Análise de implantação de programa de organização de serviços desaúde com atenção às leishmanioses na Região Metropolitana de BeloHorizonte

Abstract

The "Service Organization Program on Leishmaniasis in the Metropolitan Area of Belo Horizonte" aimed at establishing a professional who would be a reference in leishmaniasis in each municipality. In order to act as reference, such professional followed for a theoretical and practical training course on leishmaniasis. ln this way, back in the municipality the reference would be able to create a proposal forstructuring the service with case-resolving capacity. The work was organized jointly with the reference professional who was the link between municipality and an organization committee composed by Leishmaniasis Reference Center of the René Rachou Research Center/Oswaldo Cruz Foundation and the Metropolitan Department of Health. The assessment of the activities developed by referenceprofessionals after training was made by the Program coordination committee through periodic meetings and visits to the municipalities. Attendance to meetings enabled the classification of the 22 participating municipalities in terms of adhesion to the program as follows: low (eight municipalities), average (six) and high (eight). The structuring of the services in municipalities with high adhesion was more efficientwhen compared to those of average and low adhesion. The assessment also showed that in municipalities with high adhesion rate the professionals were more effective, there was a lower turnover of secretaries of health, more cases of visceral leishmaniasis were detected and more dissemination of information about the disease when compared to municipalities wíth low or average adhesion. A possibleimpact of the program was evaluated using as indicator the fatality rate reduction due to VL in the three groups. In the high-adhesion group, there was a significant reduction in the death rate in the years 2000, 2001 and 2002 when compared to 1998 and 1999, before the beginning of the program, suggesting that the actions initiated were successful. The results observed in this phase of the program will be useful in the redirection and adaptation of the program in an attempt to give theproject more sustainability and guarantee it continuity.