Effect of supervision and education on community health workers performance in the field of primary health care

Seyede Sakine Hasani Ziabari, Sareh Shakerian


Background: Effective supervision strategies help to address the challenges unique to community health workers (CHWs) or Behvarz and improve poor practices. Current research is comparing situation of two supervisors group on performance of CHWs in Lahijan city.

Methods: This study was done through a quasi-experimental method in which with census it was considered through pre and post-test after education, then the statistical society was divided through systematic random sampling method and was supervised by two supervisor groups (health care providers and headquarters experts) and their situation were compared using the standard performance checklist in 10 primary healthcare fields for a four month period.

Results: Education section showed that 120 CHWs of statistical society, 56 CHWs of capability (in pre-test) answered 70% of questions correctly and in post-test 83 CHWs have answered to 70% of questions correctly and totally it shows 34% of enhancement. Result of in performance section showed that 63% CHWs under supervision of health care providers could have performance higher than 70% in 10 fields. Also result showed that 73% CHWs supervised by headquarter experts could have performance higher than 70% in 10 fields.

Conclusions: The effect of the education and supervision on the performance increased although with little difference in the two groups of observers. It can be concluded that the only field that is fully specialized after the implementation of Health Reform Plan is the field of pregnant mothers who provide services to this highly specialized group through midwives. 


Performance, Supervision, In-service training, Community health workers, Behvarz and health reform plan

Full Text:



Jaskiewicz W, Tulenko K. Increasing community health worker productivity and effectiveness: a review of the influence of the work environment. Human Resources Health. 2012;10(1):38.

Kok M, Muula A. Motivation and job satisfaction of health surveillance assistants in Mwanza, Malawi: an explorative study. Malawi Med J. 2013;25:5-11.

Greenspan J, McMahon S, Chebet J, Mpunga M, Urassa D, Winch P. Sources of community health worker motivation: a qualitative study in Morogoro Region, Tanzania. Hum Res Health. 2013;11:52.

Hewko SJ, Cummings GG. Performance management in healthcare: a critical analysis. Leaders Health Serv (Bradf Engl). 2016;29(1):52-68.

Medical science university website of Shiraz, (2010), education unit of staff Ministry of health, 2015.

Pilehroodi S. Healthcare network, City publication. 3rd ed. 2008: 2nd chapter. Available at: Accessed on 25 September 2019.

Ministry of health. Statement of Intent 2015 to 2019. Wellington: Ministry of Health; 2015.

Javanparast S, Baum F, Labonte R, Sanders D. Community health workers' perspectives on their contribution to rural health and well-being in Iran. Am J Public Health. 2011;101(12):2287-92.

Abolalaei B. Performance management, direction of managers for assessing and improving performance of staff, publication of organization of industrial management; 2001.

Hostmann B, Gassman B, Collins K, Bitterer A, White A, Radcliffe J, et al. Hype cycle for business intelligence and performance management. Stamford, Gartner; 2008: G00159354.

Boland T, Fowler A. A systems perspective of performance management in Public Sector Organisations. Intl J Public Sector Manag. 2000;13:417-46.

Zakariaee R, Aineri A, Didarlou A, Khorami A. Effect of health education program on knowledge and attitude of Khoy health workers about prevention and control of diabetes. J Faculty Nurs Midwifer. 2005;3(2):1-7.

Mothaghi M, Rajabi Z, Kachuee Z. The effect of Training in the field of primary health care on Knowledge of Kashan Health Workers (CHWs) 2004 -2011. Res Med Educ. 2012;4(2):34-42.

Maryam Z, Shamsuddin N. The effect of health education on the performance of health care providers in the prevention of cervical cancer. Daneshvar. 2002;38(9):69-5.

Saidi M, Karimy M, Choobdaran K, Khorram R, Baradaran H, Koohpayehzadeh J. Assessment of knowledge, attitude and practice educational needs of health care providers (Behvarzan) working toward maternal health in health networks in Saveh. J Torbat Heydariyeh Univ Med Sci. 2014;1(4):62-7.

Ansaripour S. The effect of acute respiratory infection education by rural health technicians and Behvarz Training Centre instructors on knowledge and practice of Behvarzes. Iran J Med Educ. 2005;5(2):33-9.

Salazar-Lindo E, Chea-Woo E, Kohatsu J, Miranda PR. Evaluation of clinical management training programme for diarrhoea. J Diarrheoal Dis Res. 1991;9:227-34.

Poor SHR, Ardabili EH, Zeraati H, Mosleh A. The Survey of the quality of drug prescription to under 5 years children by Behvarzes in Eslamshar town and the related factors (year 2000). Tehran Univ Med J. 2003;61(4.15):254-9.

Bolhari J, Bina M, Ehssanmanesh M, Karimi Kaisomi I. Studying the knowledge, attitude, and performance of health workers. IJPCP. 1997;3(1-2):4-12.

Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience?. A systematic review. BMC Health Services Res. 2017;17:786.

Abbaszadeh A, Eskandari M, Borhani F. Changing the care process: a new concept in Iranian Rural Health Care. Asian Nurs Res. 2013;7:38-43.

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.

Javanparast S, Baum F, Labonte R, Sanders D, Rajabi Z, Heidari G. The experience of community health workers training in Iran: a qualitative study. BMC Health Services Res. 2012;12:291.