Community Health Workers’ Role in Preventing and Controlling the COVID-19 Pandemic

Extended Abstract
Background
The new viral epidemic in Wuhan, China, in December 2019 quickly spread to Iran and other nations worldwide. The World Health Organization announced the SARSCoV-2 virus as the cause of Coronavirus Disease-2019 (COVID-19). Since the outbreak's inception, the most crucial strategy for combating this disease has been to prevent its spread through individual and social preventive measures. Due to this issue, the role of Community Health Workers (CHWs) in preventing progressive health crises, such as the COVID-19 pandemic, has been stressed, particularly in countries with economic constraints.The performance of CHWs, including rural health workers-RHWs (Behvarzes)and urban health workers-UHWs (Moragheb-e-Salamats), has been monitored since the outbreak. CHWs are part of Iran's healthcare system and serve as the facilities with the highest cost-effectiveness among healthcare workers trained to prevent various diseases. There are 17,790 health houses in rural Iran, where 30,034 Behvarzes (RHWs) are employed. Furthermore, according to available statistics, 2,674 rural comprehensive health centers perform tasks in providing health care to the community. There are approximately 5,343 active health posts in the cities, with 22,573 Moragheb-e-Salamats (UHWs). This study aimed to investigate the role of CHWs in preventing and controlling the COVID-19 pandemic.
Methods
The current descriptive cross-sectional study examined the role of CHWs (Behvarzes and Moragheb-e-Salamats)in preventing and controlling the COVID-19 pandemic from February 2018 to September 2021. The data were collected using the Integrated Health Information System data and the Ministry of Health and Medical Education's Network Management Center portal. The statistical population of this study included all CHWs from 63 universities and medical schools participating in Iran's primary health network during the implementation of the NMP.In addition, the census method was used for sampling. According to available data, at the time of this study, 52,607 CHWs (including 30,034 Behvarz and 22,573 Moragheb-e-Salamat) were working in the system. The data were analyzed and reported using comparative tables, graphs, and descriptive statistical methods. Excel, Access, and SPSS were used to prepare the report.
Results
According to the data collected during the first stage of the NMP, 78 million Iranians were screened by CHWs and were provided relevant services and care. The second step of the NMP expanded laboratory screening by establishing testing units in selected COVID-19 centers, focusing on the vulnerable population, such as the elderly, patients with underlying or incurable diseases, patients with active diagnoses, and pregnant women. Also, more than 42 million people over 15 years were screened and received care in the second step. In the third step of the NMP, more than 59 million people were screened and treated. Previous surveillance interventions, home care for vulnerable people, neighborhood-based monitoring and support were added in the fourth step. From December 1, 2019, to the end of the fourth step of the NMP, 4,278,899 people were contact traced. A rapid COVID-19 test was performed for 2,072,873 people, and 315,984 people were subjected to reverse quarantine at home, visited, and received care. Rapid diagnostic tests were performed for 52% of the population, and supervisory teams made 6,293,637 visits, resulting in 618,821 warnings and 38,302 seals. About 1.5 million people received financial support for their living.In the fifth step, COVID-19 vaccination was added to the previous interventions. According to the health system report, in the fifth step, 28,073,777 vaccines were administered (until 04.09.2021) by health workers.
Conclusion
Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the primary health network management center and all affiliated units have been highly active in implementing the NMP since the beginning of this pandemic. Human resources are essential in the health sector. Despite the around-the-clock efforts of CHWs (Behvarzes and Moragheb-e-Salamats), the experience of the COVID-19 pandemic demonstrated that the programs related to the supply and distribution of health workers should be reviewed. Moreover, the effectiveness of these programs will only be realized if the necessary funding is sustained. Furthermore, special attention should be devoted to the health workers' safety, ongoing training, and activity evaluation.
Practical Implications of Research
In general, the findings of this study indicated that CHWs are at the forefront of Corona prevention, control, and counteraction. As a result, health policymakers should carefully plan for increasing the productivity of CHWs by considering health workers' safety, using motivational factors, and reducing anti-motivational factors. It is also critical to fund the recruitment and hiring of new employees to reduce burnout and the workload of the existing employees.
Ethical Considerations
Based on the services registered in the system, we determined the services provided by Behvarz and Moragheb-e-Salamat. As a result, one of the limitations of this research is that some services may not be registered and thus were not included in this study.
Conflict of Interest
The authors certify that this article does not include any conflicts of interest.
Acknowledgment
The authors of this article believe they must express their gratitude to all colleagues and healthcare providers at the forefront of dealing with the COVID-19 pandemic. We also want to thank the heads, deputies, and all managers and experts in the health field and the primary network management center.