Introduction
Methods
Relationship of participants to oral health | Number |
---|---|
Head of oral health department | 1 |
Experts of regional oral health department | 3 |
Health assistant of the University | 1 |
Head of social dentistry department | 1 |
Head of health policy making department | 1 |
Social dentists professors | 4 |
Head of dentistry school | 1 |
What do you think about the oral health policy implementation in the country? Are they successful or not? | |
In your opinion what are the most problems and barriers in oral health policy implementation in the country? | |
Can you give some examples of the problems in the way of implementing oral health policies? | |
Can you differentiate among the problems in the scopes of prevention, treatment and education? | |
Which of these three do you think need more consideration or even reform? | |
What do you think about the resources? What kind of resources you think are essential for implementing oral health policies? | |
What do you think about the role of insurance packages? | |
How about the regional executive problems, can you exemplify some problems in this area. | |
How about the policies? In your opinion are all the problems associated with the inappropriate policy implementations or policymaking as well? (the same as defining the agenda, etc.) | |
How about the structure, organization or other infrastructures? How can you illustrate their role? | |
If there is any other concept you want to point that was not mentioned in the previous questions please talk about them. |
Results
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 |
Policymaking challenges
“After the Islamic Revolution, a number of physicians were specialized and at the same time, became familiar with the management requirements as well as health policymaking and health economics. Unfortunately, such an improvement hadn’t occurred in dentistry. This is our major challenge: no manager and policymaker in the field of oral health” (P1).1
“According to the policies, the aim was to train social dentists who study management and health policymaking and become familiar with public concepts but they come into the field and practice treatment procedures. As a result, when they deal with the duty of community oral health they have no vision of community and health” (P2).
“When we ignore the evidence-based preventive packages to improve oral health today, and turn to restoration packages instead, the oral health won’t improve” (P3).
“In the Ministry of Health plans, Oral Health is ignored. Because the policies of the Ministry of Health do not follow evidence-based policymaking. The policies are passive and because of resource constraints or lack of understanding of complete benefit packages, the Ministry of Health, does not seriously pay attention to dental health or public demand” (P6).
Educational challenges
“This is a debate in our dental education in another words, dental curriculum is problematic and it is not community-oriented. At the same time, the distribution of the sources is not equitable” (P11).
“Educational curriculum is not based on community needs. The curriculum should be changed according to the population conditions such as population aging” (P1).
“For years, the Ministry of Health’s policy was to train some people with lower dental facilities who after graduating, provide dental services in underpriviledged areas the same as rural and urban fringe ones, but due to lack of proper education, this goal has not been achieved” (P12).
“The initial oral health policies was focused on training of health workers along with dental hygienists, and a lot was spent for this policy; they went to deprived areas; but after some years, the health workers tend to graduate from dentistry schools. Unfortunately, this effective policy did not continue because of the conflict of interest, which means that the dental colleges considered this program [training dental technicians] as a rival and hindered it” (P4).
Resource challenges
“At one point, there was a pressure on building a dentistry school in every city. A huge budget that should be spent on preventative dental health had been used for dental colleges, these colleges devour huge budgets every year without any attempt to reach to the national oral health goals” (P1).
“Lack of financial resources allocated to the preventive goals as well as the community oral health specially in underdeveloped regions and rural areas led to failure of the oral health policies …” (P5).
“Now health care system faced with a shortage of dentists in deprived and underprivileged areas. This shortage is also more significant for oral health technicians in that regions” (P4).
“In order to promote the oral health, allied oral health practitioners should be trained, such as a dental technician’s, hygienists, etc. These practitioners can be very effective; for example, in many developed countries due to high costs of training dentists, allied oral health practitioners are trained to do the related tasks of preventing, educating and surface restorations that are very effective of course if there is a proper monitoring system” (P7).
Executive challenges
“In the provision of dental services, no relationship is found between the private and public sectors, such as public and special problems in this field. Dentistry, as a luxury field of study, has its own costly services and difficulty and easy access is not yet fully established.” (P4).
“In service delivery, there should be a leveling service and referral system. If the referral system is implemented, the service delivery will be improved as well, which of course requires allied oral health practitioners to provide basic services; if necessary, referring the patient to the dentist will save money and provide him with timely services” (P3).
“Monitoring and evaluating are very important, especially in national plans, and if the plans are not implemented effectively, due to lack of proper monitoring after implementation, some of the prevention plans that have been implemented so far have failed. For example, dentistry students are sent to schools for education of the children and fluoride therapy. It is really important to have an appropriate monitoring system if we expect good results in practice” (P8).
“Much attention should be paid to the evaluation and monitoring of oral health plans, and the point to be made in this regard is the need for a supervisor and evaluator to be separated, which is unfortunately not the case now” (P9).
Insurance challenges
“In many European countries, children are insured since birth, examined every 3 to 6 months until the age of 18, and children and their parents are trained to do preventive activities the same as fluoride therapy or fissure-sealant. These are compulsory interventions just like vaccination even if a person does not refer, the system, follows them. This prevents the burden of treatment. Nowhere else in the world dental insurance coverage is free because expensive services and high costs cannot be insured. The insurance coverage for dental problems may be possible only when we take preventive measures and provide coverage to persons under 12 years of age or surface repair. In Iran, restoration of teeth was implemented for 6 teeth but due to lack of proper supervision they all refer for the restoration of teeth even if it is not required the dentists do it because they receive their per case. This leads to the supply induced demand” (P6).
Trusteeship challenges
“Coordination is really an important issue. Also it is important to clarify the stewardship of this coordination. It is suggested to manage an office by the Ministry of Health to run all the three sectors and coordinate accordingly. But unfortunately no one evaluated the cost-effectiveness of the funds allocated to preventive, treatment or education sections of oral health” (P2).
“No one is responsible of stewardship. The universities have different practices, in fact, because the principal executives do not hire those who have both knowledge and expertise, so these problems exist” (P4).
Prevention challenges
“In the field of health, the attraction of the treatment sector caused an increase in the willingness to treatment and wealth instead of attention to the community’s health. Unfortunately, the highest level of oral health policymaking in the country is done by the specialists, that’s why the prevention is always ignored” (P11).
“The amount of support for dentistry is not enough, because these services are so expensive and the imposed costs are inevitable for everyone who goes into the treatment cycle. So, the treatment package with a therapeutic approach can` be very effective and it is necessary to have a shift to a preventive approach with a comprehensive monitoring and supervision” (P10).