Avanços e desafios do programa de controle da esquistossomose em municípios do Vale do Jequitinhonha em Minas Gerais

Abstract

This study aims to analyze the organization and operation of surveillance and control of schistosomiasis after the decentralization process in the 25 endemic municipalities belonging to the Regional Health Management (SWM) of Pedra Azul, Minas Gerais. We conducted an normative assessment study on surveillance and control of schistosomiasis held by the Schistosomiasis Control Program (SCP) and calculating the Degree of Implementation (DI) for each municipality. We used structured questionnaires with managers responsible for coordinating the SCP, the coordination of primary care, the Municipal Health Bureau on a total of 75 professionals. Were performed frequency distribution, mean, median and standard deviations relate to aspects of control of the disease in the program and Primary Care. Besides these, we interviewed a healthcare professional, doctor or nurse, the Family Health Strategy (FHS) (n = 97). We used analysis of Latent Variable Models to define a score to assess the quality of care related to the diagnosis, treatment and control of schistosomiasis by the FHS in Primary Health Care (PHC) by these professionals. In relation to DI, 72% of municipalities had their programs considered partially implemented and the remaining classified as nondeployed. Twelve counties had the structure of services and only one satisfactory as the dimension process. Only ten municipalities can cover all its territorial extension besides livingwith the possible prioritization of other health activities. Lack of transportation and qualified professionals, and financial resources to carry out their activities with quality despite the support of regional health. There is not a direct relationship between the DI of SCP and quality of activities related to schistosomiasis control in the FHS. Municipalities classified as partially deployed distributed without great differences in the scores of quality evaluation of FHS as critical (28.0%), unsatisfactory (28.0%), satisfactory (11.0%) and excellent (33.0 %). Among the activities underused by FHS teams highlight the lack of strategies to combat the infection, not using the Kato-Katz method diagnosis and receiving insufficient material. Our results indicate that the surveillance and control of schistosomiasis at the municipal level in SWM not happen investigated systematically planned and integrated, compromising the quality andoutcomes of care and control of schistosomiasis in the population. Yet there are few strategies for surveillance and control of infection in endemic area in this PHC. There is no uniformity of actions and an effective integration between these professionals and the SPC. Insufficient monitoring and evaluation activities in the implementation. This scenario associated with social and structural problems of the municipality favors the permanence of this endemic region.