MalDent Project builds Malawi’s first home-trained dental workforce
Malawi’s oral health system has spent years operating under severe economic strain, and the consequences have been visible at the bedside and in schoolchildren’s mouths. With a population of 22 million, a median age of 18.4 years, and roughly 80% of citizens living in rural areas, the country has had to prioritize basic survival needs over preventive dental care. Public health budgets have been too small to absorb the full burden, and oral health has often sat at the margins of national planning. In that setting, the MalDent Project has attempted something unusually ambitious: build a workforce, create a policy framework, and establish the academic base needed to sustain both.
The project began in 2018 as a partnership between the University of Glasgow and what is now Kamuzu University of Health Sciences, with support from the Scottish Government, the Borrow Foundation and the World Bank. At inception, Malawi had only 40 dentists and 100 dental therapists for a population of 18 million. The scale of the gap matters because oral disease does not wait for systems to mature. Untreated caries advances, pain becomes chronic, infections spread, and children miss school while adults lose productive time in an economy already vulnerable to climate-related food insecurity and poverty.
The response has been structural rather than symbolic. Development of the Bachelor of Dental Surgery curriculum started in 2017 with input from Scotland, South Africa and the United States. A Department of Oral Health Sciences was created within the Faculty of Medicine, and the curriculum was approved by the University of Malawi Senate in March 2019. The first students enrolled later that year. Interim clinical teaching facilities were created in two central hospitals with support from Dentaid and Henry Schein Dental, while staff recruitment and training were strengthened through World Bank support. In practical terms, the project did not wait for a perfect system to appear before beginning to train dentists.
First graduates changed the size of the national workforce
The first cohort of BDS students graduated in April 2025 as Malawi’s first home-trained dentists. They completed internships in central hospital dental departments and are now fully registered with the Medical Council of Malawi. A second cohort has since completed the course. Together, those two groups of young professionals have increased the country’s dental surgeon workforce by 50%. A further 179 students are currently enrolled on the BDS programme, creating a pipeline that Malawi has never previously had.
That shift is more than a workforce statistic. In a country where many patients have never had access to a dentist, local training changes the geography of care. Graduates are more likely to understand rural service constraints, the realities of referral pathways, and the importance of prevention in settings where treatment capacity is limited. The project is also beginning to address a second bottleneck: academic staffing. Historically, Malawi lacked dentists with teaching or research experience, and overseas recruitment has been difficult because of remuneration and working conditions. The emergence of new graduates now creates a practical route to recruit junior staff and develop clinical academics from within the country, following a model already used at KUHeS in physiotherapy.
International academic support has remained essential during this transition. Visiting faculty from Glasgow, Aberdeen, Liverpool, Newcastle and the University of Western Cape have delivered intensive hands-on teaching, typically in one-week blocks with up to six academics at a time. Online teaching from international centres has supplemented that work. The arrangement is clearly temporary, but it has allowed the programme to keep functioning while local capacity is built. A purpose-built dental teaching building for KUHeS is now under construction, with design supervision led by John McAslan + Partners and a Malawian architectural team. The new facility will include a lecture theatre, resuscitation training space, computer cluster, meeting rooms and offices, expanding teaching capacity for dentistry and other health programmes.
National oral health policy has shifted prevention into the center
Work on the service side has progressed alongside the university programme. Malawi’s first National Oral Health Policy was developed by a Ministry of Health-led multisectoral task force with input from KUHeS, the University of Glasgow and WHO AFRO. Launched in 2022, the policy emphasizes prevention while acknowledging the need to expand access to curative services. A follow-up workshop in Lilongwe later that year produced an implementation plan aimed at integrating oral health into broader workforce, service and structural planning.
The policy direction is clinically important because oral disease in low-resource settings is often treated too late and too narrowly. Prevention is not a soft option here; it is the only scalable response when specialist treatment is sparse. Integration into primary care, child surveillance and school health services gives oral health a chance to reach children before dentine-level decay becomes irreversible. This approach also aligns dental prevention with WASH and nutrition, both of which shape caries risk in early life.
Child caries burden is high and treatment access is almost absent
The strongest evidence for the need to act came from Malawi’s first National Child Oral Health Survey, conducted in 2023 by KUHeS, the University of Glasgow, the Ministry of Health and the Scottish charity Smileawi. Among 2,941 children examined, almost 50% of 6-year-olds and 25% of 12-year-olds had dental caries into dentine. None had received treatment. The findings were presented at a workshop in Mponela in 2024 and helped trigger a multisectoral task force to develop a National Child Oral Health Improvement Plan based on principles drawn from Scotland’s evidence-based Childsmile programme.
Those numbers describe a very specific type of clinical failure: disease identified late, when enamel breakdown has already moved into dentine, and no treatment pathway available for most children. In that context, supervised toothbrushing, fluoride exposure and school-based prevention are not optional add-ons. They are the only interventions capable of reaching children at scale before pain and infection force emergency care.
A pilot effort in August 2026 showed what can be done. Anna Smith, a recent graduate of the University of Birmingham, worked with five senior KUHeS dental students at a school in Chilomoni outside Blantyre City to co-design a supervised toothbrushing programme with staff and pupils. The project demonstrated that the logistics of implementation can be managed. The harder problem is supply: affordable fluoride toothpaste remains difficult to secure, and the barrier affects many low- and middle-income countries in sub-Saharan Africa. Solving that issue will require coordinated action rather than isolated school projects.
Sustainability will depend on political commitment and research capacity
The long-term goal has moved beyond building a BDS degree. KUHeS and the University of Glasgow are now working to turn the Department of Oral Health Sciences into a research-led academic unit and eventually a dental school in its own right. Planned collaborations focus on epidemiology, public health and inflammation biology, a combination that could strengthen both disease surveillance and the scientific basis for prevention-oriented care.
The project has also depended heavily on donor support. Scottish Government funding made the launch possible, and the World Bank, the Borrow Foundation and additional partners have helped sustain training and infrastructure. Even so, the greatest uncertainty sits outside the university. Malawi’s public debt stood at 82.1% of GDP in 2023, and long-term investment in oral health will compete with many other demands on a strained health budget. Without sustained government commitment, the gains in training and policy could stall before they become durable national capacity.
John Swinney MSP visited KUHeS in October 2025, met the first graduating cohort and saw the new building under construction. The visit marked international recognition of progress already made, but the harder task is still ahead: turning a donor-supported project into a permanent part of Malawi’s health system, with enough workforce, preventive reach and funding stability to keep children out of the treatment queue.