Process of oral health policy making
Working methods	Policy development team (Planning Department) in Malawi Government dictated the process to be followed, in line with its standard policy writing procedures.
	Broad range of stakeholders was brought together for a two-day oral health workshop in Malawi to commence the policy creation process.
	Established a multisectoral task force to undertake the policy writing.
	Twice monthly meetings occurred on Zoom, including guest speakers being invited for consultation purposes.
Concept Paper	Concept Paper was drafted by the Ministry of Health Planning Department and refined by other Task Force members.
Research and data collation to inform policy writing 1: Narrative review	University of Glasgow representatives drafted Narrative Review. Review of existing peer-reviewed literature only identified one publication on oral health in Malawi, compared with multiple publications from South Africa and Nigeria.
	The review of documents included those from the World Health Organisation, International Dental Federation, and other organizations relevant to oral health improvement.
Research and data collation to inform policy writing 2: Situation analysis	Use was made of UNICEF data and Malawi Census data from 2018 to inform the demographics for the Situation Analysis.
	Task force members identified how to obtain data from Malawi‘s Central Hospitals for an indication of patient flow statistics.
	Data from PhD student projects in both Scotland and Malawi on fluoride in groundwater and fluoridation globally in relation to oral health provided valuable data.
Policy writing	The information gained from the Narrative Review and Situation Analysis was used to inform the writing of the policy itself. Much of the drafting and editing was completed by two of the international partners, with input and refining by other members of the task force. Final drafting was completed by a Ministry of Health sub-group.
Implementation Plan section of the Policy.	Identified an urgent need to appoint a Chief Dental Officer in the Ministry of Health.
	Identified the need to link oral health improvement and dental services implementation to the broader NCD agenda using a common risk factor approach.
	Scottish approach of focusing on heavy investment in prevention of child dental caries to save treatment costs down the line (exemplified by Childsmile) was emphasized as a potential component of implementation. This would require interaction with the Ministry of Education.
	It was imperative to address workforce shortages and issues, including consideration of task-shifting initiatives.
	Increased financial resources are required, as current limited funds for oral health care provide a challenge to what is feasible.
	Distribution of funding could be de-centralized but there must be clearly defined budget lines for oral health.
	A key objective of the policy is to generate data to work with, strengthening research, data collection and analysis.
	The ethical review process for research projects was noted as a drawn-out process, which could be streamlined to encourage researchers.
	Ensuring research outputs and outcomes through mixed methods to establish population and stakeholder’s thoughts on how policy is working will be critical to assess effectiveness of policy benefits and outcomes.
	A robust Monitoring and Evaluation Plan will be essential to ensure the main parts of the policy are prioritized and the policy is working as intended.