Avaliação das ações de controle da tuberculose em Juiz de Fora: a ótica dos gestores

Abstract

Tuberculosis is characterized as a communicable disease, responsible for one of the main causes of morbidity and mortality worldwide. It is curable and preventable if successfully treated with medications that reduce its transmissibility, and through multisectoral actions factors such as poverty, malnutrition, HIV infection, smoking, resource management, and others. In Brazil, the Ministry of Health has TB as a priority on the political agenda and a Control Plan with the purpose of expanding actions throughout the country and granting powers to the spheres of government, with Primary Health Care being an essential and strategic axis at the municipal level to meet the complexity of organization that tuberculosis requires throughout its trajectory. This study aimed to evaluate, based on the attributes of PHC, the management performance regarding the PCT in Juiz de Fora, from the perspective of managers. It focused on evaluative research with a quantitative, cross-sectional approach, anchored in the attributes of PHC. The study took place in the municipality's Primary Care Units with their respective managers, between March and August 2024 through the application of a questionnaire that is part of the PCATool specific to tuberculosis.The data were analyzed using R software. General, essential and derived scores were assigned, as well as scores for each PHC attribute. In the managers' perception, the general, essential and derived scores obtained a satisfactory evaluation; however, the statistical proximity to the reference value allowed us to infer that the managers considered the actions promoted in as UBS's to be average and that there is a need to improve the service in some way. Access to treatment was one of the attributes with an unsatisfactory evaluation, thus implying some considerations about the functioning of the UBS's, the difficulty with transportation and the delay in care and scheduling. The community orientation component also showed an unsatisfactory evaluation, with low orientation for PHC, but this converges with other studies that negatively evaluate this attribute. Despite this, the coordination, bonding and family orientation components presented results above satisfactory, placing these attributes with excellent orientation for PHC. Finally, the study allowed analyzing the perspective of managers regarding their direct and indirect actions in TB control and the extent of the attributes, demonstrating the challenges related to the decentralization of actions and management in its entirety, as well as the fragility of PHC in some attributes, which brings reflections for necessary analyses of the problems encountered and provision of resolution goals.