GTSP 2021-2025 Plan A '2021-2025 Plan for the Gudfala Tut Skul Program' is currently under development and will provide a detailed five-year plan on completion. This Plan will detail the roll-out to a selection of the 400+ Primary Schools and 520+ Kindergartens in Vanuatu, specifying: • The ‘Target Number’ of Schools and

Kindergartens for implementation by 2025 (possibly 120 Primary Schools and 240 Kindergartens)

• The infrastructure required to implement and support these schools, including human resources, materials and supplies, and systems

• Implementation challenges • Sustainability of the program • Overall budget for the five-year plan.

This plan is the basis of Funding Applications to potential donors. The role of MSM Inc (with the help of Dentalife Australia) is to support PCV Health in the delivery of Gudfala Tut services and resources to the Ministry of Health, Integrated Oral Health Unit, and assist in the implementation of the national program.

Mixing Gudfala Tut Paste in Port Vila, Vanuatu

Morning Kinder classes at Central School, Port Vila

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Introducing Gudfala Tut Skul Program to different grades and schools. Dr Jenny Stephens, Head of the Integrated Oral Health, Eye Care and ENT Unit, is pictured in the bottom left photograph holding one of the toothbrush storage containers