Bridging Aspirations and Reality: Challenges in Oral Health Policy Implementation in Karnataka, India

<ns3:p>Introduction Equitable access to and service provision for oral health in Karnataka, India, remains challenging despite several policy and program initiatives. It was unclear whether the formulation and implementation of the oral health policy were coordinated and involved all stakeholders and institutions. Therefore, this study aimed to explore the gaps and barriers in oral health policy formulation and implementation in Karnataka. Methods This exploratory qualitative study employed a backward mapping approach and policy landscaping from 2000 to 2025. Content analysis was performed on 8 policy documents to identify how oral health was problematised in policies. The resultant policy matrix was subjected to assessing the implementation status of their recommendations and the perceptions of 31 stakeholders, including policymakers, administrators, program implementers, and dental health professionals, through in-depth interviews and focus group discussions. Theories of implementation were employed to guide data collection and analysis. Results Policy document analysis revealed inconsistencies in oral health policy, characterised by recommendations lacking actionable details, clear funding, or integration into broader health frameworks. Stakeholder consultations highlighted systemic neglect, including chronic underfunding, workforce shortages, and limited awareness of oral health policies. Weak accountability structures and the lack of monitoring and evaluation mechanisms further impeded implementation. Administrators, identified as key implementers, were often excluded from policymaking processes, resulting in limited policy ownership and effectiveness. Conclusion Although oral health has gained traction in policy discussions over two decades, implementation remains inconsistent. Oral health policymaking in Karnataka state has been fragmented, lacking a concerted effort involving all stakeholders and the institutions that support policy implementation. Addressing these challenges requires structural changes such as dedicated budgets, increased workforce capacity and stronger monitoring frameworks. These measures are critical to improving oral health services, particularly for marginalised and underserved communities, to achieve the health for all goal.</ns3:p>