Avaliação do grau de implantação do programa de controle da tuberculose no município de Natal/RN

Abstract

Introduction: The National Tuberculosis Control Program aims to reduce morbidity, mortality and transmission of the disease through prevention, diagnosis and treatment. Tuberculosis control is a matter of responsibility for all spheres of government, such as those for the implementation of disease control programs. Objectives: The general objective of this study was to evaluate the grade of implementation of the Tuberculosis Control Program in Primary Health Care, in the city of Natal, Rio Grande do Norte. The specific objectives were: to elaborate the logical model of the Tuberculosis Control Program focusing on the dimensions of Structure and Process and to identify the measure of implementation of the Tuberculosis Control Program in Primary Health Care, in the city of Natal, Rio Grande do Norte. Method: This is a normative evaluation study, with a quantitative approach, with emphasis on the grade of program implementation, using Avenis Donabedian's health evaluation as a theoretical-methodological reference. The study population consisted by nurses from the Primary Health Care of Natal / RN, distributed in the 54 Health Units of the municipality. From the sample calculation, considering 5% of error and 95% confidence interval, the collection was defined in 48 Health Units, with the participation of at least 02 nurses per unit, resulting in a sample of 96 nurses, without replacement. The data collection took place from November 2017 to February 2018, through a questionnaire consisting of 62 questions. The data were organized and analyzed through the Statistical Package for the Social Sciences program, version 22.0 IBM. For the identification of the measure of implantation, 31 criteria were selected and the percentage of identified answers was distributed in four classifications: Not implanted (from 0% to 25%); Incipient (26% to 50%); Partially implanted (from 51% to 75%); Implanted (76% to 100%). The study was analyzed by the Research Ethics Committee of the Federal University of Rio Grande do Norte, which issued its approval through opinion 2,327,693 and Certificate of Presentation for Ethical Assessment 76788317.9.0000.5537. Results: The construction of the logical model allowed the identification of the structural organization, the activities developed and the expected results of the program. From the 96 nurses selected in the sample, 08 were distant from their work activities during data collection, 06 refused to participate in the survey and in 02 units there were only 1 nurse responsible for the activities of the unit, totaling 80 participants. From the data collected, it was possible to identify the grade of implementation of the Tuberculosis Control Program in the city of Natal / RN as partially implanted (62.85%). The Structure and Process dimensions were also classified with the same degree of evaluation (61.80% and 63.17%, respectively). In the Structure dimension, material resources were classified as implemented (86.92%); human resources, as partially implemented (55.00%) and structural resources, with incipient implementation (49.58%). Regarding the Process dimension, the operational activities obtained the grade of partially implemented (59.26%); health education activities, incipient (36.88%) and activities of information systems were classified as implanted (87.00%). Conclusion: The logistic model of the Tuberculosis Control Program that was built allowed an understanding of the organization of the program and subsidized the evaluation process. The identification of the criteria related to the Structure and Process classified the municipal tuberculosis program of Natal as partially implemented. It is necessary to structure spaces for the care of patients with Tuberculosis, as well as integral care, with greater participation of the health team, as well as the intensification of health education activities.