Table 3.

Oral Health Policy making Implementation challenges

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