Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis

Rarianne Carvalho Peruhype,Juliana Feliciati Hoffmann,Catiucia De Andrade Surniche,Fernando Mitano,Pedro Fredemir Palha

doi:10.1590/1518-8345.2213.3015

Abstract

ABSTRACTObjective:to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method:a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results:three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion:the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.

Highlights

Discussing the importance of planning activity in the health area seems redundant and not very innovative
We begun to discuss: what can we do to ensure that patients can get through the end of treatment, or not abandon it in the first and second months of treatment? And, if you look into the literature, you will find publications, and the World Health Organization itself is talking about directly observed treatment (DOT) for many years, right? we initiated a discussion, with the teams and with the managers of the service, on the possibility of DOT
Regarding the axis of the antagonism between planning and daily requirements, the response of another subject when asked about the periodicity of review, reevaluation, and reformulation of planning for the transfer policy of DOT was: Look [laughs], periodicity as we would like does not exist; it is faced as when we found the emergence room crowded, the isolation full of patients, many cases of tuberculosis, the people [...] for me is a phone call like this: ah! You are very experienced, you know the workflow, you know the network, come in and help us because we are worried about tuberculosis, it starts over again: there we [...] but we have a plan, look here, just apply it

Summary

Introduction

Discussing the importance of planning activity in the health area seems redundant and not very innovative. Considering it in a context of public policy transfer constitutes an interesting challenge, mainly because it is an incipient and little-known topic in the Brazilian literature (1). The scarcity of systematic studies on the process of public policy transfer in this field (4) inspired us to investigate how planning the pathways in the transfer of directly observed treatment (DOT) policy for treating people with tuberculosis (TB) occurred in Porto Alegre, Rio Grande do Sul, which had one of the greatest incidence of this disease in 2016 (80.4 cases/100,000 inhabitants) among Brazilian capitals(5). For operational purposes, DOT can be considered as the follow-up of those patients with 24 supervised doses during phase one (loading dose), and 48 doses in phase two (maintenance)(6)

Objectives

Methods

Results

Conclusion