Descentralização das ações de controle da tuberculose na superintendência regional de saúde de Uberlândia: visão dos gestores

Abstract

The management of health policies is a very wide field of knowledge as well as complex and therefore, requires that local health authority managers in the position of coordinator in the Programme for the Control of Tuberculosis fully comprehend and act upon policies related to the control of tuberculosis. Objective: To get a sense of the local health authority mangers`, covering the area of SRS/UDIA, understanding of the decentralising process for procedures concerning PNCT in accordance with the evaluation surrounding access to services in Basic Health. Method: A cross-section study using a Primary Care Assessment Tool (PCAT) questionnaire adapted to the concerns of TB in Brazil. Thirty-three managers/coordinators were interviewed. Results: The analysis highlights that 65% of managers consider TB as a priority disease; in relation to the distribution of recourses for 42% of managers, this criterion was not an issue, for 21% this is always based on the needs of the population. Concerning the investment of recourses allocated to TB, 33% referred to this criterion as not being applicable, 18% as always. When it comes to the participation of managers in the discussion and definition of control procedures of TB, 52% always participate, 15% almost always, 36,4% of managers allege that it does not apply and 30% never participate in the definition of resource application for the control of TB. When health care users show signs and symptoms of TB, for 39.4% of managers, these sometimes wait more than 60 minutes to be attended; 18.2% almost never and 15.2% never wait for an hour. According to 84.8% of managers the BHU (Basic Health Unit) always offer pots for the sputum test in order to diagnose TB and for 78% the unit always offer tests for HIV/AIDS. The search for respiratory symptoms for 42% of managers is always and for 18.2% is almost always carried out by professionals. According to 84.8% of managers, health care users when it comes to some form of preventative health control look for a BHU and 81.8% affirm that users when presenting symptoms signs and symptoms of TB look for a BHU. Again 94.7% of managers state that units always offer monthly consultation; 63.2% that patients with TB always manage a doctor`s appointment within 24 hours. These data were submitted for variance analysis. Conclusion: It was found that managers consider the BHU as the principal focus point for health care users searching for preventative or assistance procedures, with the guarantee of easy access to appointments. However, one of the main attributes of the BHU that being first contact, is still not fully operational in that it does not have appropriate investments in the cost of alimentation and transport for patients with TB. Managers have little participation in the application of financial recourses from SUS. The multiplicity of activities have contributed to the low governability in the procedures concerning the control of the disease, concluding that the incorporation of procedures in BH have in fact not been sufficient in increasing the control of TB. When the subject comes to accountability concerning the guarantee of the principals of regionalization and integrity management, it becomes necessary that mangers take ownership of instruments for epidemiological analysis and share information for local and regional planning of control procedures of the disease in BH.