Abstract
BackgroundResearches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions.MethodsThis cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the Primary Care Assessment Tool adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites.Results"Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP.ConclusionsTwo types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.
Highlights
Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease
Brazil has considerably invested in health system reform, including the development of new primary health care (PHC) organization and delivery models [2]
The results showed a higher percentage of male patients (65.6%), patients with less than 8 years of education (51.1%) and those with: home ownership (67.9%), electricity (98.8%), public water supply at home (86.7%) and telephone (70.2%)
Summary
Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services’ performance in TB treatment in cities across different Brazilian regions. Even in this millennium, tuberculosis (TB) remains the leading killer infectious disease in the world, with 1.7 million deaths in 2009. One third of the world population is infected by Mycobacterium tuberculosis and a Brazil ranks 19th among the 22 countries with the highest incidence levels of tuberculosis (TB) smear-positive cases [1]. PHC attributes (access, range of services, coordination, bond and family focus) need to be accomplished, so that a good organization of this level contributes to improve care, with a view to positive impacts on population health and health system efficiency [5]
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