Community health workers (Behvarz) in primary health care: a qualitative inductive content analysis of challenges
Lida Shams
A , Maryam Zamani Fard B , Taha Nasiri C and Marita Mohammadshahi D *
A Department of Health Management, Policy and Economic, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
B Department of Community Health Education, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
C Department of Health Services Management, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran.
D Health Economics, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Australian Journal of Primary Health 29(5) 428-436 https://doi.org/10.1071/PY22052
Submitted: 6 March 2022 Accepted: 12 February 2023 Published: 6 March 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Behvarzs are the backbone of primary healthcare services in the Iranian health system and play a key role in providing efficient, responsive, and equitable services at the first level of service provision. This study aimed to identify the challenges of Behvarzs to provide a perspective for policymakers and managers to help them formulate future programs to enhance the efficiency of the health system.
Methods: Following a qualitative design, an inductive content analysis approach was used to analyse the data. The healthcare network of the Alborz province (Iran) was considered as the study context. A total of 27 interviews were conducted with policymakers, development managers, managers of Behavrz training centres, and Behvarz workers in 2020. All interviews were audio-taped and transcribed, followed by data analysis using MAXQDA ver. 10.
Results: Five themes were identified: service provision (scope of services, ambiguity of roles, non-compliance with the referral system, the quality of data entry, quality of services), access to equipment (quantity, quality), administrative issues (macro planning, micro planning), training (appropriateness of information, quality of training, recruiting related staff), perceived equity and fairness (balance between workload, income, and benefits, job satisfaction, job promotion).
Conclusion: Occupational challenges affect the performance of Behvarzs in responding to society’s needs because they not only play a major role in the health system, but also contribute to addressing the communication gap between local communities and high-level institutions, leading to the alignment of policy implementation. Therefore, strategies that emphasise the role of Behvarzs should be followed to promote community engagement.
Keywords: Behvarz challenges, community health workers, health system, inductive content analysis, Iran, policymaker, primary healthcare services, qualitative study.
References
Abbaszadeh A, Eskandari M, Borhani F (2013) Changing the care process: a new concept in Iranian rural health care. Asian Nursing Research 7, 38–43.| Changing the care process: a new concept in Iranian rural health care.Crossref | GoogleScholarGoogle Scholar |
Basiri M, Karimy M, Shahnazi H (2019) Effect of educational intervention on communication skills and self-efficacy of primary healthcare workers (Behvarz). Journal of Education and Community Health 6, 71–77.
| Effect of educational intervention on communication skills and self-efficacy of primary healthcare workers (Behvarz).Crossref | GoogleScholarGoogle Scholar |
Bitton A, Ratcliffe HL, Veillard JH, Kress DH, Barkley S, Kimball M, Secci F, Wong E, Basu L, Taylor C, Bayona J, Wang H, Lagomarsino G, Hirschhorn LR (2017) Primary health care as a foundation for strengthening health systems in low- and middle-income countries. Journal of General Internal Medicine 32, 566–571.
| Primary health care as a foundation for strengthening health systems in low- and middle-income countries.Crossref | GoogleScholarGoogle Scholar |
Eijkenaar F, Emmert M, Scheppach M, Schöffski O (2013) Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy 110, 115–130.
| Effects of pay for performance in health care: a systematic review of systematic reviews.Crossref | GoogleScholarGoogle Scholar |
Gilson L, Walt G, Heggenhougen K, Owuor-Omondi L, Perera M, Ross D, Salazar L (1989) National community health worker programs: how can they be strengthened? Journal of Public Health Policy 10, 518–532.
| National community health worker programs: how can they be strengthened?Crossref | GoogleScholarGoogle Scholar |
Hatami H, Razavi M, Ardebili H, et al. (2019) ‘Public health.’ 4th edn. (Arjmand: Tehran) p. 156.
Jafari H, Ranjbar M, Amini Rarani M, Hashemi FS, Bidoki SS (2020) Experiences and views of users about delivering services through the integrated health system: a qualitative study. The Journal of Tolooebehdasht 19, 57–71.
| Experiences and views of users about delivering services through the integrated health system: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Javanparast S, Baum F, Labonte R, Sanders D (2011) Community health workers’ perspectives on their contribution to rural health and well-being in Iran. American Journal of Public Health 101, 2287–2292.
| Community health workers’ perspectives on their contribution to rural health and well-being in Iran.Crossref | GoogleScholarGoogle Scholar |
Javanparast S, Baum F, Labonte R, Sanders D, Rajabi Z, Heidari G (2012) The experience of community health workers training in Iran: a qualitative study. BMC Health Services Research 12, 291
| The experience of community health workers training in Iran: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Kebriaei A, Moteghedi MS (2009) Job satisfaction among community health workers in Zahedan District, Islamic Republic of Iran. EMHJ-Eastern Mediterranean Health Journal 15, 1156–1163.
| Job satisfaction among community health workers in Zahedan District, Islamic Republic of Iran.Crossref | GoogleScholarGoogle Scholar |
Keshvari M, Mohammadi E, Farajzadegan Z, Zargham-Boroujeni A (2016) Experience of Behvarzes (Iranian primary healthcare providers) from giving primary health services in health houses. Journal of Education and Health Promotion 5, 7
| Experience of Behvarzes (Iranian primary healthcare providers) from giving primary health services in health houses.Crossref | GoogleScholarGoogle Scholar |
Kok MC, Dieleman M, Taegtmeyer M, Broerse JEW, Kane SS, Ormel H, Tijm MM, De Koning KAM (2015) Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy and Planning 30, 1207–1227.
| Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review.Crossref | GoogleScholarGoogle Scholar |
Lincoln YS, Lynham SA, Guba EG (2011) Paradigmatic controversies, contradictions, and emerging confluences, revisited. In ‘The sage handbook of qualitative research’. 4th edn. (Eds NK Denzin, YS Lincoln) pp. 97–128. (Sage)
Marashi S, Zarin Ara A, Mohseni K, Abazari H (2019) ‘Iran statistical yearbook 1397 (2018–2019).’ (Statistics Center of Iran: Iran, Tehran)
Mehrdad R (2009) Health system in Iran. JMAJ 52, 69–73.
Moser A, Korstjens I (2018) Series: Practical guidance to qualitative research. Part 3: sampling, data collection and analysis. European Journal of General Practice 24, 9–18.
| Series: Practical guidance to qualitative research. Part 3: sampling, data collection and analysis.Crossref | GoogleScholarGoogle Scholar |
Ozano K, Simkhada P, Thann K, Khatri R (2018) Improving local health through community health workers in Cambodia: challenges and solutions. Human Resources for Health 16, 2
| Improving local health through community health workers in Cambodia: challenges and solutions.Crossref | GoogleScholarGoogle Scholar |
Rahbar M, Raeisi A, Chowdhury Z, Javadi D (2020) Iran’s community health worker program. Available at https://chwcentral.org/irans-community-health-worker-program-2/ [Accessed 19 August 2020]
Sadrizadeh B (2004) Primary health care experience in Iran. Iranian Red Crescent Medical Journal 7, 79–90.
Salehi Zalani G, Bayat M, Shokri A, Mirbahaeddin SE, Rasi V, Alirezaei S, Manafi F (2016) Affecting factors on the performance of community health workers in Iran’s rural areas: a review article. Iranian Journal of Public Health 45, 1399–1410.
Saprii L, Richards E, Kokho P, Theobald S (2015) Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Human Resources for Health 13, 95
| Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles.Crossref | GoogleScholarGoogle Scholar |
Sauerborn R, Nougtara A, Diesfeld HJ (1989) Low utilization of community health workers: results from a household interview survey in Burkina Faso. Social Science & Medicine 29, 1163–1174.
| Low utilization of community health workers: results from a household interview survey in Burkina Faso.Crossref | GoogleScholarGoogle Scholar |
Shadpour K (2000) Primary health care networks in the Islamic Republic of Iran. EMHJ-Eastern Mediterranean Health Journal 6, 822–825.
| Primary health care networks in the Islamic Republic of Iran.Crossref | GoogleScholarGoogle Scholar |
Shafee Koranjik G (2020) A survey on stakeholder’s perception and perspectives on Behvarz reception conditions in Golestan Province. Master thesis, Shahid Beheshti University of Medical Sciences.
Shams L, Tajik M, Heidari P, Nasiri T, Mohammadshahi M (2022a) Quality of life of Iranian and Afghan pregnant women in rural Iran. Annali di Igiene 34, 70–78.
| Quality of life of Iranian and Afghan pregnant women in rural Iran.Crossref | GoogleScholarGoogle Scholar |
Shams L, Yazdani S, Nasiri T (2022b) The value framework governing Iran’s health system policy: a practical gap. International Journal of Preventive Medicine 13, 96
| The value framework governing Iran’s health system policy: a practical gap.Crossref | GoogleScholarGoogle Scholar |
Shayan S, Rafieian M, Kazemi M (2018) Design and develop logbook student’s nationwide health providers training courses of the entire country. Journal of Medicine and Spiritual Cultivation 27, 124–132.
Staples LH (2001) Insider/outsider upsides and downsides. Social Work with Groups 23, 19–35.
| Insider/outsider upsides and downsides.Crossref | GoogleScholarGoogle Scholar |
Tabatabaei Asl SN, Nikravan A, Nazarymanesh L (2018) The study of relationship between the workload of Health workers with working hours of medical Homes in Robat Karim. Beyhagh 23, 57–47.
World Health Organization (1978) Declaration of alma-ata (No. WHO/EURO: 1978-3938-43697-61471). World Health Organization, Geneva.
World Health Organization (2016) Community health workers: a strategy to ensure access to primary health care services. World Health Organization.
