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BACKGROUND: National palliative care plans depend upon stakeholder engagement to succeed. Assessing the capability, interest, and knowledge of stakeholders is a crucial step in the implementation of public health initiatives, as recommended by the World Health Organisation. However, utilising stakeholder analysis is a strategy underused in public palliative care. OBJECTIVE: To conduct a stakeholder analysis characterising a diverse group of stakeholders involved in implementing a national palliative care plan in three rural regions of an upper-middle-income country. METHODS: A descriptive cross-sectional study design, complemented by a quantitative stakeholder analysis approach, was executed through a survey designed to gauge stakeholders' levels of interest and capability in relation to five fundamental dimensions of public palliative care: provision of services, accessibility of essential medicines, palliative care education, financial support, and palliative care vitality. Stakeholders were categorised as promoters (high-power, high-interest), latent (high-power, low-interest), advocates (low-power, high-interest), and indifferent (low-power and low-interest). Stakeholder self-perceived category and knowledge level were also assessed. RESULTS: Among the 65 surveyed stakeholders, 19 were categorised as promoters, 34 as advocates, 9 as latent, and 3 as indifferent. Stakeholders' self-perception of their category did not align with the results of the quantitative analysis. When evaluated by region and palliative care dimensions the distribution of stakeholders was nonuniform. Palliative care funding was the dimension with the highest number of stakeholders categorised as indifferent, and the lowest percentage of promoters. Stakeholders categorised as promoters consistently reported a low level of knowledge, regardless of the dimension, region, or their level of interest. CONCLUSIONS: Assessing the capability, interest, and knowledge of stakeholders is a crucial step when implementing public health initiatives in palliative care. It allows for a data-driven decision-making process on how to delegate responsibilities, administer financial resources, and establish governance boards that remain engaged and work efficiently.

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Introduction: Banning the sales of loose cigarettes is recommended by Article 16 of the World Health Organization - Framework Convention on Tobacco Control. This study aims to understand the perceptions of cigarette users and tobacco vendors regarding such a ban. Methods: Using a systematic recruitment and interview protocol, we interviewed cigarette users (n = 28) and tobacco vendors (n = 28) from two Indian cities where sales of loose cigarettes were banned (Mumbai) or not banned (Delhi). Separate semi-structured interview guides were used for users and vendors. Interview questions focused on reasons for purchasing loose cigarettes, preference for buying and selling loose vs. packs, thoughts on the necessity of banning loose cigarettes, and the perceived impact of the policy ban for vendors and cigarette users. We performed thematic analysis and used NVivo for organizing transcript coding. Results: The main reasons users cited for purchasing loose cigarettes were financial constraints, social restrictions (fear of getting caught), and limiting cigarette consumption. In Mumbai, awareness of the existing ban was poor among both users and vendors. Those who were aware did not think the policy had been implemented. Users thought that loose cigarettes promoted smoking initiation and prevented them from quitting. Both users and vendors reported that a ban on loose cigarettes would reduce cigarette consumption and promote quit attempts as it would not be possible for everyone to purchase packs because of financial and social reasons. Conclusion: Users in both cities reported easy access to and widespread availability of loose cigarettes. Low awareness of the ban in Mumbai suggested inadequate enforcement. A country-wide ban on the sale of loose cigarettes could be highly effective in preventing smoking initiation and promoting quitting.

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INTRODUCTION: Along with the social and economic challenges posed by an aging society, creating work conditions that allow persons to stay healthy and work into old age has become a major task of Western societies. Retaining employment after returning to work is particularly difficult for individuals with a disability, as evidenced by the high rate of premature labor market dropout. Individuals with acquired brain injury (ABI) exemplify this challenge, as it often impairs cognitive, technical, and interpersonal abilities that are crucial in today's labor market. To effectively support these individuals, vocational integration practitioners require comprehensive knowledge of risk factors for premature labor market dropout and effective strategies for sustainable work. OBJECTIVE: This study aimed to identify perceived risk factors and related service gaps regarding sustainable work for people with ABI, as reported by affected individuals, employers, vocational integration professionals, and health professionals. METHODS: Secondary data analysis. Data that was originally collected through seven focus groups and two interviews with persons with ABI, 15 interviews with employers, and 13 interviews with vocational integration and health professionals in the context of the project 'Sustainable employment' was re-analysed thematically. RESULTS: Two major themes of risk factors were identified: (1) person-related factors (including the subthemes: post-ABI impairments; lack of understanding of post-ABI impairments; poor health management) and (2) environment-related factors (including the subthemes: challenges related to the service structure; insufficient knowledge and education about ABI; challenges at the workplace; difficulties in private life). While stakeholders noted the variety of the currently available services, they particularly pointed to the missing long-term monitoring and counseling services for persons with ABI following the initial return-to-work, reflecting a major challenge for sustainable work. An overarching gap related to the fragmentation of the service structure and the lack of case coordination along the working life. CONCLUSIONS: Multiple stakeholders emphasized the importance of empowering individuals, ensuring easy access to professional support, and providing a suitable work environment to address key risk factors and facilitate sustainable work for individuals with ABI. Continuous coaching, long-term monitoring and counseling following return-to-work, were identified as potential strategies to achieve these goals.

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BACKGROUND: The national breast screening programme in the United Kingdom is under pressure due to workforce shortages and having been paused during the COVID-19 pandemic. Artificial intelligence has the potential to transform how healthcare is delivered by improving care processes and patient outcomes. Research on the clinical and organisational benefits of artificial intelligence is still at an early stage, and numerous concerns have been raised around its implications, including patient safety, acceptance, and accountability for decisions. Reforming the breast screening programme to include artificial intelligence is a complex endeavour because numerous stakeholders influence it. Therefore, a stakeholder analysis was conducted to identify relevant stakeholders, explore their views on the proposed reform (i.e., integrating artificial intelligence algorithms into the Scottish National Breast Screening Service for breast cancer detection) and develop strategies for managing 'important' stakeholders. METHODS: A qualitative study (i.e., focus groups and interviews, March-November 2021) was conducted using the stakeholder analysis guide provided by the World Health Organisation and involving three Scottish health boards: NHS Greater Glasgow & Clyde, NHS Grampian and NHS Lothian. The objectives included: (A) Identify possible stakeholders (B) Explore stakeholders' perspectives and describe their characteristics (C) Prioritise stakeholders in terms of importance and (D) Develop strategies to manage 'important' stakeholders. Seven stakeholder characteristics were assessed: their knowledge of the targeted reform, position, interest, alliances, resources, power and leadership. RESULTS: Thirty-two participants took part from 14 (out of 17 identified) sub-groups of stakeholders. While they were generally supportive of using artificial intelligence in breast screening programmes, some concerns were raised. Stakeholder knowledge, influence and interests in the reform varied. Key advantages mentioned include service efficiency, quicker results and reduced work pressure. Disadvantages included overdiagnosis or misdiagnosis of cancer, inequalities in detection and the self-learning capacity of the algorithms. Five strategies (with considerations suggested by stakeholders) were developed to maintain and improve the support of 'important' stakeholders. CONCLUSIONS: Health services worldwide face similar challenges of workforce issues to provide patient care. The findings of this study will help others to learn from Scottish experiences and provide guidance to conduct similar studies targeting healthcare reform. STUDY REGISTRATION: researchregistry6579, date of registration: 16/02/2021.

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BACKGROUND: Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS: We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS: We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS: Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.

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BACKGROUND: Resilience in healthcare is the capacity to adapt to challenges and changes to maintain high-quality care across system levels. While healthcare system stakeholders such as patients, informal carers, healthcare professionals and service managers have all come to be acknowledged as important co-creators of resilient healthcare, our knowledge and understanding of who, how, and in which contexts different stakeholders come to facilitate and support resilience is still lacking. This study addresses gaps in the research by conducting a stakeholder analysis to identify and categorise the stakeholders that are key to facilitating and sustaining resilience in healthcare, and to investigate stakeholder relationships relevant for the enactment of resilient healthcare systems. METHODS: The stakeholder analysis was conducted using a sample of 19 empirical research projects. A narrative summary was written for 14 of the projects, based on publicly available material. In addition, 16 individual interviews were undertaken with researchers from the same sample of 19 projects. The 16 interview transcripts and 14 narratives made up the data material of the study. Application of stakeholder analysis methods was done in three steps: a) identification of stakeholders; b) differentiation and categorisation of stakeholders using an interest/influence grid; and c) investigation and mapping of stakeholder relationships using an actor-linkage matrix. RESULTS: Identified stakeholders were Patients, Family Carers, Healthcare Professionals, Ward/Unit Managers, Service or Case Managers, Regulatory Investigators, Policy Makers, and Other Service Providers. All identified stakeholders were categorised as either 'Subjects', 'Players', or 'Context Setters' according to their level of interest in and influence on resilient healthcare. Stakeholder relationships were mapped according to the degree and type of contact between the various groups of stakeholders involved in facilitating resilient healthcare, ranging from 'Not linked' to 'Fully linked'. CONCLUSION: Family carers and healthcare professionals were found to be the most active groups of stakeholders in the enactment of healthcare system resilience. Patients, managers, and policy makers also contribute to resilience to various degrees. Relationships between stakeholder groups are largely characterised by communication and coordination, in addition to formal collaborations where diverse actors work together to achieve common goals.

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Background: Kenya has a remarkably high burden of oral diseases, especially in vulnerable communities like persons with HIV (PWH). In the last few decades, the National AIDS & STI Control Programme has efficiently and successfully provided care and prevention against HIV for people living in Kenya. Objective: To assess the feasibility of integrating oral health into HIV research and policy structures in Kenya. Methods: The study took place between November 2021 and April 2022 in the cities of Nairobi, Kisumu, Mombasa, and Eldoret town. Using a semi-structured interview, three remote and 14 in-person sessions were conducted. Participants included individuals with professional experience in HIV and/or oral health such as researchers, potential mentors, institutional administrators, and other grant-funded experts. A qualitative analysis of recordings was performed by nine pretested independent reviewers, all with qualitative data analysis experience. Areas of interest included research, motivation, obstacles, and support. The free coding phase as well as an iterative grouping analysis (MIRO) was used. Findings: Of the 22 stakeholders interviewed in the study, researchers accounted for the majority (48%) of stakeholders, with the rest composed of practitioners (29%), university administrators (19%), and one public health administrator. University administrators were identified as having the most ability for resource mobilization followed by researchers and practitioners. All participants desired improved health outcomes using an evidence-based approach. The primary motivators were increased networks, collaborations, publications, and bridging the gap between oral health and HIV. While the obstacles to their desires included time and lack of funding, Institutional support through recruitment of qualified personnel, mentors, and mentees was their major desirable support. Conclusion: Stakeholders were unanimous in supporting integrating oral health within the current research and policy environment to address the gap between oral health and HIV, and to improve health outcomes through evidence-based interventions.

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(1) Background. Antimicrobial resistance (AMR) poses a substantial global health threat with profound economic implications. Acknowledging the imperative for a One Health (OH) strategy to combat this menace, Belgium introduced an annual national OH report, known as the "BELMAP report," encompassing antimicrobial use (AMU) and AMR, with the first edition completed in 2021. The integration of innovations for the healthcare system demands a meticulously planned process. (2) Methods. We introduced a three-step stakeholder analysis (SA) as a prospective framework for navigating this new report process, fostering complementary collaboration, pinpointing obstacles, suggesting approaches to overcome them, and facilitating national policy development. The SA unfolds in three steps: stakeholders identify and list their relevant activities, assess their positions regarding the BELMAP report, and complete "actor mapping" of national AMR and AMU stakeholders. (3) Results. Stakeholder identification reveals a fragmented landscape of AMR and AMU activities across Belgium. Assessment of stakeholder positions uncovers diverse expectations, collaborative challenges, and resource considerations. "Actor mapping" identifies key stakeholders, emphasizing the importance of high-interest and high-power actors. (4) Conclusions. This SA approach not only provides insights into the present stakeholder landscape in Belgium, it can also serve as a blueprint for other countries in the process of developing OH reports.

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Managed Entry Agreements (MEAs) play a pivotal role in addressing the challenges arising from escalating prices of innovative medical technologies, especially in areas like oncology, immunology, and rare diseases. Among MEAs, Performance-Based MEAs (PB MEAs) and Outcome-Based MEAs (OB MEAs) stand out as innovative strategies. This study examines the adoption of PB MEAs in the Czech Republic post a 2022 legislative change. Interviews with key stakeholders, including the Ministry of Health, pharmaceutical companies, insurers, and patient groups, were conducted to explore perceptions and challenges. Stakeholders expressed concerns about legislation completeness, data quality, transparency, and methodology. Interestingly, pharmaceutical companies were less concerned about transparency and methodology, likely due to their multinational experience. Despite legislative progress, challenges persist, especially in data infrastructure, risk-sharing perceptions, and stakeholder readiness. Addressing these issues requires collaboration between pharmaceutical companies and payers. Patient involvement, though mandated, remains limited, potentially due to a lack of awareness. This study emphasizes the need for a comprehensive transformation beyond legislation for a successful PB MEA implementation. Trust, technical infrastructure, and data availability are crucial, necessitating a holistic approach. It contributes to the global discourse on PB MEAs, stressing the adjustment of financial frameworks, embracing value-based healthcare principles, and ensuring high-quality health data metrics. A more holistic, value-based MEA approach could reshape pharmaceutical reimbursement in the future.

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Biodiversity conservation and economic profit from forests can be combined by various land-sparing and land-sharing approaches. Using a semi-structured survey, we evaluated support for scenarios representing contrasting conservation strategies in a managed boreal forest landscape. Land-sparing approaches were supported by the conservation organisation, regional administrations and the forest company, mainly motivated by the benefit for biodiversity based on ecological theory. Land-sharing approaches were supported by one recreational organisation, some municipalities and the forest owners' association, mainly motivated by the delivery of ecosystem services. Stakeholder groups using certain ecosystem services had motivations that we related to an anthropocentric mindset, while others focused more on species conservation, which can be related both to an anthropocentric or an ecocentric mindsets. Forest conservation planning should consider stakeholders' preferences to handle land-use conflicts. Since reaching consensus among multiple stakeholders seems unfeasible, a combination of land-sparing and land-sharing approaches is probably the best compromise.

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Background: Rational drug prescription (RDP) is one of the main components of the healthcare systems. Irrational prescribing can bring about numerous negative consequences for the patients and governmental agencies. This study aims to analyze the involvement of stakeholders in rational drug prescribing, their position (opponent or proponent), and the rationale behind it. Methods: This was a qualitative study conducted in 2019. Semi-structured face-to-face interviews were conducted with 40 stakeholders. Purposive and snowball sampling techniques with maximum heterogeneity were adopted to select the interviewees. Data was analyzed by MAXQDA software using thematic approach. Results: Iranian Food and Drug Administration employs the highest authority on the rational prescribing policy. Although the Ministry of Health and Medical Education, the Social Security Organization as one of the main health insurance organizations, pharmaceutical companies, and the Medical Council of the Islamic Republic of Iran, are among agencies that have great authority to improve rational prescribing, they fail to act professionally as they have conflicting interests. Remarkably, the Iran Food and Drug Administration, insurance organizations, family physicians, and patients, highly support the rational prescribing policy while the pharmaceutical companies display the least support for it. Conclusions: To make the prescription and using drugs more rational, policy makers should focus on different sources of conflicts of interest that different actors have. They should devise legal, behavior and financial policies accordingly to lessen or at least neutralize these conflicting interests, otherwise achieving RDP would be impossible in short and long terms.

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Nannini et al analyze barriers to national health insurance reforms in Uganda using a political economy approach primarily rooted in stakeholder analysis. This approach is valuable, not only for its clear description of the interest-based politics at play, but also for its extension of stakeholder analysis to include consideration of the role of ideas and institutions in the policy process. However this analysis, and others like it, could be further strengthened by adding insights from two different sources. The first is the comparative politics literature on the Ugandan regime. The second is a related approach which analyzes public service delivery in the context of a country's underlying "political settlement." Stakeholder-based approaches to health financing reform emphasize interest group conflict about the contents of policy reforms. By contrast, these complementary approaches imply distinct barriers to successful implementation of national health insurance in Uganda, rooted in the regime's de-industrialization and the personalization of politics and resource allocation. They also suggest possible leverage points or avenues for progress which differ from those suggested by stakeholder analysis.

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Drug development is a complex, resource intensive and long process in any disease area, and developing medicines to treat rare diseases presents even more challenges due to the small patient populations, often limited disease knowledge, heterogeneous clinical manifestations, and disease progression. However, common to all drug development programs is the need to gather as much information as possible on both the disease and the patients' needs ahead of the development path definition. Here, we propose a checklist named START, a tool that provides an overview of the key pillars to be considered when starting an orphan drug development: STakeholder mapping, Available information on the disease, Resources, and Target patient value profile. This tool helps to build solid foundations of a successful patient-centered medicines development program and guides different types of developers through a set of questions to ask for guidance through the starting phase of a rare disease therapeutic pathway.

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Environmental agencies around the world have adopted policies to manage e-waste and reduce the negative environmental impacts associated with its collection, sorting, dismantling, and recycling. In many OECD countries, where adequate policies and processing technologies exist, those who manage extended producer responsibility programs claim performance challenges due to competition from various actors collecting and managing e-waste "under the radar". While the material and economic losses attributed to such informal activities have been estimated by previous research, a detailed understanding of who is involved in these activities, why and how they operate, and with what social and environmental impacts, is often lacking. Our research offers an in-depth investigation into Montréal's informal e-waste flows. Whereas e-waste research and advocacy posit a dichotomy between "formal" and "informal" e-waste flows, our research reveals a more nuanced situation, with no water-tight separation between these flows. Formal and informal flows are often blurred, and change over time; and many actors are involved in both formal and informal activities. We reveal mechanisms whereby actors inadvertently contribute to informal activities because of inadequate incentives, limited program scope, reuse, parts harvesting, and documentation issues. This nuanced understanding helps identify policy loopholes, program shortcomings, and strategies for more sustainable e-waste flows, taking account of more ambitious circularity objectives and a just transition.

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INTRODUCTION: Achieving nutritional goals depends on individual, organisational and environmental capacities. The aim of this study was to analyse and identify capacity gaps among the coordination platforms and networks, and the key technical institutions related to nutrition in Burkina Faso for a capacity development plan formulation. METHODS: Using the new Nutrition Capacity Framework developed by the United Nations Network, information were collected using the Nutrition Stakeholder Mapping and Analysis tool, and the Checklist for Capacity Areas. Capacity needs were analysed in terms of Human resource and infrastructure, functional, organisational, coordination and partnership, and financial and resource mobilisation. RESULTS: Limited human resource capacity in nutrition was highlighted in most cases by the structures, and the nutrition coordination structure and more than 4/5 of the technical structures are faced with the unavailability of working materials, tools and basic Internet connection. Only 10 among the 30 structures have a unit or service for exchange on nutrition, and only three of them have integrated nutrition actions. Shortfalls were noted in terms of functional, facilitation, communication and advocacy skills, as well as a weak diversification of resource mobilisation strategies. CONCLUSION: The use of the analytical framework helped to identify the gaps and to propose paths for capacity development. Efforts need to be strengthened, intensified, coordinated, monitored, evaluated and funded.

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BACKGROUND: Fogging is a conventional technique used to combat Aedes mosquitoes and prevent dengue disease. It is often implemented in outbreak areas or areas harbouring a high density of Aedes mosquitoes. Currently, studies on stakeholders' attitudes towards fogging are still limited in number. Therefore, this study aims to assess Malaysian attitudes, and identify the predicting factors influencing such attitudes. METHODS: A validated instrument was used to interview 399 randomly selected respondents from the public (n = 202, 50.6%) and scientists (n = 197, 49.4%) in the Klang Valley region of Malaysia. The data were analysed using PLS-SEM involving Smart-PLS software. RESULTS: The results confirmed that stakeholder attitudes toward fogging should be viewed in terms of a multi-dimensional association. The stakeholders surveyed were highly positive with regard to the application of fogging to control dengue but professed moderate concerns as to associated risks. The PLS-SEM analyses demonstrated that the perceived benefit was the most important factor influencing attitudes, followed by trust in key players. CONCLUSIONS: This result provides a good insight from the perspective of education and unravels the underlying fundamentals of stakeholders' attitudes toward the fogging technique. The findings also provide a positive indicator to the responsible parties involved to continue the usage of this technique in conjunction with improvements with regard to its safety aspects, and possibly in combination with other environmental-friendly alternatives in order to achieve a healthy environment without dengue in Malaysia.

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Recently, there has been a growing interest in understanding how decentralized clinical trial (DCT) solutions can mitigate existing challenges in clinical development, particularly participant burden and access, and the collection, management, and quality of clinical data. This paper examines DCT deployments, emphasizing how they are integrated and how they may impact clinical trial oversight, management, and execution. We propose a conceptual framework that employs systems thinking to evaluate the impact on key stakeholders through a reiterative assessment of pain points. We conclude that decentralized solutions should be customized to meet patient needs and preferences and the unique requirements of each clinical trial. We discuss how DCT elements introduce new demands and pressures within the existing system and reflect on enablers that can overcome DCT implementation challenges. As stakeholders look for ways to make clinical research more relevant and accessible to a larger and more diverse patient population, further robust and granular research is needed to quantify the impact of DCTs empirically.

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Knowledge co-production has become part of an evolution of participatory and transdisciplinary research approaches that are increasingly important for achieving sustainability. To effectively involve the most appropriate stakeholders there is a need for engagement and increasing prominence of stakeholders in environmental management and governance processes. The paper aims at developing and testing a methodology for stratifying stakeholders by (i) classifying organisations involved in coastal and ocean governance by their agency, and (ii) grouping them into organisational archetypes for representation and selection in research processes. Agency was measured by the three dimensions of scale, resources, and power. Each dimension was further elaborated as a set of indicators. The methodology is applied in the context of a research project set in Algoa Bay, South Africa. The stratification of organisations enabled the research team to gain a better understanding of the stakeholder landscape of organisational agency, and thus identify the most relevant stakeholder with which to engage. The use of a hierarchical cluster analysis identified five organisational archetypes in relation to ocean and coastal governance in Algoa Bay. The methodology used in this study proposes an informed and intentional approach to create the conditions under which the co-production of and participation in research processes can take place.

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The COVID-19 pandemic has significantly affected the higher education sector in Singapore. Existing tertiary studies seeking to understand the intraperiod response to COVID-19 often focus on single institutions, jurisdictions or stakeholder groups. This study is the first in-depth qualitative multi-stakeholder examination of the higher education environment in Singapore during the COVID-19 pandemic. It explored the perceptions of the quality of digital pedagogy during COVID-19, how universities have adapted because of the pandemic, and how leaders, teaching staff and students have been affected by the management and educational changes via 13 semi-structured interviews across six Singapore higher education institutions. Through purposive sampling, we explore current stakeholder perceptions, structural education changes, and personal learning and teaching impacts of COVID-19. Applying Braun and Clarke's approach to thematic analysis, we inductively uncovered four major themes: the Singapore government's approach to COVID-19 and its effects on delivery; academic leadership approaches; education technology; and well-being. This article is critical as a key foundation to understand how Singapore is responding with unique geopolitical differences. We discuss the practical implications of our research for current university faculty and students during and beyond the pandemic, and outline opportunities for future research.

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The total fertility rate in Iran has declined to below replacement level recently, and a new approach has been taken to tackle this issue. Thus, this study aimed to identify the involved stakeholders and their characteristics in the new population policy change in Iran. We employed a qualitative approach using the purposive sampling of key informants and the identification of relevant documents. The main stakeholders were divided into seven key groups: religious, political, governmental, professional, international sectors, media, and nongovernmental organizations. In addition, there was no centralized, clear, and comprehensive mechanism to guide the activities of stakeholders to coordinate and bring the total fertility rate to the replacement level in Iran. Despite the importance of the new population policy in Iran, in recent years, we still experience dispersion and inconsistency among various actors in this area. It is imperative to go through a consensus and coalition at macro-level authorities alongside evidenced-based population policymaking.

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