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Depiction of Health. 2022;13(Suppl 1): 22-29.
doi: 10.34172/doh.2022.13
  Abstract View: 60
  PDF Download: 13

Community Involvement and Intersectoral Collaboration in Health Care System

Original Article

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

Hamed Fattahi ORCID logo, Alireza Raeisi ORCID logo, Jafar Sadegh Tabrizi ORCID logo, Babak Farokhi ORCID logo, MohamadReza Rahbar* ORCID logo
*Corresponding Author: Email: rahbar-m@health.gov.ir

Abstract

Background. From the start of the COVID-19 pandemic in February 2019 in Iran, the Iranian health system, following its mission, began planning with the goal of pandemic prevention and control. Various steps were taken, and the program of National Mobilization against COVID-19 was devised to provide services for individuals in the community, mainly the sick and vulnerable, and promote people's knowledge and skills regarding the crisis. Given the role of Community Health Workers (Behvarzes and Moragheb-e-Salamats) in preventing and controlling infectious diseases, this study was carried out to investigate their role in the COVID-19 pandemic.
Material. The present study is a descriptive cross-sectional study. The census method was used to study 30034 Behvarzes and 22573 Moragheb-e-Salamats working in medical universities. The required data were extracted using the integrated health system and the portal of the Ministry of Health and Medical Education's Primary Health Network Management Center and were analyzed using descriptive and analytical statistical methods.
Results. More than 78 million people were screened during the first step of the national mobilization against COVID-19, more than 42 million during the second step, and more than 59 million during the third step. In addition, by the end of the fourth step of the national mobilization, 4,278,899 people who had come into close contact were screened. According to the health system's report, these community health workers had injected 28,073,777 vaccines since the implementation of the fifth step (until 04.09.2021).

Conclusion. Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the National Mobilization against COVID-19 program has been significant since the beginning of this pandemic. Inadequacies in healthcare human resources, financial resources, and training planning should all be considered.

Keywords: Network Management Center, Behvarz, Health Caregivers, COVID-19, Multi-Disiplinary Health Workers

Extended Abstract
Background
The outbreak of a new virus was reported in Wuhan, China, in December 2019. In less than a few months, it had spread to Iran and other countries all around the world. A new type of coronavirus causes this disease. The World Health Organization has named it SARSCoV-2 and the resulting disease COVID-19 (COVID-2019). 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 progressive health crises in society, such as the COVID-19 pandemic, has been stressed, particularly in countries with economic constraints.The activities of CHWs, including Behvarzes (rural health workers) and Moragheb-e-Salamats (urban health care providers), have been scrutinized since the outbreak. These CHWs of Iran's primary health care system serve as an example of the facilities with the highest cost-effectiveness among healthcare workers who are trained to prevent various diseases. There are 17790 health houses in rural areas in Iran, where 30034 Behvarzes are employed. Furthermore, according to available statistics, 2,674 rural comprehensive health centers perform tasks in providing health care to the community members. There are approximately 5,343 active health posts in the cities, with 22,573 Moragheb-e-Salamats. Given the role of CHWs (Behvarzes and Moragheb-e-Salamats) in the COVID-19 pandemic, this project was performed to investigate their function in preventing and controlling the COVID-19 pandemic.
Material
The current cross-sectional descriptive study looks at 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. According to its thematic area, the statistical population of this study includes all CHWs in the 63 universities and medical schools, which are active in the executive units of Iran's primary health network during the implementation of the National Mobilization against COVID-19.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 softwares were used to prepare the report.
Results
According to data gathered during the first stage of the National Mobilization against COVID-19, 78 million Iranians were screened by CHWs and were provided relevant services and care. The second step of the National Mobilization adds laboratory screening to the first step's measures by establishing testing units in selected COVID-19 centers, focusing on the vulnerable population, such as the elderly, those with underlying or incurable diseases, and those with active diagnoses, pregnant women. CHWs were in charge of this. More than 42 million people over 15 years old were screened and taken care of in the second step. In the third step of the National Mobilization Program, more than 59 million people were screened and treated during this stage. Previous surveillance interventions, home care for vulnerable people, and neighborhood-based monitoring and support were added in the fourth step. From December 1, 2019, to the end of the fourth step of the National Mobilization Program, 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 cared for. Rapid diagnostic tests were performed for 52% of them, and supervisory teams made 6,293,637 visits, resulting in 618,821 warnings and 38,302 seals. About 1.5 million people were financially supported for their living.In the fifth step, COVID-19 vaccination was added to the previous interventions. According to the health system report, with the fifth step's implementation, the number of vaccines injected (until 04.09.2021) by these health workers amounted to 28,073,777 vaccines.

Conclusion
Considering the facilities and capabilities of primary health care networks in providing prevention, diagnostic, and treatment services, the activity of the primary health network management center and all affiliated units in the implementation of the National Mobilization against COVID-19 program has been significant since the beginning of this pandemic. Human resources are regarded as the essential resources 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 not be realized unless the necessary funding is sustained. Furthermore, special attention should be paid to the health workers' safety, training updates, and activity evaluation.
Practical Implications of Research
In general, the findings of this study indicate that CHWs are at the forefront of Corona prevention, control, and counteraction. Moreover, they have a heavy workload. As a result, health policymakers should carefully plan for increasing the productivity of these forces 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, the number of services provided by Behvarz and Moragheb-e-Salamat was calculated in this study. 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.
Aknowledgment
The authors of this article believe they must express their gratitude to all of their colleagues and health care providers who are at the forefront of dealing with the COVID-19 pandemic. We also want to thank the heads, deputies, and all of managers and experts in the health field and the primary network management center.

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Submitted: 15 Sep 2021
Revision: 20 Sep 2021
Accepted: 06 Oct 2021
ePublished: 14 Mar 2022
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