Luisa Gonçalves Dutra de Oliveira

Fatores condicionantes para o acesso às equipes da Estratégia Saúde da Família no Brasil

O artigo analisa o acesso as equipes certificadas pelo Programa Nacional de Melhoria de Acesso e da Qualidade da Atencao Basica, tendo por categoria central o acesso potencial e duas dimensoes: acolhimento e disponibilidade. A partir de questoes selecionadas dos instrumentos da Avaliacao Externa do Programa, geraram-se escores e tres estratos. Os resultados confirmam que os fatores favoraveis ao acesso potencial foram: localizacao na regiao Sudeste, em capitais e municipios de maior porte e com maior numero de equipes por unidade. Apesar dos progressos, os resultados indicam a necessidade de politicas e acoes voltadas a qualificacao da atencao prestada, especialmente nos municipios de pequeno porte.

Evaluation model for tuberculosis control program

The implementation process is one of the steps of policy cycle, corresponding to the execution of activities which the purpose is to achieve previously defined targets. It could also be considered that policys formulation and implementation means a process, subject to context and intervening actions. The building of theoretical models allows the evaluation of policies and programs to go beyond the dichotomist view of input x results and enables to understand the reasons of successful actions in different contexts and population groups. The evaluation process becomes an instrument to continuous reformulation of public policies and possibly leads to their reversal or substitution. An evaluation study based on programs theory shows the mechanisms which lead to changes. A self-evaluation model is proposed as a way to assist the manager in the identification of problems, the characterization of favorable factors to successful interventions and the measurement of effects. The present proposal was based upon three evaluation studies on actions for tuberculosis control which used of different methods and multiple sources of evidence. Main results observed were: lack of technical and managerial autonomy, shortage of both human and financial resources and also a deficient link among the programs ability to achieve the development of actions control.

Implementation contexts of a Tuberculosis Control Program in Brazilian prisons

OBJECTIVE To analyze the influence from context characteristics in the control of tuberculosis in prisons, and the influence from the program implementation degrees in observed effects. METHODS A multiple case study, with a qualitative approach, conducted in the prison systems of two Brazilian states in 2011 and 2012. Two prisons were analyzed in each state, and a prison hospital was analyzed in one of them. The data were submitted to a content analysis, which was based on external, political-organizational, implementation, and effect dimensions. Contextual factors and the ones in the program organization were correlated. The independent variable was the program implementation degree and the dependent one, the effects from the Tuberculosis Control Program in prisons. RESULTS The context with the highest sociodemographic vulnerability, the highest incidence rate of tuberculosis, and the smallest amount of available resources were associated with the low implementation degree of the program. The results from tuberculosis treatment in the prison system were better where the program had already been partially implemented than in the case with low implementation degree in both cases. CONCLUSIONS The implementation degree and its contexts – external and political-organizational dimensions – simultaneously contribute to the effects that are observed in the control of tuberculosis in analyzed prisons.