Performance Challenges Faced by 'Behvarzes' as Community Health Workers of Iran: A Systematic Review of Literature

Context: Iranian community health workers (known as behvarzes) have played an undeniable role in improving the health status of the rural community in recent decades. Therefore, this study aimed to identify the performance challenges faced by behvarzes using a literature review. Methods: This systematic review searched the Web of Science, Scopus, Science Direct, Springer, PubMed, ProQuest, SID, and Magiran databases/search engines in January 2020. There were 2 inclusion criteria, namely articles published in English or Persian languages and those published in or after 2000. The search strategy resulted in the retrieval of 1,472 primary articles, 16 of which were finally included in the study, and their related contents were entered into extraction tables. Then, the identified challenges were categorized based on the context, input, process, and product (CIPP) model. Results: The study results recognized the major challenges in 5 dimensions, including context (i.e., changes in societal, cultural, demographical, and epidemiological characteristics of rural communities), input (i.e., inadequate number of behvarzes, their insufficient competencies, and limited resources), process (i.e., increase in healthcare process complexity and the number of bahvarzes’ tasks and managerial problems), output (i.e., decrease in the quality, efficiency, accessibility, continuity, utilization, and effectiveness of services provided by behvarzes, poor health literacy of rural population and their weak involvement in health affairs, and emerging mental health problems in behvarzes), and outcome (i.e., low equity, urban-rural disparity in the diagnosis and treatment of diseases, and dissatisfaction of behvarzes and caregivers). Conclusions: This study revealed numerous important challenges faced by behvarzes, which need effective intervention by policymakers.