Policy transfer of the directly observed treatment of tuberculosis: speeches of health managers

Adário, Karinne Dantas de Oliveira; Oliveira, Rita de Cassia Cordeiro de; Videres, Arieli Rodrigues Nóbrega; Henriques, Amanda Haissa Barros; Palha, Pedro Fredemir; Barrêto, Anne Jaquelyne Roque

doi:10.1590/1983-1447.2021.20200427

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Original Article • Rev. Gaúcha Enferm. 42 • 2021 • https://doi.org/10.1590/1983-1447.2021.20200427 copy

Policy transfer of the directly observed treatment of tuberculosis: speeches of health managers

Transferencia de políticas del tratamiento directamente observado de la tuberculosis: discursos de los gestores de salud

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the effects of meanings produced by the speechess of health managers about the Policy Transfer of Directly Observed Treatment of Tuberculosis.

Method:

Qualitative study developed in 2017 with six managers working in health services located in municipalities in the state of Paraíba. The corpus, constituted by interviews, was analyzed by Discourse Analysis.

Results:

The speeches expressed aspects favorable to the operationalization of the policy transfer process, such as investing in human, technological, physical and material resources; coordinating management in the organization of the network and raising the awareness of the professionals involved. Barriers were identified, such as the prevalence of cases in the Reference Unit; professional turnover; prejudice and social vulnerability.

Conclusions:

The study showed that financial investments, government pacts and commitment of the actors involved in the production of care are necessary to carry out the policy transfer process in the municipalities investigated.

Keywords:
Health management; Tuberculosis; Primary health care; Qualitative research; Health policy

Discursive formations	Text segmentation
Investment in human, technological, physical and material resources	As I also work [...] (in the Reference Unit) [...], this has made my work easier [...] I've been making improvements to the city that would have been difficult to achieve if I was not there [...] (HM1)
	[...] we had already talked to this lung specialist, we asked him to pay more attention to tuberculosis, and as he has a postgraduate and master's degree in the area, everything was much easier [...] (HM4)
	[...] the material used by the Ministry of Health, that is the Clinical Management of Tuberculosis, which is very interactive, right? [...](HM4)
	[...] bacilloscopy is performed here at our Lacen - a laboratory for these exams, and also X-ray [...] in the hospital [...] (HM3)
	If the diagnosis is made there (RU), the nurse sends the notification [...] via WhatsApp, [...] this has improved substantially (HM2)
Coordination of management in the organization of the network	[...] through partnerships, [...] the state Lacen, to give us diagnostic support, [...] the Reference Laboratory, [...] which has also helped us in this fight, and [...] (in the Reference Unit), because we are trying to decentralize the process [...](HM1)
	[...] we open a CAPS, [...] the coordinator of Primary Care, the supporter, [...] coordinator of the NASF, [...] I have being talking a lot with them [...] (HM4)
	[...] internal coordinations [...] and we also have close ties with the State Health Surveillance, [...] and there is also Social Action and Education. (HM6)
	[...] partnerships with universities [...] the academics participate effectively, [...] and we still have full support from the mayor's office, [...] for all events, full support [...] (HM3)
Awareness and participation of health professionals involved	[...] the Surveillance team is concerned with Tuberculosis, which is very positive [...] it is no use having a structure, but not having the will to act, having professionals who are not sensitive to this disease, not concerned with it,, and who do not want to leave their comfort zone [...] (HM4)
	[...] the professionals, they are absorbing everything [...] (HM6)

Discursive formations	Text segmentation
Cases diagnosed and treated in the Reference Unit	[...] these patients had not been seen for more than 2 years; so the patients were all seen in the reference unit [...]when we assessed the situation: the cure down there, neglect up there, you see, [...] no information [...] (HM1)
	[...]It became a habit... in pain, has a fever, and coughing? Goes to [...] (Reference Unit) [...], the patient often is not even referred to the hospital in his own municipality, because he thinks it is no use, [...] due to the lack of proper health care assistance in the municipality... (HM4)
	[...](in the Reference Unit)[...] can schedule an X-ray, a bacilloscopy and an appointment with a lung specialist only on day X, [...]a rapid test that detects the bacillus within two hours and indicates whether it is resistant to multiple drugs [...] (HM2)
Professional turnover	[...] the municipality is also facing some difficulties, from a political point of view, [...] changes are always going on there, right? [...]this is happening there more often this year, [...] (HM4)
Professional turnover	[...]professional turnover is a complicating factor [...] (HM2)
Prejudice and social vulnerability	[...] it (TB) is a disease that generally leads to segregation of sufferers because of the risk of contamination, and TB sufferers are discriminated against by people who are afraid of getting infected by the disease [...] (HM5)
	[...] there are many alcohol and drug users here, which is a big problem, a big challenge [...] (HM1)
	[...] because of the port issue, because of TB/AIDS co-infection, we [...] started to consider [...] this municipality as a priority [...] (HMS4)
	[...] we have a port area, can be considered a barrier, a difficulty [...] (HMS3)
Difficulty adhering to treatment	[...]the health agents cannot monitor TB patients who work all day and take the medication very early in the morning, right? there are drug users, there is a lot of prostitution, anyway, [...] it's difficult enough for a health agent to come to your house, to see that you take the medicine, let alone for TB patients to report every day to a health unit that 'should [...] be close to their homes, but usually is not (HM2)
Lack of knowledge of health professionals	[...] I think people do not understand the DOT as an effective part of drug treatment [...] the professionals who administer it and who carry out this monitoring do not understand the policy [...] This is too complicated. [...] (HM2)
Lack of knowledge of health professionals	[...] They do not go, do not attend the mobilization and updating programs, and they (health agents) are the ones who receive patients with Tuberculosis, [...]They think they are experts on the subject, I've often heard them say, “ah, I've treated a lot of people with Tuberculosis, I know how it is”, [...] they think they don't need to participate in the programs[...] (HM2 )

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[1] Corresponding author:
Karinne Dantas de Oliveira Adário E-mail: karinnedantasenf@gmail.com