O programa de controle da tuberculose do município de Coari - Amazonas: avaliando a sua implantação e operacionalização

Abstract

Tuberculosis (TB), contagious disease caused by a bacillus, Mycobacterium tuberculosis. It is housed mainly in the lungs and may spread to other parts of the body. For controlling this disease, key plans, strategies and campaigns in Brazil are developed by the National Program of Tuberculosis Control, run jointly by federal, state and municipal levels. In this study, the evaluation of health programs, for TB control as a tracer condition, the analysis of deployment is seen as a strategy to identify the procedures involved in producing the effects of an intervention, considering their contextual asp cts. This study proposes to examine the implementation of the Tuberculosis Control Program (TCP) in Coari through evaluative and exploratory research, using to the process was associated with primary data collection from health services and professionals working on TB controlling in primary health care in that city, such as: visit a routine observation from the units as well as analysis of documents of municipal management. Them were associated data from notifications of TB cases in the base state of the information system of reporting injuries (SINAN) for the city of Coari-AM, in the period 2001 to 2008. The adaptation of a logic model guided the analysis of the PCT in Coari and subsequent construction of an array of trial used to guide data collection and subsequent analysis. The results showed the mean incidence rate for the period was 27 per 100,000 inhabitants in urban area, compared to 9.4 per 100,000 inhabitants in rural area, predominantly among men 61.2%. In urban area the highest incidence occurred in the people more than 60 years (109.3 / 100,000 inhabitants). The evaluation of the external context, epidemiological surveillance and the operational actions of the Pnct showed that the degree of implantation for these categories was intermediate. In assessing the organizational context, the physical structure of the Basic Health Units, the dimension of the effectiveness and the human resources, the Program has been rated as incipient. Overall dimensions assessed, the indicators showed an intermediate level of program implantation.The partnership with the PSF unsystematized weakens the actions of the PCT and the distance of the territorial situation of care to families. There are difficulties in operationalizing the PCT Coari, not a prioritized action in the health activities of the municipality, making it necessary to adopt comprehensive measures, such as decentralization of the PCT and further integration of their actions with the Primary Care requiring many strategies. Among them a policy of human resources training, internalization of health and its specifi programs, to encourage new strategies for intersectoral work and reorganization of health for effective care of patients with tuberculosis.