Stakeholders influence to reduce vitamin A deficiency in children aged 15 to 23 months in Iran: an analysis of stakeholders and networking.

Abstract

AIME: Vitamin A deficiency remains a significant public health concern in developing countries, substantially contributing to morbidity and mortality among young children. In Iran, the prevalence of vitamin A deficiency among children aged 15 to 23 months increased during the decade from 2002 to 2012, mostly due to socio-economic reasons. Given the complexity of managing this deficiency, multiple stakeholders are involved in its prevention and treatment. The objective of this study is to identify these stakeholders and assess their interests, influence, and interconnections to enhance coordinated efforts in addressing vitamin A deficiency.

Method: In this qualitative study, we identified primary and secondary stakeholders through interviews with experts and key informants, as well as content analysis of relevant documents. To examine the interactions between stakeholders' power, interests, and positions, we utilized Policy-Maker software (Version 4). Additionally, we employed Gephi software (Version 0.9.2) for social network analysis, mapping stakeholder relationships to enhance our understanding of their interconnected dynamics.

Results: Our research identified 45 stakeholders, categorized as follows: 71% from the public sector, 4.5% international entities, 11.11% private organizations, and 13% from civil society groups. Additionally, 62% of stakeholders were associated with the executive domain, while 38% belonged to the education sector. Degree centrality ranged from 1 to 12, Closeness centrality scores ranged from 0.25 to 0.67, indicating moderate to high accessibility within the network. Athough the Ministry of Health and Medical Education was identified as the most influential stakeholder, and also it plays a key role in collaboration with other stakeholders, multiple stakeholders, including NGOs, universities, and international organizations such as UNICEF and FAO, also played significant roles in reducing Vitamin A deficiency. Network analysis metrics-including degree, closeness, betweenness, and eigenvector centralities-indicated that the highest degree value was attributed to the Secretariat of the Supreme Council for Health and Food Security (affiliated with the Ministry of Health and Medical Education), UNICEF, FAO, and the Deputy of Public Health within universities of medical sciences.

Conclusion: Addressing vitamin A deficiency among children aged 15-24 months in Iran requires a coordinated and strategic approach, with the Ministry of Health and Medical Education serving as the key stakeholder. While the ministry plays a central role in legislative efforts and collaboration, the relatively low to medium level of interest among other key stakeholders highlights the need for proactive engagement. Strengthening awareness through targeted advocacy, continuous negotiations, and deliberate outreach can enhance stakeholder involvement and ensure effective policy implementation. By fostering stronger partnerships and promoting informed decision-making, a more sustainable and impactful approach to reducing vitamin A deficiency can be achieved.