Table 2 Participants’ views on existing challenges

Content challenges

Knowledge gap regarding NCDs

Lack of access to correct information

The need for stronger declarations of interests

Structural challenges

Organizational conflicts of interest (e.g. conflict of interest of some industries such as tobacco industry with health mission)

Individual conflicts of interest (profitability of tobacco industry for certain individuals)

Multisectoral nature of NCDs

Growing trend of childhood obesity

Lack of access to essential medicines and services for NCDs

Financial burden of NCDs, both for individuals/families and for national/health budgets

Lack of a unified management approach and management language

Structural weaknesses in developing countries

Heavy influence of developed nations on the United Nations (UN), which undermines efforts to achieve the ideals set forth by this organization

Financial aspect of NCDs

Power and business interests of private companies in the policy environment of NCDs, especially in low- and middle-income countries

Impact of the private sector on the market and people’s preferences

Policies made behind closed doors with little transparency

Low investment by the Ministry of Health and Medical Education as the entity in charge of implementing the Tobacco Control Act compared to the capacity that has been built globally

Lack of political will to engage all stakeholders in policy development

Adverse economic conditions

Food industries have the most complex conflicts of interest due to their special nature

Process challenges

Slow response of the country’s diplomatic apparatus in relation to international organizations

Appointment of managers based on the wrong principles

Difficulty in engaging certain agencies

Failure of health sector outsiders to understand the problem of NCDs

Different interpretations of the law in sectors other than healthcare

Plans that are individual-based and are discarded with a change in management

Weakness of the health sector in health policy-making, health economics and diplomacy

Lack of transparency in food labelling

Influence of industries and lobbying by unhealthy commodity industries in the parliament, WHO and other regulatory and legislative bodies

Unawareness or inability to seize international opportunities

Poor performance of the country in terms of tobacco control compared to 2030 targets

Lack of strong NGO presence in actions against NCDs

Lack of development in the country’s economy, and weak customs and border control

Passive involvement of the Ministry of Foreign Affairs

Shortage of financial resources nationwide

Low priority of NCDs in the national policy agenda

Lack of coordination between current processes

Absence of physicians and specialists in the Ministry of Foreign Affairs

Lack of proper procedure in policy-making nationwide

Lack of R&D departments in organizations for better identification of best practices

Governance challenges

Global

Soft and superficial approach of the Global Coordination Mechanism

National

Lack of transparency

Difficulty deciding on the level of transparency of certain policies such as those related to tobacco use

Lack of accountability and oversight

Challenges related to inadequate funds, financing and mobilization of funds to address NCDs

Disparity between budgets and development plans

Dependence of the government on the private sector and taxes on unhealthy commodities

Defects in the law dealing with individuals and organizations that ignore the ban on advertising unhealthy commodities

Lack of attention to the Development Plan and macroeconomic policies in health policy-making

Lack of clear mechanisms for identifying and resolving conflicts of interest

Influence of tobacco companies in health policy

Resistance of companies, the private sector and executive agencies to the implementation of some documents and laws

Health sector

Most governments are concerned with primary healthcare or treatment rather than health sector governance

Lack of strong lobbying or negotiation teams at the level of the Ministry of Health and Medical Education

Vertical, problem-oriented approach in the health system

Abolition of the Community Affairs Department, which reduced the follow-up of NCDs and multisectoral action at the local level (provinces, cities and universities)

Challenges to implementation of the pilot IraPEN [Iran’s Package of Essential NCDs] programme, including the deficiencies of the referral system, the problem of increasing public participation in cities, the high cost of the full package, and the problems caused by sanctions

Priority of treatment over prevention across the health system

Individual

Lack of public participation in decision-making and the low public demand for NCD policies

Democratic governments catering to the wishes of the populace

Cultural challenges

Lack of teamwork

Low community involvement

The prevalence of unhealthy diets and sedentary lifestyles

Resistance to change

Short-term orientation

The need for culture-building in line with changes in laws