Abstract
Dengue is one of Brazil's most important public health challenges. Activities for its prevention and control have been based on the strategy of integrated management proposed in health policies, in which the central actors are the Endemic Disease Control Agent(ACE) and the Community Health Agent (ACS). This study analyzes consensus opinions produced by ACSs and ACEs on theactions for incorporating ACEs into the teams of the Family Health Strategy (ESF). It is a qualitative study from a large municipality in Brazil in which dengue is endemic, using a focus group of professionals that is subsequently analyzed using Collective Subject Discourse Analysis, supported by WebQDA. The results indicate consensus positions in relation to the following subjects: I) difficulty in the process of integration of ACSs and ACEs for control of dengue; II) inclusion of ACEs in the primary healthcare of the ESF; and III) absence of monitoring and assessment of the integrated actions. In conclusion, there are needs: to make participants more aware, seeking changes in behavior; to offer an environment of support to those involved with training courses about dengue; and to monitor the process of integration, and evaluate it periodically, creating indicators of quality and quantity.
Highlights
Epidemics of dengue have their effect on the economy of countries, through mortality and disease, causing absenteeism from work and school, an adverse effect on the tourist industry, and possibly a collapse of the health services due to the high demand from patients[1,2].In 2002 the Brazilian Health Ministry launched the National Dengue Control Program (PNCD), which incorporated the principles of integrated management, based on certain essential aspects among which we highlight integration of the actions to control dengue in basic healthcare, in an attempt to improve coverage, quality and regularity of the fieldwork combating the vector of the disease[3]
Integration is the conceptual basis of the National Guidelines for Prevention and Control of Dengue Epidemics, in which a highlight is the intention for joint action by Endemic Disease Control Agents (ACEs) and Community Health Agents (ACSs)[2,3,4,5]
ACSs and ACEs of 12 city districts belonging to the Northeast Health District of the city of Goiânia took part in this study, and the meanings attributed to them emerged from analysis of the transcript of the focus group, comprising five lines of consensus (DCSs), constituted by 100 KEs: DCSA – 14 KEs; DCSB – 22 KEs; DCSC – 12 KEs; DCSD – 40 KEs; and DCSE – 12 KEs
Summary
Epidemics of dengue have their effect on the economy of countries, through mortality and disease, causing absenteeism from work and school, an adverse effect on the tourist industry, and possibly a collapse of the health services due to the high demand from patients[1,2].In 2002 the Brazilian Health Ministry launched the National Dengue Control Program (PNCD), which incorporated the principles of integrated management, based on certain essential aspects among which we highlight integration of the actions to control dengue in basic healthcare, in an attempt to improve coverage, quality and regularity of the fieldwork combating the vector of the disease[3]. Integration is the conceptual basis of the National Guidelines for Prevention and Control of Dengue Epidemics, in which a highlight is the intention for joint action by Endemic Disease Control Agents (ACEs) and Community Health Agents (ACSs)[2,3,4,5]. By Ministerial Order 1007/GM of 2010, Brazil’s Health Ministry set the criteria regulating incorporation of the ACEs into Primary Healthcare[6]. The Order indicates changes in the function of the ACEs and the ACSs, aiming to empower the activities of both, according to the National Council of Health Secretaries (Conass)[7], implementation of this law could bring risks with it, due to details of the functions of the professionals involved not being given
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