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Table 2 Participants’ views on existing challenges

From: Challenges and opportunities for Iranian global health diplomacy: lessons learned from action for prevention and control of noncommunicable diseases

Main themes Subthemes
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