Table 3 Oral Health Policy making Implementation challenges
From: Oral health policymaking challenges in Iran: a qualitative approach
Main themes | Sub-themes | Final codes |
|---|---|---|
Executive challenges | Health care interventions | Design of therapeutic interventions |
The high cost of treatment centered plans | ||
The need to design comprehensive and fair plans | ||
Fair access to services | ||
Pay attention to prevention in the design of intervention | ||
Leveling Services | ||
Considering the cost effectiveness of package design | ||
Monitoring and evaluation | Lack of cost-effectiveness assessments of oral health plans | |
Separation of the evaluation team from the implementation | ||
Lack of a proper evaluation system | ||
Lack of a proper monitoring and evaluation protocol | ||
Problem monitoring due to the complexity of services | ||
Service delivery | Pay attention to the burden of diseases | |
Serious attention to the referral system | ||
Necessary to design appropriate service structure | ||
Provide preventive and effective care by intermediate forces | ||
Oral Health Information System | Inappropriate analysis of oral health state | |
Mismatch of statistics and information with existing situation | ||
Necessity of designing a strong and efficient information system | ||
Lack of an integrated information system | ||
Prevention challenges | Priority of treatment to prevention | Dentists’ desire for treatment |
More revenue in the field of treatment | ||
Resource allocation to prevention | ||
Pay attention to self-care | ||
Ignore the prevention debate | Not paying attention to prevention | |
Design of prevention-based interventions | ||
Prioritize for prevention | ||
Lack of prevention attitude in policymakers | ||
Use inexpensive prevention tools | ||
Lack of proper prioritization in oral health | ||
Inadequate understanding of prevention in intervention design and policy making | ||
Educational challenges | Educational curriculum | Treatment-based education curriculum |
The educational curriculum is not community-based | ||
Need-based curriculum Change | ||
Attention to prevention in students’ curriculum | ||
Educational rules | Educational wrong policy making | |
Lack of policy-making for oral health education | ||
Inefficiency of the Human Resources Plan Act | ||
Strong regulatory for hiring intermediate forces | ||
Necessity of intervention and implementation of the obligations of trained forces | ||
Educational infrastructure | Weaknesses in educational need assessment | |
Hiring Social Dentistry Graduates | ||
Declining dental schools | ||
The cost of undesired effectiveness of increasing dental colleges | ||
Dental colleges beyond need | ||
Training of a dental specialist is overly needed | ||
Convert some colleges to clinics | ||
Lack of impact of increasing colleges on improving indicators | ||
Training of allied oral health practitioners | Oral Health worker Education | |
Using educational interfaces for schools | ||
The Cost of training a Dentist | ||
Effectiveness of allied oral health practitioners | ||
Low cost of training allied oral health practitioners | ||
Successful experiences of allied oral health practitioners | ||
Resource challenges | Financial resources | Lack of optimal allocation of funds |
Lack of clear financial resources | ||
Human resources | Dentist training as needed | |
Density of dentists in centers | ||
HR Needs Assessment | ||
Improper distribution of dentists | ||
Physical Resources | Necessary equipment and infrastructure | |
Infrastructure and equipment needed in deprived areas | ||
Lack of infrastructure and facilities at prevention centers | ||
Infrastructure burnout in deprived areas | ||
Policy making challenges | Lack of policy makers | Lack of policy maker in the field of oral health |
The presence of therapists at the top of policy making | ||
Non-hire of social dentists | ||
Weakness in policy making knowledge and health economics among policymakers | ||
Lack of relevant policymakers | ||
Neglecting Social Dentistry in Policy Making | ||
Lack of relevant policymakers | ||
Evidence-based policy making | The policymaker’s view of dentistry as a luxury service | |
The therapeutic approach in policy making | ||
Designing native health packages | ||
Lack of evidence-based policymaking | ||
Lack of awareness of full service package of policy making | ||
Serious attention to supply and demand in policymaking | ||
Conflict of interest | Necessity to reduce profession and union look | |
Conflict of interest in training intermediate forces | ||
Conflict of interest in policy making | ||
Transparency in the public and private sectors | ||
Protecting corporate interests in the face of wrong measures | ||
Insurance challenges | Unclear laws for identifying target groups | Pay attention to target groups |
High-risk age group coverage | ||
Lack of coverage for high disease burden age group | ||
Elderly insurance coverage | ||
Correction of basic benefit package | Dental services under insurance coverage | |
Need to modify basic insurance package | ||
Expensive services and unwillingness of insurance | ||
Target groups basic insurance | ||
Pay attention to the burden of diseases on the insurance package | ||
Poor insurance coverage | ||
Trusteeship/Stewardship challenge | Unit trusteeship | Multiple trusteeship in the field of oral health |
Necessity of coordination of all three departments of education, health and treatment | ||
Difficult to enforce policies | ||
Multiple decision making in the field of oral health | ||
Single trusteeship with separate experts | ||
Private sector trusteeship | ||
Wandering over resources and structure | ||
Monitoring and coordination | Dividing tasks in the trusteeship | |
Appropriate trusteeship and attention to the private sector | ||
Coordination and monitoring of public and private sectors in service provision | ||
No oral health plan at the Ministry of Health |