Community health workers (Behvarz) in primary health care: a qualitative inductive content analysis of challenges.

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. Behvarz workers or community health workers not only play a major role in the health system, but also contribute to filling the gap between communities and high-level institutions by delivering basic healthcare services and for more complicated needs they can refer people to receive appropriate services, leading to more homogeneity in policies. Therefore, strategies are needed to emphasise Behvarz workers' role, with a special focus on engaging local communities. The identified challenges can provide valuable information for health policymakers and the experiences of Behvarz workers can be used to inform international community health workers' programs, which in turn provides better outcomes for treated patients. [ABSTRACT FROM AUTHOR]