Capacity building and role optimization among primary health care workers in Rasht, Iran, during the COVID-19 pandemic

Coronavirus disease 2019 (COVID-19) posed significant challenges to health systems worldwide, highlighting the need for resilient health systems. This study aimed to assess capacity-building and role optimization interventions for primary health care (PHC) workers in Rasht, Iran, during the COVID-19 response, based on World Health Organization (WHO) guidance. A cross-sectional study was conducted in 2023 among 297 PHC workers and 12 managers in Rasht County, northern Iran. Of 342 worker questionnaires distributed, 297 were completed (response rate, 86.8%). Data were collected using structured questionnaires adapted from WHO guidance on health workforce policy and management, whose validity and reliability were assessed. Data were analyzed using descriptive statistics and stepwise multiple linear regression. Among PHC workers, 90.2% received training in prevention and 80.8% in infection prevention and control (IPC), but only 30.3% in medication safety and 30.6% in triage. In addition, 82.5% reported delivering COVID-19-related care beyond their competencies, and 55.2% reported no appropriate supportive supervision structure for COVID-19 tasks. Regression analysis showed that supportive supervisory visits (B = 0.353, p < 0.001) and perceived usefulness of training courses (B = 0.269, p < 0.001) were associated with higher capacity-building scores, whereas workers in health posts (B=-0.207, p = 0.007) and urban-rural health centers (B=-0.317, p < 0.001) reported lower scores than those in health houses. Supportive supervisory visits (B = 0.451, p < 0.001), a higher volume of data collected and reported (B = 0.188, p = 0.013), and job title ( Moraghebe-salamat vs. Behvarz ; B=-0.142, p = 0.039) were associated with role optimization. The findings suggest that strengthening PHC preparedness for future health emergencies may require institutionalizing competency-based training, shifting inspection-focused supervision toward supportive and mentoring-based models, ensuring context-specific role guidelines, expanding digital health infrastructure including telemedicine, and streamlining data-reporting requirements to reduce workforce burden.