Retrospective Policy Analysis Research Articles

Decentralization Of Vietnam'S forestlands: The policy process and impact

The decentralization of land is crucial for effective production, welfare improvement, and social development. However, the formulation, outcome, and impact of land decentralization policies are influenced by political regimes, policy processes, geographical areas, and socio-economic settings. This study focuses on Vietnam's forest and forestland allocation program over the past 30 years to investigate its impact on poverty dynamics. Retrospective policy analysis and an extended random effect treatment model with longitudinal panel data collected from 53,568 plots in 12 provinces across Vietnam from 2008 to 2018 were used. The findings suggest that while the forestland allocation policy has a positive effect on poverty alleviation, it has minimal impact on the poorest household groups. Additionally, actual tree planting is more beneficial to the non-poor group, indicating a lack of incentivized policies for tree planting and inadequate consideration of the genuine livelihood needs and investment capacities of land recipients, especially poor households. Policy improvements are recommended to better align with the rationale, aims, and social expectations.

Adopting a WHO Framework Convention on Tobacco Control-Based Tobacco Control Law in Ethiopia: Sustained Transnational Health Advocacy and Multi-Sectoral Institutionalized Support.

The objective of this study was to document how Ethiopia adopted a WHO Framework Convention on Tobacco Control (FCTC)-based tobacco control law. We analyzed publicly available documents, including news media articles, advocacy reports, and government documents. We triangulated these findings by interviewing nine key stakeholders. Data were analyzed to construct a historical and thematic narrative and analyzed through a retrospective policy analysis. Local and international health advocacy efforts helped introduce and support WHO FCTC-based legislation by (1) educating policymakers about the WHO FCTC, (2) providing legal assistance in drafting legislation, (3) generating local data to counter industry claims, and (4) producing media advocacy to expose industry activity. Health advocates worked closely with government officials to create a multi-sectoral tobacco committee to institutionalize efforts and insulate tobacco companies from the policymaking process. Japan Tobacco International bought majority shares of the government-owned tobacco company and attempted to participate in the process, using standard industry tactics to undermine legislative efforts. However, with health advocacy assistance, government officials were able to reject these attempts and adopt a WHO FCTC-based law in 2019 that included 100% smoke-free indoor places, a comprehensive ban on tobacco advertising, and large pictorial health warning labels, among other provisions. Sustained local health advocacy efforts supported by international technical and financial assistance can help establish WHO FCTC-based tobacco control laws. Applying a standardized multi-sectoral approach can establish coordinating mechanisms to further institutionalize the WHO FCTC as a legal tool to build support with other government sectors and insulate the tobacco industry from the policymaking process.

Why Violence Cannot be Prevented in Healthcare Settings in Türkiye?: A Retrospective Policy Analysis.

Preventive policies have been devised with the aim of curbing health-related violence, and their efficacy is believed to furnish evidence for their continued implementation, thereby enhancing their effectiveness. This study undertakes a retrospective analysis of these policies in the context of Türkiye. A comprehensive examination involved the review of 26 documents, employing a progressive scanning approach for data collection. This methodology encompassed the utilization of gray literature databases (OECD iLibrary and WHO Iris), extensive Google searches, thorough website scans, and consultations with subject-matter experts. Data analysis was meticulously conducted within the framework of the Health Policy Triangle. The findings reveal active participation from diverse stakeholders, including governmental bodies, political entities, professional organizations, and trade unions, in various preventive initiatives aimed at mitigating health-related violence. Notably, the adoption of legislation for health violence prevention, perceived as a paramount achievement, can be attributed to persistent efforts by both the media and other influential actors and stakeholders. These endeavors have sustained the topic's prominence on the policy agenda, positioning it as a promising source for the development of novel violence prevention and management strategies. This study underscores the necessity for a comprehensive investigation into the working conditions, personal rights, and wage policies of healthcare workers, in light of documented factors that frequently precipitate violence. Concomitantly, it advocates for the development of effective mechanisms to address these issues.

Why Was the Policy Idea on the Health Benefits Package Advisory Panel Gazetted in Kenya? A Retrospective Policy Analysis.

In 2018, Kenya's Ministry of Health (MoH) gazetted the Health Benefits Package Advisory Panel (HBPAP) to develop a benefits package for its universal health coverage (UHC) programme. In this study, we examine the political process that led to the gazettement of the HBPAP. We conducted a case study based on semi-structured interviews with 20 national-level participants and, reviews of documents such as organizational and media reports. We analyzed data from the interviews and documents thematically using the Braun and Clarke's six step approach. We identified codes and themes deductively using Kingdon's Multiple Streams Theory which postulates that the successful emergence of a policy follows coupling of three streams: the problem, policy, and politics streams. We found that the problem stream was characterized by fragmented and implicit healthcare priority-setting processes that led to unaffordable, unsustainable, and wasteful benefits packages. A potential policy solution for these problems was the creation of an independent expert panel that would use an explicit and evidence-based healthcare priority-setting process to develop an affordable and sustainable benefits package. The political stream was characterized by the re-election of the government and the appointment of a new Cabinet Secretary for Health. Coupling of the problem, policy, and political streams occurred during a policy window that was created by the political prioritization of UHC by the newly re-elected government. Policy entrepreneurs who included health economists, health financing experts, health policy analysts, and health systems experts leveraged this policy window to push for the establishment of an independent expert panel as a solution for the issues identified in the problem stream. They employed strategies such as forming networks, framing, marshalling evidence, and utilizing political connections. Applying Kingdon's theory in this study was valuable in explaining why the HBPAP policy idea was gazetted. It demonstrated the crucial role of policy entrepreneurs and the strategies they employed to couple the three streams during a favourable policy window. This study contributes to the body of literature on healthcare priority-setting processes with an unusual analysis focused on a key procedural policy for such processes.

Vitamin D deficiency prevention policies in Iran: a retrospective policy analysis.

Iran has a higher prevalence of vitamin D deficiency (VDD) than the global level. This study aimed to assess VDD prevention policies in Iran through a policy analysis of agenda setting using the multiple streams framework (MSF). Using Kingdon's MSF model, this qualitative analytical study performed a policy analysis on vitamin D-related policies in Iran. The policy documents were reviewed, and in-depth interviews were conducted with stakeholders (n = 27) using the framework analysis method. To categorize data and extract the related themes, MAXQDA version 10 was used. According to Kingdon's MSF theory, the problem stream included the high prevalence of VDD among Iranian infants (23.3%), adolescents (76%), and adults (59.1%). The policy stream was identified to focus on preventing programs for non-communicable diseases in the health sector. The political stream indicated that national and international support could provide a political climate for this issue. According to our results, a window of opportunity for policymaking on VDD prevention has opened. However, there are some challenges related to the implementation of these policies. These include the dominance of a treatment-based view rather than a prevention-based approach in the health sector, economic problems, and restricted access to health services due to the outbreak of coronavirus disease 2019 (COVID-19). To strengthen and implement VDD prevention policies, the stakeholders need support from high-level policymakers.

The Analysis of the Content of Tobacco Control Policymaking and Legislation in Iran and Providing Policy Solutions

Background. Tobacco use is the fifth risk factor for non-communicable diseases in Iran. This study aimed to analyze the policies and measures of tobacco control in Iran in the last four decades (1983-2021). Methods. The present study is a retrospective policy analysis that used a case study plan based on the Walt and Gilson triangle policy analysis framework to examine the content of tobacco control policies in Iran. Data were collected using tobacco use policies and legal documents and analyzed using documentary analysis. MAXQDA 11 software was used to categorize and analyze the findings. Results. The policies include setting prices and taxes on tobacco to reduce demand; protecting the public from second-hand smoke; controlling the composition of tobacco products; setting regulations on the disclosure of information about tobacco packaging and labeling; educating the public about the dangers of tobacco use; advertising, promotion, and financial support of tobacco; setting measures to encourage smoking cessation and reduce the demand and dependence on tobacco; banning illegal tobacco product trading; banning youngsters from tobacco trading; financially supporting the practical alternatives such as economic activities and research; setting monitoring and evaluation systems; and enhancing the exchange of information. Conclusion. Strengthening the government's tobacco control capacity and formulating a clear and coherent national tobacco control strategy and roadmap, including a mechanism for practical cross-sectoral cooperation between different actors, can reduce conflicts of interest between the actors involved and determine the country's current and future tobacco control policies.

Waste management in primary healthcare centers in Saudi Arabia: a policy analysis

ABSTRACT Medical waste poses high risks to healthcare workers, patients, the environment, and public health. Governments have adopted measures and enacted policies to ensure proper medical waste management. Through a retrospective policy analysis, we analyzed the waste management policy for primary healthcare centers in Saudi Arabia. By adopting Walt and Gilson’s health policy analysis framework, we conducted a thematic analysis of documents to analyze the policy context, process, actors, and content. Contextual factors including accreditation, the Saudi Vision-2030 and the healthcare transformation plan contributed to the development of the policy. The policy was adapted from a regional policy that was enacted about 15 years ago. The policy content overlooked components relevant to the specific context of primary healthcare centers. Lack of training and cooperation among stakeholders challenged successful implementation and thus compliance with the policy. Respective stakeholders must take further actions to ensure implementation fidelity and sustainability of the policy.

Policy analysis of the protection of Iranian households against catastrophic health expenditures: a qualitative analysis

BackgroundDespite the adoption of various policies and strategies in recent decades, the Iranian health system has not succeeded in protecting households against catastrophic health expenditures (CHE) and impoverishment. Accordingly, this qualitative study aimed to critically analyze current policies for reducing CHE.MethodsThis qualitative study was conducted as a retrospective policy analysis based on a document review and semi-structured interviews with key informants between July to October 2022. Two theoretical frameworks were used, including the Analysis of Determinants of Policy Impact (ADEPT) model and Walt and Gilson’s “Policy Triangle framework.” The country's related documents were searched through databases. In total, 35 participants were interviewed. Interviews and documents were analyzed using directed content analysis in MAXQDA v12 software. Interobserver reliability, peer check, and member check were done to confirm the trustworthiness of the data.ResultsTwelve main themes and 42 sub-themes emerged from the data. The findings revealed that policy accessibility, policy background, and a clear statement of goals influenced the policy process. However, resources, monitoring and evaluation, opportunities, and obligations negatively affected the implementation process. In addition, a policy analysis based on the policy triangle framework demonstrated that the main factors affecting the policy on reducing CHE in Iran were “conflicts of interest,” “contextual factors,” “monitoring and evaluation,” and “intersectoral relationship” factors.ConclusionThe present study reflected the multifaceted nature of the barriers to reducing CHE in Iran. The implementation of the policy on reducing CHE requires the political will to improve intersectoral collaboration, strengthen the stewardship role of the Ministry of Health, design monitoring and evaluation mechanisms, and prevent personal and organizational conflicts of interest.

Evaluasi Kebijakan Pencegahan Perkawinan Anak Melalui Program Strategi Nasional Pencegahan Perkawinan Anak (STRANAS PPA)

The child marriage rate in Indonesia is still relatively high, the government through Presidential Regulation (Perpres) Number 18 of 2020 concerning the RPJMN is targeting a reduction in the marriage rate in Indonesia by 8.74% through the National Strategy for the Prevention of Child Marriage (Stranas PPA). evaluate the policy on preventing child marriage through the Stratnas PPA program to see the achievement of targets and the effectiveness of implementing the policy. This study uses a qualitative descriptive method of retrospective policy analysis with a formal evaluation approach according to William n Dunn. This research resulted in: (1) Nationally, the prevalence target for women aged 20-24 who were married before the age of 18 decreased from 10.35 in 2020 to 9.23 in 2021, but in 2020 it did not reach the target, where the prevalence in 2020 it was 10.19, but the achievement reached 10.35; (2) based on indicators of implementation of coordination, there has been good coordination between the relevant Ministries/Institutions in efforts to prevent child marriage, but there are still 5 M/I that have not filled out the National Strategy for PPA matrix; (3) based on an analysis of the program's evaluation criteria, the PPA policy through the National Strategy PPA program is considered effective in efforts to prevent child marriage.

Understanding the Dynamics of More Restrictive Medicines Policy: A Case Study of Codeine Up-Scheduling in Australia.

There has been increasing concern over opioid-related harms across the world. In Australia in 2018, codeine-containing products were up-scheduled from over-the-counter access at pharmacies, to requiring a prescription. The drug regulator's decision to up-schedule was contentious and widely debated, due to the potentially large impact on consumers and healthcare professionals. This study aimed to analyse influences on the codeine up-scheduling policy. This retrospective policy analysis used the Advocacy Coalition Framework (ACF) to understand how policy actors with shared beliefs formed adversarial coalitions to shape policy. Data were drawn from documents (regulator policy documents, public submissions, news reports, organisational media releases and position statements) and semi-structured interviews with 15 key policy actors. Codes were generated relating to policy processes and actor beliefs; broad themes included the role of health professionals, perceptions of opioids, impact on consumers, and the role of government in healthcare. Two coalitions in this policy subsystem were identified: (1) supportive [with respect to the up-scheduling], and (2) opposing. The key evident beliefs of the supportive coalition were that the harms of codeine outweighed the benefits, and that government regulation was the best pathway for protecting consumers. The opposing coalition believed that the benefits of codeine accessible through pharmacists outweighed any harms, and consumers should manage their health without any more intervention than necessary. The policy decision reflected the influence of the supportive coalition, and this analysis highlighted the importance of their public health framing of the issue, the acceptability of their experts and supporting evidence, and the perceived legitimacy of the up-scheduling process. Understanding these coalitions, their beliefs, and how they are translated through existing policy processes and institutions provides insight for those interested in influencing future health policy. Specific lessons include the importance of strategic frames and advocacy, and engagement with formal policy processes.

A Policy Analysis of the Deployment of International EMT in the WHO African Region during the COVID-19 Pandemic

Background/Introduction:The COVID-19 pandemic, especially in Africa, has increased the need for EMTs for surge management, clinical care, and capacity-building support for establishing national EMTs.Objectives:To analyze the implementation of EMTs deployments in the AFRO Region during the COVID-19 pandemic.Method/Description:This is a retrospective policy analysis done from the perspective of the EMT policy implementor using Walt and Gilson’s policy triangle1 (capturing processes, the actors, the context, and the content). Data were collected through document reviews, key informant interviews, semi-structured in-depth interviews, and focus-group discussions. Analysis was done through a priori framework analysis.Results/Outcomes:Overall, 22 countries benefited from international EMT deployments since the onset of COVID-19, with deployment periods varying between six to 24 weeks. Development partners, governments, and local authorities supported deployments. Some deployments were hampered by inadequate knowledge of EMTs processes, bureaucratic and administrative barriers, and slow mobilization of resources. Other challenges were the lack of critical care equipment and teams facing resistance due to cultural differences. Some teams only worked in big cities rather than local regions with low capacity and high morbidities from COVID-19. Collaboration between international and national teams resulted in enhanced capacity building, optimistic volunteerism and resilience, and provision of clinical care in constraint settings to save lives.Conclusion:The deployments were critical in saving lives in under-resourced settings despite the challenges. COVID-19 has provided an impetus to strengthen national public health response by providing training opportunities, twinning or exchange programs, building health infrastructure, and prepositioning supplies and equipment to ensure national reliance and sustainability.

Assistance dogs in Russia: legal environment review and perspectives

The article aims to highlight the gaps in Russia’s policy regarding assistance dogs and subsequently seeks to identify ways to improve this policy. First, a retrospective policy analysis was conducted to outline a regulatory framework on assistance dogs in Russia and to highlight the gaps and contradictions in it. Next, the three key policy areas covered by the assistance dog legislation were compared in Russian, Australian, UK, and US policies to reveal ways to improve the situation in Russia. According to the comparative analysis, issues such as unclear definitions, denial of public access, and the absence of universal certification standards are common in all countries compared. In Russia, active participation in the international community and raising awareness about assistance dog issues are necessary to allow assistance dog owners to fully exercise their rights, as codified in the United Nations Convention on the Rights of Persons with Disabilities (CRPD).

Examining Macro-Policy Development Stages of Vocational Education in China: A Retrospective Policy Analysis

Abstract Since the reform and opening up, China’s vocational education has experienced a process of gradual recovery and development, which can be divided into five stages: the recovery and establishment period (1978–1984), the simultaneous development period (1985–1990), the sustained development period (1991–1998), the consolidation and adjustment period (1999–2009) and the strategic development period (2010-present). There are some problems, such as low degree of recognition, insufficient degree of adaptation to industrial development, incomplete school management system and lagging teacher team construction. To better cope with the challenges of the new era, we can accelerate the school-enterprise cooperation and industry-education integration, adapt to the changes brought by digital technology to vocational education, improve the management system of vocational education schools, strengthen the construction of vocational education teachers and other ways to promote the high-quality and balanced development of vocational education.

Agenda-setting of tobacco control policy in Iran: a retrospective policy analysis study

BackgroundThe prevalence of tobacco use, especially hookah, has increased in Iran In recent years, particularly among young people and women, and the age of onset of use has decreased. Tobacco use is the fourth leading risk factor for non-communicable diseases in Iran. These issues cause concerns in the country and led to the present study on tobacco control agenda-setting in Iran over a 30-year timeframe.MethodsWe conducted this retrospective analytical study to investigate process analysis in Iran using Kingdon’s multiple-streams framework (MSF). We collected the data using semi-structured interviews with key informants (n = 36) and reviewing policy documents (n > 100). Then, we analyzed the policy documents and in-depth interviews using the document and framework analysis method. We used MAXQDA 11 software to classify and analyze the data.ResultsIran’s accession to the Framework Convention on Tobacco Control (FCTC) opened a window of opportunity for tobacco control. The policy window opens when all three streams have already been developed. The adoption of the comprehensive law on the national control and campaign against tobacco in the Islamic Consultative Assembly in 2006 is a turning point in tobacco control activities in Iran.ConclusionsThe tobacco control agenda-setting process in Iran was broadly consistent with MSF. The FCTC strengthened the comprehensive plan for national control of tobacco as a policy stream. However, there are several challenges in developing effective policies for tobacco control in the Iranian setting.

ANALISIS ANGGARAN PENDAPATAN BELANJA NEGARA(APBN) TERHADAP PENDANAAN KEBIJAKAN PENDIDIKAN

The State Revenue and Expenditure Budget or APBN is the annual financial plan of the state government approved by the House of Representatives. The purpose of the preparation of the APBN is as a guideline for state expenditures and revenues so that there is a dynamic balance in carrying out state activities to achieve increased production, increased employment opportunities, high economic growth and ultimately aimed at achieving a just and prosperous material and spiritual society based on Pancasila and the 1945 Constitution. “Indonesia is still behind several Asian countries in terms of education, even though 20 percent of the state budget has been spent on education for the last ten years. This is still not satisfactory. It may even be a disappointment because Indonesian education graduates do not reach the desired level. Equitable access to education and inadequate facilities and infrastructure, especially in Eastern Indonesia and the Disadvantaged, Frontier, Outermost (3T) areas. This is one of the challenges that the government will fix. The results of this research are (1) the process of formulating education funding policies reflects the lack of political will commitment from the government and the DPR. (2) Implementation of the education funding policy of 20% of the APBN. (3) Results of the education funding policy analysis. This study aims to determine how to formulate education funding policies, their implementation and analyze them. The method used in this study is a policy analysis method with a retrospective policy analysis model and the type of policy process analysis.

Implementing effective salt reduction programs and policies in low- and middle-income countries: learning from retrospective policy analysis in Argentina, Mongolia, South Africa and Vietnam.

To understand the factors influencing the implementation of salt reduction interventions in low- and middle-income countries (LMIC). Retrospective policy analysis based on desk reviews of existing reports and semi-structured stakeholder interviews in four countries, using Walt and Gilson's 'Health Policy Triangle' to assess the role of context, content, process and actors on the implementation of salt policy. Argentina, Mongolia, South Africa and Vietnam. Representatives from government, non-government, health, research and food industry organisations with the potential to influence salt reduction programmes. Global targets and regional consultations were viewed as important drivers of salt reduction interventions in Mongolia and Vietnam in contrast to local research and advocacy, and support from international experts, in Argentina and South Africa. All countries had population-level targets and written strategies with multiple interventions to reduce salt consumption. Engaging industry to reduce salt in foods was a priority in all countries: Mongolia and Vietnam were establishing voluntary programs, while Argentina and South Africa opted for legislation on salt levels in foods. Ministries of Health, the WHO and researchers were identified as critical players in all countries. Lack of funding and technical capacity/support, absence of reliable local data and changes in leadership were identified as barriers to effective implementation. No country had a comprehensive approach to surveillance or regulation for labelling, and mixed views were expressed about the potential benefits of low sodium salts. Effective scale-up of salt reduction programs in LMIC requires: (1) reliable local data about the main sources of salt; (2) collaborative multi-sectoral implementation; (3) stronger government leadership and regulatory processes and (4) adequate resources for implementation and monitoring.

Consumer directed care aged care reforms in Australia since 2009: A retrospective policy analysis

In 2009, the Australian federal government used the projected rise in aged care expenditure and changing societal attitudes to justify the decision to overhaul the funding for aged healthcare services. A major feature of the reforms was the introduction of a consumer directed care (CDC) model. This followed the UK, Sweden, Canada and the USA who had already implemented CDC to some degree. The CDC model transferred aged care decisions from providers to consumers. This promised to create a competitive market system, resulting in decreased costs, increased quality and increased consumer satisfaction of aged healthcare services. Advocacy services were also reformed to address market failures. These changes were achieved by engaging key actors throughout the policy cycle, giving perceived legitimacy and transparency; and commissioning reviews with restricted scope and at calculated times, limiting their ability to produce negative criticism. In July 2018, the federal government gained full funding and responsibility for aged care with the support of key stakeholders and multiple reviews, yet with little objective data on the benefit of the reforms. This analysis highlights the power of the policymaking process in creating policies.

Retrospective Policy Analysis of Tobacco Prevention and Control in Ethiopia.

The trend of non-communicable diseases is alarmingly increasing and tobacco consumption and exposure to its smoke have been playing the leading role. Thirty-seven Ethiopians deaths per day are attributable to tobacco. Unless appropriately mitigated, this has social, economic and political impacts. Implementation of the appropriate policy is a good remedy; however, the policy process has never been straight forward and always successful. The involvement of different actors makes policy process complex hence agenda setting, policy formulation, implementation, and evaluations have been full of chaos and even may fail at any of these levels. Thus the aim of this review was retrospectively analyzing tobacco-related policies in Ethiopia that are relevant to control tobacco use and mitigate its impacts. Systematically, we searched in pub-med, Scopus, Web of Science and Embase. Additionally, we did hand search on Google scholar and national websites. The terms "tobacco", "cigar", "cigarette", "control", "prevention", "policy" and "Ethiopia" were used. Eleven of 128 records met the inclusion criteria and then included. For data analysis, we applied the health policy analysis framework developed by Walt and Gilson. Lately, Ethiopia enacted and started to implement tobacco control policies and programs, but its implementation is problematic and consumption rate is increasing. Despite the early involvement in tobacco control initiatives and enactment of legal frameworks, Ethiopia's journey and current stand to prevent and control the devastating consequences of tobacco is very limited and unsatisfactory. Therefore, we strongly call for further action, strong involvement of private sector and non-governmental organizations.

Development and implementation of nutrition labelling in Iran: A retrospective policy analysis.

Nutrition labelling is a strategy to promote healthy eating and combat non-communicable diseases (NCDs). The present study aimed to provide an analysis of the nutrition labelling policy and its opportunities to improve in Iran. Data were collected by 1) reviewing relevant documents and 2) semi-structured interviews with stakeholders through purposive and snowball sampling, continued until data saturation was achieved. A deductive content analysis was used by applying the policy triangulation framework and the Kingdon multiple stream theory. MAXQDA software was used to manage data analysis. Iran, is the first country in the Eastern Mediterranean region which has accomplished to implement nutrition traffic light labelling. The main contextual factors that affected nutrition labelling policy to become a national included health, political commitment, and international factors. Poor involvement of media for public awareness of nutrition traffic labeling, the inconsistency of nutrition traffic light color ranking using food standard guidelines, lack of consistency between nutrition traffic light colors and the healthy/unhealthy nature of some food products and the absence of a comprehensive evaluation plan were among the policy challenges identified. Strengthening the governance for a healthy food environment is recommended to improve the program. Also, establishing national portion sizes for food labelling, initiating public awareness campaigns, evaluation of the policy effect and public perception of the labels and their application are recommended.

Policy analysis of salt reduction in bread in Iran

Given that average salt intake among Iranians is approximately 10–15 g per day particularly from sodium hidden in bread, cheese, and fast food; lowering this mineral has been followed up seriously in this country for almost 10 years (since 2009). The main objective of the present study was to provide an opportunity to recognize unwanted and unfavorable outcomes of implementing decisions and policies together with associated problems of salt reduction in bread in order to achieve national and global health promotion goals. Thus, this qualitative and retrospective policy analysis was completed to evaluate the policy of salt reduction in bread in Iran. To collect the data, the researchers traveled to six cities in different regions, wherein relevant documents were utilized added to interviews with key actors. Related websites were correspondingly searched to find reports on this policy. Moreover, the researchers referred to some organizations in-person to search documents in this area. Five group discussions were also held to obtain public opinions in this regard. Data analysis was further carried out using framework analysis. The findings revealed that allocation of the highest rates of subsidy to wheat, flour, and bread had led to elimination of competitiveness in wheat, flour, and bread supply chain in Iran. Despite the presence of proper structures as coordinators of other organizations working on public health, there was no intersectoral collaboration in terms of maintaining health of bread products and lowering salt content in this staple food. With regard to changes in priorities of the Iranian Ministry of Health and Medical Education, attempts made to improve bread quality had also failed. In addition, first-line staff (i.e. bakers) had viewed formulation and implementation of the given policy as a top-down one. Given the ambiguities in establishment of new standards, there were similarly contradictions in execution of the policy at various levels. With reference to education provided at a national level, it was concluded that some people had become more sensitive to salt reduction in bread to some extent.