Tuberculosis control: decentralization, local planning and management specificities

Abstract

The goal was to analyze, according to the perception of health managers, the practices that guide tuberculosis control actions in cities in the metropolitan region of João Pessoa - PB, Brazil. This qualitative study involved eight professionals in management functions. Testimonies were collected through semi-structured interviews between May and June 2009 and organized through content analysis. Despite the acknowledged benefits of tuberculosis control action decentralization, local planning indicates the predominance of a bureaucratic model that is restricted to negotiation and supplies. Local programming is centered on the coordinator, which shows a command line and vertical management that lead to the fragmentation of the work process. Management action should follow an innovative and transformative route that surpasses bureaucratic barriers and faces the biggest challenge it is proposed: to balance professional interrelations with a view to improving health work performance.

Adesão dos Serviços Especializados à Nova Tecnologia no Tratamento da Hepatite C

“…Cabe, portanto, ao gestor, ter habilidades para mediar, manter e transformar essas relações em função das necessidades da população (TRIGUEIRO et al, 2011).…”

Dificuldades, caminhos e potencialidades da descentralização do atendimento à tuberculose

“…A organização da rede de atenção à TB requer laboratórios disponíveis para exames diagnósticos, abastecimento de medicamentos, garantia de tratamento supervisionado, fornecimento e análise de dados 10 . Segundo as enfermeiras, tais serviços não estão disponíveis na Atenção Básica do município em questão.…”

“…As formas inadequadas de contratação dos trabalhadores de saúde e a rotatividade de pessoal implicam a perda de pessoas estratégicas, prejudicando a eficiência organizacional e acompanhamento dos casos de TB 10 . O problema da rotatividade dos profissionais é agravado pela ausência da educação permanente, visto que se trata de um meio eficaz de qualificação da equipe.…”

Assessment of Primary Health Care in the Treatment of Tuberculosis in a Brazilian Locality of the International Triple Frontier

“…Paradoxically, there is underperforming access to diagnosis, lack of involvement and coordination between managers, vertical management and high turnover of professionals – what contributes to poor performance of TB control in the PHC [4, 14-17]. Although people suffering from TB usually first resort to the PHS to treat their condition, these services have not been effective, considering the delay in the diagnostic and consequently in the treatment as well, demonstrating the lack of integration between the health services [18].…”