A Service Pressure Index (SPI) for quantifying service pressure in India’s public oral health system and its implications for curative care and Public Health Dentistry

Abstract

Public oral health services in India show a persistent mismatch between nominal workforce availability and effective service delivery. Despite infrastructure and sanctioned posts, care remains predominantly symptomatic, indicating underlying system level constraints. Conventional indicators do not adequately capture functional service capacity, limiting their relevance for Public Health Dentistry planning. To develop and operationalize a Service Pressure Index (SPI) as a conceptual measure of the imbalance between required and available clinical capacity, and to examine its implications for service delivery. A conceptual modelling approach was adopted. SPI was defined as the ratio of time required (TR) for standard dental care to effective clinical time available (TA) under routine public sector conditions. Required time was estimated using conservative procedure norms, while available time was adjusted for operational losses. System level constraints were incorporated using weighted adjustment factors and an accountability coefficient. Under an assumed outpatient load of 30 patients per day, the estimated time required for care was 825 min compared to 210 min of effective clinical time available, yielding a base SPI of 3.93. After incorporating system level constraints and utilisation adjustments, the final SPI increased to 6.96, indicating a high level of service pressure. At this level, delivery of comprehensive care is likely to be constrained, with a shift towards time-efficient interventions. SPI provides a conceptual, systems level framework to interpret service delivery patterns in public oral health settings. The findings suggest that workforce availability alone may not ensure effective care under routine conditions. Public Health Dentistry plays a critical role in reducing service pressure through prevention, workforce planning, and system strengthening. SPI may serve as a useful tool for aligning service delivery models with realistic operational capacity.