Introducing Mid-Level Dental Providers in Iran: Challenges and Opportunities

The WHO Global Strategy and Action Plan on Oral Health 2023-2030 encourages innovative approaches such as shifting tasks from dentists to Mid-level Dental Providers (MLDPs), who work independently to improve access to and equity in oral health. This study aimed to examine stakeholders' perspectives on the challenges and opportunities associated with introducing MLDPs in Iran.

A qualitative descriptive approach was adopted. Guided by the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 10 stakeholders selected through an informant-based sampling strategy. Interviews were transcribed verbatim and analysed thematically.

Stakeholders widely acknowledged the need for MLDPs but disagreed on their scope. Some supported limiting their role to preventive services, while others argued for including essential clinical tasks. Participants recognised that Iran has a legal basis for introducing MLDPs, though some criticized its "career transition" pathway which allowed dental therapists entry into dental programmes. Rural communities and primary health care facilities perceived as receptive to dental therapists, though infrastructure gaps persist. Implementation was considered as dependent on ministry and non-ministry actors.

The findings highlight both opportunities and challenges associated with introducing MLDPs in Iran. The Introduction of MLDPs is hindered by professional protectinism and power dynamics that prioritise dentists' interests over public needs, as well as infrastructural weaknesses. Overcoming these barriers will require redistributing decision-making power. This can be advanced through participatory research approaches and public engagement to promote the inclusion of community voices.