Decentralization of Leprosy Control Actions in the Micro-Region of Almenara, State of Minas Gerais1
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Rev. Latino-Am. Enfermagem Original Article 2011 Jan-Feb;19(1):187-94 www.eerp.usp.br/rlae Decentralization of Leprosy Control Actions in the Micro-Region of Almenara, State of Minas Gerais1 Fernanda Moura Lanza2 Francisco Carlos Félix Lana3 This study analyzes the decentralization process of Leprosy control actions for Family Health Strategy units in the cities of the Almenara micro-region, in the state of Minas Gerais, Brazil. This qualitative research, based on the concept “Technological Organization of Work”, was carried out in nine municipalities. Semi-structured interviews and document research were used for data collection. Forty-five interviews with care providers and health managers were conducted. The data collection took place between November 2007 and February 2008. Content Analysis was utilized to study the data and results indicate that the cities present different levels of decentralization and that the process was determined based on local specifications and on the engagement of care providers and health managers. Several cities kept a reference team to provide support to primary health care. The conclusion is that the decentralization process is a strategy that proves to be useful in facing Leprosy in the micro-region. Descriptors: Decentralization; Primary Health Care; Leprosy/Prevention & Control. 1 Paper extracted from Master’s Dissertation “Tecnologia do Processo de Trabalho em Hanseníase: Análise das Ações de Controle na Microrregião de Almenara, Minas Gerais” presented to Escola de Enfermagem, Universidade Federal de Minas Gerais, MG, Brazil. Supported by CNPq, process # 40.0785/2005-6. 2 RN, Doctoral Student, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, MG, Brazil. E-mail: [email protected]. 3 RN, Ph.D. in Nursing, Associate Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, MG, Brazil. E-mail: [email protected]. Corresponding Author: Fernanda Moura Lanza Universidade Federal de Minas Gerais. Escola de Enfermagem Av. Alfredo Balena, 190, sala 402 Bairro Santa Efigênia CEP: 30130-100 Belo Horizonte, MG, Brasil E-mail: [email protected] 188 Descentralização das ações de controle da hanseníase na microrregião de Almenara, Minas Gerais O estudo teve como objetivo analisar o processo de descentralização das ações de controle da hanseníase, para as unidades da Estratégia de Saúde da Família, em municípios da microrregião de Almenara, Minas Gerais. Esta é uma pesquisa qualitativa, fundamentada no conceito de Organização Tecnológica do Trabalho, realizada em nove municípios. Como técnicas para a coleta de dados foram utilizadas a entrevista semiestruturada e a pesquisa documental. Foram realizadas 45 entrevistas com gestores e profissionais de saúde. A coleta de dados ocorreu entre novembro 2007 e fevereiro 2008. Para tratamento e análise dos dados, foi utilizada a análise de conteúdo. Os resultados apontam que os municípios se encontram em diferentes estágios de descentralização e que esse processo foi determinado pela especificidade local e pelo engajamento dos gestores e dos profissionais de saúde. Vários municípios mantiveram uma equipe de referência para dar apoio à atenção básica. Conclui-se que o processo de descentralização é estratégia capaz de enfrentar a endemia hansênica na microrregião. Descritores: Descentralização; Atenção Primária à Saúde; Hanseníase/Prevenção & Controle. Descentralización de las acciones de control de la lepra en la microrregión de Almenara, Minas Gerais El estudio tuvo como objetivo analizar el proceso de descentralización de las acciones de control de la lepra para las unidades de Estrategia de la Salud de la Familia en municipios de la microrregión de Almenara, Minas Gerais. Se llevó a cabo una investigación cualitativa en nueve municipios, basada en el concepto de “Organización Tecnológica del Trabajo”. Se emplearon como técnicas para hacer la recolección de datos la entrevista semiestructurada y la investigación documental. Se realizaron 45 entrevistas con administradores y profesionales de la salud. Los datos fueron recolectados entre noviembre de 2007 y febrero de 2008. Para tratamiento y análisis de los datos se utilizó el Análisis de Contenido. Los resultados apuntan que los municipios se encuentran en diferentes períodos de descentralización y que ese proceso fue determinado por la especificidad local y por el compromiso de los administradores y de los profesionales de la salud. Se concluyó que el proceso de descentralización es una estrategia capaz de enfrentar la endemia en la microrregión. Descriptores: Descentralización; Atención Primaria de Salud; Lepra/Prevención & Control. Introduction Leprosy is still a public health problem in Brazil. the poorest locations(2-3). The Vale do Jequitinhonha – In World Health Organization (WHO) statistics for 2008, the region with the worst socioeconomic indicators in the country ranks second in absolute numbers of new the State of Minas Gerais, fits into this profile. The region cases detected (38,914), with 52.4% of these cases comprises five micro-regions that have displayed leprosy being diagnosed as multibacillary forms; 5.9% with level prevention and control problems. Local health services II physical disability and 7.0% in people younger than may not be capable of capturing all existing cases in 15 years(1). the region(4) and the Almenara micro-region includes Spatial occupation patterns strongly influence cities that are considered priorities to control this leprosy, with unequal distribution and concentration in endemic disease in Minas Gerais. Data for 2008 reveal a www.eerp.usp.br/rlae Lanza FM, Lana FCF. 189 prevalence rate of 47.8 cases/ 10,000 inhabitants and a leprosy control actions (LCA) to Family Health Strategy detection rate of 49.4/ 100,000 inhabitants in this micro- units in cities from the Almenara micro-region in Minas region. Out of 90 new cases, 53.3% were diagnosed Gerais. with multibacillary clinical forms and 2.2% with level II physical disability(5). Method The disease’s epidemiological behavior in this This qualitative research was based on the concept micro-region – predominance of multibacillary clinical of “Technological Organization of Work”, developed in the forms and high percentages of diagnosed cases already health area(11). This theoretical-methodological option displaying physical disabilities – suggests that health was chosen because it can capture the reality of different services are facing difficulties to control the disease(6). scenarios and subjects involved in leprosy care, entailing The key principle of leprosy control is morbidity control, some particularities of this practice as moments of a i.e. timely detection of new cases; treatment with broader totality and its historically determined context. chemotherapy (WHO MDT regimens); prevention of The research scenario comprised nine cities from disabilities and rehabilitation(7). Therefore, it should be the Almenara micro-region, located in the Vale do guaranteed that disease control activities are part of Jequitinhonha, State of Minas Gerais. The cities that Primary Health Care services. In Brazil, the current primary health care scenario is participated in the research were: Almenara, Jacinto, based on the Family Health Strategy (FHS), which plays Jequitinhonha, Jordânia, Monte Formoso, Palmópolis, a fundamental role in the reorientation of the care model Rubim, Santa Maria do Salto and Salto da Divisa. and in the consolidation of SUS (Sistema Único de Saúde Data were collected at the Primary Health Care – Unified Health System) guidelines, thus contributing services working with leprosy in response to routine to the universalization of health service access and to care demands. In each city, a health unit was chosen care decentralization. The publication of NOAS 2001 was to be part of the study scenario. In Almenara, which essential for health care decentralization purposes and is considered the hub of this micro-region, data were defined the elimination of leprosy as one of the strategic collected at two Primary Health Care units and the activity areas for primary care services(8). Secondary Health Care service (Medical Specialty Thus, leprosy prevention and control actions have Center) was also included, which is a municipal referral been decentralized to FHS units. Multiprofessional center for leprosy care. In total, the researchers visited teams at these units work with the health surveillance ten Primary Health Care units, all of which authorized concept. Their practices aim to solve the most frequent within the FHS, and one referral center, located in the and relevant health problems within their territory. city of Almenara. “The main aspect that has facilitated the integration Semistructured interviews and document research of leprosy control actions into Primary Health Care is in institutional and statistical records were used as data undoubtedly the establishment of the Family Health collection techniques. To achieve the representativeness Program Strategy, which also approximated leprosy of services and subjects, with a view to a closer look at patients to the necessary care”(9). the research problem, in total, 45 interviews were held. The successful integration of disease control Those subjects who were most representative regarding actions into Primary Health Care can be assessed based health practices in leprosy in the social group under on the improvement of some epidemiological indicators, study were invited, as indicated