Diálogos sobre a descentralização do programa de controle da hanseníase em município endêmico: uma avaliação participativa

Abstract

Objective: to evaluate the decentralization of the Leprosy Control Program (LCP) in Governador Valadares. Method: the theoretical and methodological framework was the Fourth Generation Evaluation, with a qualitative-participatory approach. The study involved 30 subjects divided into four groups: managers of the LCP; professionals of the Reference Center (RC); primary care professionals and users. Data were collected through interviews, using the Hermeneutic-Dialectic Circle technique. Subsequently, three workshops were held for data validation and negotiation. The Constant Comparative Method was used for the analysis. Results: the maintenance of the vertical model of leprosy care was evidenced, sustained by social-historical-cultural determinants that are expressed in: thepermanence of the gateway to spontaneous demand in the RC; the routine referral of the user to secondary care; the ine昀케ciency of counter-reference; the centralization of multidrug therapy; the belief in the need for specialized care, and stigma. Weaknesses in the link with primary care were evidenced. Conclusion: the decentralization of the LCP involves tension between the actors of each health care point, generating disputes of knowledge and health practices. Implications for practice: the sustainability of decentralization requires political and institutional involvement focused on strengthening primary care, reorienting the role of the services in the leprosy care network, and health education.