Table 2 Barriers to the employment of qualified people (contradictions between the participants’ viewpoints and instructions)
From: Recruitment and selection of community health workers in Iran; a thematic analysis
Conflicting codes with the MOH instructions | Basic sections (supervisors and managers’ viewpoints) | Suggestions for improvement |
|---|---|---|
Instruction problems | “The Ministry of Health manual has many pitfalls that need to be eliminated. Some of the specific or general terms restrict the recruitment of qualified people.” | The instructions should be further revised. |
Non-specification of the field of study (high school diploma) in the MOH instructions | “…Employment of health workers from any field of study leads to the recruitment of low-literate people by training centers.” | Most managers and supervisors believed that CHWs should be selected among people holding diplomas in experimental, or at least mathematical sciences. |
Absence of a passing score on the admission test for native candidates (from the main village) | “…The admission process does not have a minimum score, and volunteers with low general literacy levels are accepted. The presence of people with different literacy levels in the same class causes teaching and learning problems…” | If a native villager does not obtain the minimum score, people who have acquired the required score should be selected from nearby villages and other places. (Revision of Note 4 in the instructions) |
Inattention to previous academic records | “…There should be a requirement for having a high school diploma, because people with a low average score experience problems in learning high school courses; things will be even more difficult in community health training courses.” | Performance records in high school graduates should be assessed. |
Type of employment | “…It is preferred to hire people on contract. I believe that this is beneficial, as people know that they are being regularly evaluated; so, they keep themselves up-to-date.” | Contract employment is preferred over permanent employment. |
Challenges of selecting native people and local hiring | “I believe that health workers should be hired in a decentralized manner, based on a national entrance exam by giving extra credits to the natives of cities rather than villages.” | The concept of local hiring (e.g., extending the scope of local hiring from villages to cities and registering candidates at the province level rather than the village level) should be assessed. |
“…Natives have incomplete information in large villages, and the village proximity to the city reduces cultural differences among people…” | ||
“…We could not register more talented young people from nearby villages.” (Note 4 of the MOH instructions) | ||
“…The likelihood of a community health worker to stay in the village forever is substantially low…” | ||
“In our region, there is no difference in the cultural status of villagers and urban residents, because most cities are newly developed due to the migration of rural people.” | ||
“Sometimes, people share their private issues more easily with a non-indigenous person who does not live in the village and has no family relations with the people of that village, because they do not have to worry about the confidentiality of their information.” | ||
Effects of marital status on the CHW’s stay in the village | “The acceptance likelihood of married people is higher, because their residence status is known. If they want to hire native people, they should be married and live in the village so that they don’t immediately ask for a transfer.” | Married people should be prioritized as CHWs. |
Unclear interview process | “…The interview items should be clearly specified…” “Experts present in the interview lack enough experience and competency for diagnosis of mental disorders.” | The interview process, rules, and regulations should be amended, and experienced interviewers should be recruited. |
Absence of a standard method for the assessment of candidates’ mental and psychological health | “…They are not properly examined in terms of personality and psychological issues. Any person with any psychological and physical characteristics can be accepted…” | The mental and psychological status of candidates should be examined using standard tests. |
Non-transparency of items related to criminal convictions and offences | “…Criminal convictions and penalties should also have specific items in the exam. Certainly, a person who has a legal violation problem cannot be a suitable health worker, but it is different when a person has a legal problem, due to, for example, an unintentional car accident.” | Certain items should be set for identifying the candidates’ criminal convictions. |
Failure to assess the candidate’s interest in job | “People who are interested in their job and participate in the entrance exam work just as hard until retirement, whereas people who enter with quotas or because of family coercion or unemployment are not successful.” | Interest in providing community health services should be assessed. |
Failure to assess the candidate’s communication and language skills | “…Be friendly, give good guidance; expression is very important.” | Communication and language skills should be assessed. |
Recruitment of incompetent CHWs | “Quotas prevent the recruitment of qualified people, because they are accepted without any evaluation.” | People with quotas should be assessed the same way as other volunteers. |