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Open Access Research article

Health services performance for TB treatment in Brazil: a cross-sectional study

Tereza CS Villa1*, Antônio Ruffino-Netto2, Lucia M Scatena3, Rubia LP Andrade4, Maria EF Brunello4, Jordana A Nogueira5, Pedro F Palha4, Lenilde D Sá6, Marluce MA Assis7, Silvia HF Vendramini8, Aline A Monroe4, Ricardo A Arcêncio4 and Tiemi Arakawa4

Author Affiliations

1 Ribeirao Preto College of Nursing, University of São Paulo, Avenida Bandeirantes, 3900 - Campus Universitário - Ribeirão Preto, SP, CEP: 14040-902, Brazil

2 Departamento de Medicina Social, Ribeirao Preto School of Medicine, University of São Paulo, Ribeirão Preto, SP, Brazil

3 Departamento de Medicina Social, Triangulo Mineiro Federal University, Uberaba, MG, Brazil

4 Ribeirao Preto College of Nursing, University of São Paulo, Ribeirão Preto, SP, Brazil

5 Departamento de Enfermagem Clínica, Paraíba Federal University, João Pessoa, PB, Brazil

6 Departamento de Enfermagem em Saúde Pública e Psiquiátrica, Paraíba Federal University, João Pessoa, PB, Brazil

7 State University of Feira de Santana, Feira de Santana, BA, Brazil

8 Departamento de saúde Coletiva e Orientação Profissional, São José do Rio Preto School of Medicine, São José do Rio Preto, SP, Brazil

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BMC Health Services Research 2011, 11:241  doi:10.1186/1472-6963-11-241

Published: 28 September 2011

Abstract

Background

Researches to evaluate Primary Health Care performance in TB control in Brazil show that different cities aggregate local specificities in the dynamics of coping with the disease. This study aims to evaluate health services' performance in TB treatment in cities across different Brazilian regions.

Methods

This cross-sectional study was conducted in five cities that are considered priorities for TB control in Brazil: Itaboraí (ITA), Ribeirão Preto (RP) and São José do Rio Preto (SJRP) in the Southeast; Campina Grande (CG) and Feira de Santana (FS) in the Northeast. Data were collected through interviews with 514 TB patients under treatment in 2007, using the Primary Care Assessment Tool adapted for TB care in Brazil. Indicators were constructed based on the mean response scores (Likert scale) and compared among the study sites.

Results

"Access to treatment" was evaluated as satisfactory in the Southeast and regular in the Northeast, which displayed poor results on 'home visits' and 'distance between treatment site and patient's house'. "Bond" was assessed as satisfactory in all cities, with a slightly better performance in RP and SJRP. "Range of services" was rated as regular, with better performance of southeastern cities. 'Health education', 'DOT' and 'food vouchers' were less offered in the Northeast. "Coordination" was evaluated as satisfactory in all cities. "Family focus" was evaluated as satisfactory in RP and SJRP, and regular in the others. 'Professional asking patient's family about other health problems' was evaluated as unsatisfactory, except in RP.

Conclusions

Two types of obstacles are faced for health service performance in TB treatment in the cities under analysis, mainly in the Northeast. The first is structural and derives from difficulties to access health services and actions. The second is organizational and derives from the way health technologies and services are distributed and integrated. Incentives to improve care organization and management practices, aimed at the integration of primary, secondary and tertiary services, can contribute towards a better performance of health services in TB treatment.

Keywords:
Primary Healthcare; Tuberculosis, prevention & control; Health Care; Health Services Accessibility; Health Services Evaluation