Lessons Learnt From the Model of Instructional System for Training Community Health Workers in Rural Health Houses of Iran


Mohammadreza Rahbar 1 , * , Mina Ahmadi 1

1 Center for Health Networks Management, Ministry of Health and Medical Education, Tehran, IR Iran

How to Cite: Rahbar M, Ahmadi M. Lessons Learnt From the Model of Instructional System for Training Community Health Workers in Rural Health Houses of Iran, Iran Red Crescent Med J. 2015 ; 17(2):e2145. doi: 10.5812/ircmj.2145.


Iranian Red Crescent Medical Journal: 17 (2); e2145
Published Online: January 26, 2015
Article Type: Rapid Communication
Received: August 23, 2011
Revised: December 26, 2014
Accepted: December 30, 2014




Background: Many experts believe that the “health houses” of Iran have had major effects in increasing health status of Iranian rural community. One of the factors, which was critical to this success is the employment of young women and men from rural communities who serve as multipurpose health workers. They participate in a two-year task-oriented training course.

Objectives: The purpose of this article was to describe the model of training behvarzes as the community health workers who deliver health services to the health houses of Iran. This description included the specific method of recruiting these CHWs, strategies and methods of their training which is different from general academic education.

Materials and Methods: A descriptive study design was utilized for this analysis in six areas. These areas have been selected according to the expert opinions and experiences of the Center for Health Networks Management.

Results: The results showed the specific method of student selection and clear objectives and standards of training related to the health needs of the community. Recruitment of native human resources, the relationship between training and performance are the characteristics, which have been made this system more efficient and responsive to the health system needs.

Conclusions: Development of the job and task analysis to ensure providing the right training needs, applying more evidences through different studies for reforms, more decentralized equipped system with decision-making tools have been proposed for development.


Primary Health Care Community Health Worker Iran

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1. Background

In Iran, priority of rural areas in resource allocation was a main policy for primary health care (PHC) system development from the beginning. There are more than 60000 villages, which the average population for them is less than 300 and the average distance between two villages is more than 25 Km. Delivering health services to this scattered population was possible by employing a specific community health worker so called "behvarz". Rural health service utilization rates are now the same as in urban areas (1), and it was so that the Iran’s health houses have been known by the report of World Health Organization responsible for a sharp drop in mortality and life expectancy increasing (2). One of the main factors had been critical to the success of the Iranian PHC development was feasibility of using young female and male behvarzes from rural communities and training them in district health networks (3). For the time being there are more than 17000 health houses all over the country (4) in which more than 32,000 behvarzes are working (5). In each health house, based on the master plan there should be at least one female behvarz, which covers an average 1000 population (6). As many health experts in the country and outside of it believe that one of the main factors in the success of PHC system is the specific model of behvarz training; we intend to describe the strategies and characteristics of this training system. Moreover, the Iranian health system utilizes the other community health workers with academic education of two years. They consist of family health, disease control and sanitary health technicians. In this article, we have also briefly explained the differences of these educations in comparison to behvarz training system.

3. Materials and Methods

A descriptive study design in six areas as a result of expert opinion was utilized for the analysis of behvarz training system. We also made comparisons between behavarz training system and other academic educations including family health, disease control and environmental health technicians. These comparisons were done by the eligible people who had enough experiences in the health networks and education and were reflected in different instructions issued by Ministry of Health and Medical Education (MoH). Meanwhile, as the training is generally focused on the job-specific knowledge, skill and ability to a person’s career or job and is specifically tailored to the job requirements, the overview of a training system should be based on the job and task analysis (7). By applying this logic and with gathering the opinions of the experts, the CHNM (Center for Health Networks Management) in the MoH of Iran utilizes a six-step evaluation tool to ensure the outcome-based training system development. Utilizing the items of this logic framework can be found in the “Instructions for Behvarz Training”, “The Rules for Recruitment of Behvarzes” (8, 9) and usually these critical points are being used in the academic curricular development format in undersecretary for medical education.




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