Abstract
BackgroundThe role of Community Health Workers (CHWs) in improving access to basic healthcare services, and mobilising community actions on health is broadly recognised. The Primary Health Care (PHC) approach, identified in the Alma Ata conference in 1978, stressed the role of CHWs in addressing community health needs. Training of CHWs is one of the key aspects that generally seeks to develop new knowledge and skills related to specific tasks and to increase CHWs’ capacity to communicate with and serve local people. This study aimed to analyse the CHW training process in Iran and how different components of training have impacted on CHW performance and satisfaction.MethodsData were collected from both primary and secondary sources. Training policies were reviewed using available policy documents, training materials and other relevant documents at national and provincial levels. Documentary analysis was supplemented by individual interviews with ninety-one Iranian CHWs from 18 provinces representing a broad range of age, work experience and educational levels, both male and female.ResultsRecognition of the CHW program and their training in the national health planning and financing facilitates the implementation and sustainability of the program. The existence of specialised training centres managed by district health network provides an appropriate training environment that delivers comprehensive training and increases CHWs’ knowledge, skills and motivation to serve local communities. Changes in training content over time reflect an increasing number of programs integrated into PHC, complicating the work expected of CHWs. In-service training courses need to address better local needs.ConclusionAlthough CHW programs vary by country and context, the CHW training program in Iran offers transferable lessons for countries intending to improve training as one of the key elements in their CHW program.
Highlights
The role of Community Health Workers (CHWs) in improving access to basic healthcare services, and mobilising community actions on health is broadly recognised
This study assessed the key elements of the CHW training program in Iran, how these elements are perceived by CHWs, and the lessons that may be applicable to similar settings
Training of CHWs is an integral part of Iranian primary health system and considerable attention has been made to make sure that the training content, duration and approaches matches with the educational qualification of CHW students as well as community health needs
Summary
The role of Community Health Workers (CHWs) in improving access to basic healthcare services, and mobilising community actions on health is broadly recognised. Delegation of tasks to community level health workers has more recently been considered as a response to the global. Iranian CHW, called behvarz in the Farsi language, is a full time employee of the health system, is selected from her/his own community and works in the village Health House, the most peripheral health delivery facility in the rural areas of Iran. According to the most recent statistics, in 2007 there were about 17,000 Health Houses in Iran, staffed by almost 31,000 male and female CHWs providing services to most of Iran's 65,000 villages with an estimated population of 28 millions [9]. From the inception of the CHW program in Iran, training has been a key component that has undergone regular review based on changes in health patterns, behvarz qualifications and new demands in their roles. In this paper we focus on behvarz training including training centres and trainers, training content, duration and facilities, and how these elements are perceived by behvarz to affect their performance and work satisfaction
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