A Framework to Guide Basic Denture Services Provision in Selected Public Health Districts of KwaZulu-Natal, South Africa.

OBJECTIVES: This study aimed to develop a framework to guide the provision of basic denture services within public oral health facilities in selected districts of KwaZulu-Natal, South Africa. The study addressed gaps in oral rehabilitation services, particularly the dominance of tooth extractions, limited prosthodontic capacity, and the lack of systematic, evidence-based planning for denture service delivery in underserved communities. METHODS: A multi-stage qualitative synthesis integrating four data sources was undertaken: a 5-year review of district-level oral health service statistics, semi-structured interviews with provincial executives, oral health managers, clinicians, and private providers, and a patient survey on tooth loss and oral health-related quality of life. Findings were triangulated and interpreted using Health Needs Assessment Theory, Public-Private Partnership Theory, the Universal Health Coverage framework, and principles of social justice and quality of life. RESULTS: Analysis revealed persistently high extraction rates, minimal denture provision, rural-urban disparities, and inadequate laboratory and human resources. Stakeholders reported limited financial capacity, infrastructure constraints, and inconsistent understanding of National Health Insurance requirements. Patient responses demonstrated substantial functional and psychosocial impacts of missing teeth and highlighted unmet rehabilitative needs. These insights informed the development of a three-stage framework comprising evidence production, stakeholder engagement, and enactment of program changes. CONCLUSIONS: The resulting framework offers a context-responsive, evidence-informed approach to improving denture services at district level. By integrating needs-based planning, collaborative implementation, and continuous monitoring, the framework supports equitable access to oral rehabilitation and aligns with national priorities for universal health coverage and improved oral health-related quality of life.