Sonia Natal

Anti-PGL-1 Positivity as a Risk Marker for the Development of Leprosy among Contacts of Leprosy Cases: Systematic Review and Meta-analysis

Background There is no point of care diagnostic test for infection with M. Leprae or for leprosy, although ELISA anti PGL-1 has been considered and sometimes used as a means to identify infection. Methods A systematic review of all cohort studies, which classified healthy leprosy contacts, at entry, according to anti-PGL1 positivity, and had at least one year follow up. The outcome was clinical diagnosis of leprosy by an experienced physician. The meta-analysis used a fixed model to estimated OR for the association of PGL-1 positivity and clinical leprosy. A fixed model also estimated the sensibility of PGL-1 positivity and positive predictive value. Results Contacts who were anti PGL-1 positive at baseline were 3 times as likely to develop leprosy; the proportion of cases of leprosy that were PGL-1 positive at baseline varied but was always under 50%. Conclusions Although there is a clear and consistent association between positivity to anti PGL-1 and development of leprosy in healthy contacts, selection of contacts for prophylaxis based on anti PGL1 response would miss more than half future leprosy cases. Should chemoprophylaxis of controls be incorporated into leprosy control programmes, PGL1 appears not to be a useful test in the decision of which contacts should receive chemoprophylaxis.

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.

O uso de uma avaliação por gestores da atenção primária em saúde: um estudo de caso no Sul do Brasil

O objetivo do artigo foi realizar uma meta-avaliacao, com foco na utilizacao, em um estado do Sul do Brasil. Caracterizou-se como estudo de caso unico, com coleta de dados primarios por meio de entrevistas semiestruturadas com gestores e tecnicos de secretarias de saude. A analise de conteudo ocorreu por categorias definidas na matriz avaliativa: contexto politico-organizacional e implantacao da avaliacao. Verificou-se que o contexto politico-organizacional apresentou fragilidades nos quesitos de experiencia, equipe de avaliacao e espaco e tempo para reflexao. A autonomia tecnica foi verificada no estado e em um municipio. Na implantacao da avaliacao a qualidade avaliativa satisfez os criterios, porem nao houve uma definicao previa a avaliacao dos usos e usuarios. Houve relato de uso para planejamento de acoes e uso politico. Concluiu-se que a avaliacao produziu informacoes importantes aos interessados, sendo o contexto politico-organizacional o principal limitante do uso.This article reports on a meta-evaluation, focused on utilization, in a state in southern Brazil. This was a single case study with primary data collection using semi-structured interviews with health department administrators and staff. Content analysis used categories defined in the evaluation matrix: political and organizational context and implementation of evaluation. The political and organizational context revealed weaknesses in the items on experience, evaluation team, and time and space for reflection. Technical autonomy was verified in the State and in one municipality. In the implementation of evaluation, evaluative quality met the established criteria, but there was no prior definition of the uses and users of evaluation. One report referred to use for planning actions and political use. The study concluded that evaluation produced important information for stakeholders, with the political and organizational context as the principal limiting factor for use.

Análise da implantação de um programa com vistas à institucionalização da avaliação em uma Secretaria Estadual de Saúde

Objectives: to evaluate the implementation of the Strengthening of Technical Capacity in Monitoring and Evaluation Project at a State Department of Health and thereby assessing the degree to which the program has been introduced and the influence of the political and institutional context. Methods: an evaluative implementation analysis study was carried out using the theoretical concepts proposed by Denis & Champagne (1997) and Matus (1987; 1996). These concepts form the basis of the analysis and allow for dialogue between theories of evaluation and planning. Results: 80% of the project was found to have been implemented, 91% in the field of technical financial management, 95% in information and communications, and only 56% in the field of integration. Conclusions: implementation of the program was found to be satisfactory, thereby corroborating the Government Project and the Government Capacity. Although a certain degree of governability had been achieved, limitations were identified regarding insufficient integration of sectors, difficulties in relation to the department in the capital city and electoral changes, which explain the partial implementation of the Integration component of Monitoring and Evaluation.

Desenvolvimento da capacidade avaliativa na gestão da atenção básica: um estudo de caso exemplar em Santa Catarina, Brasil, de 2008 a 2011

This article analyzes evaluation capacity-building based on the case study of a State Health Secretariat participating in the Project to Strengthen the Technical Capacity of State Health Secretariats in Monitoring and Evaluating Primary Healthcare. The case study adopted a mixed design with information from documents, semi-structured interviews, and evaluation of primary care by the State Health Secretariat in 2008-2011. Process analysis was used to identify the logical events that contributed to evaluation capacity-building, with two categories: evaluation capacity-building events and events for building organizational structure. The logical chain of events was formed by negotiation and agreement on the decision-making levels for the continuity of evaluation, data collection and analysis by the State Health Secretariat, a change in key indicators, restructuring of the evaluation matrix, and communication of the results to the municipalities. The three-way analysis showed that the aim of developing evaluation capacity was achieved.O artigo analisa o desenvolvimento da capacidade avaliativa em um caso exemplar de uma Secretaria de Estado da Saude (SES) participante do Projeto de Fortalecimento da Capacidade Tecnica das Secretarias Estaduais de Saude em Monitoramento e Avaliacao da Atencao Basica. Estudo de caso de abordagem mista, com informacoes provenientes de documentos, entrevistas semiestruturadas e da avaliacao da atencao basica realizada pela SES no periodo de 2008-2011. Empregou-se a analise de processos para identificar os eventos logicos que contribuiram para o desenvolvimento da capacidade avaliativa, com duas categorias: eventos de construcao da capacidade avaliativa e eventos de construcao de estrutura organizacional. A pactuacao em instâncias deliberativas para a continuidade da avaliacao, a coleta e analise dos dados realizada pela SES, a iniciativa de mudanca de indicadores e reestruturacao da matriz avaliativa e a comunicacao dos resultados aos municipios formaram a cadeia logica de eventos. A analise triangulada demonstrou que o objetivo de desenvolver a capacidade avaliativa foi alcancado.

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.

Reestruturação produtiva na saúde: atuação e desafios do Núcleo de Apoio à Saúde da Família

RESUMO Estudo de casos a fim de identificar estrategias para a atuacao do Nucleo de Apoio a Saude da Familia, verificando seu processo de reestruturacao produtiva, bem como seus desafios. Utilizaram-se as tecnicas de analise documental, observacao direta e entrevistas. Os resultados apontam que apoio da gestao, planejamento integrado, comunicacao agil, cogestao, reflexao sobre a pratica, qualificacao dos profissionais e infraestrutura adequada viabilizam a atuacao compartilhada entre profissionais. Persistem desafios, como a inadequada formacao para a pratica do apoio matricial, no entanto, foi identificado um processo de reestruturacao produtiva com potencialidade para ampliar acoes e qualificar o cuidado em saude.

Disseminação e uso dos resultados de pesquisas financiadas pela Secretaria de Ciência, Tecnologia e Insumos Estratégicos do Ministério da Saúde, Brasil, 2004 a 2007

RESUMO Este artigo verifica a disseminacao e o uso das pesquisas financiadas pelo Departamento de Ciencia e Tecnologia do Ministerio da Saude. Trata-se de um estudo de seis casos com analise imbricada, em que se verifica que a politica de descentralizacao do fomento contribuiu para a reducao da desigualdade na producao de conhecimento em saude, embora haja desigualdade no volume de recursos alocados. A disseminacao dos resultados foi o limitador da incorporacao dos resultados de pesquisa. Os formatos de acompanhamento das pesquisas devem ser melhorados. O fator determinante na incorporacao de conhecimentos e tecnologias pelo sistema de saude e a intencionalidade tecnica e politica para o uso dos resultados.

Desarrollo de la capacidad de evaluación en la gestión de la atención primaria: un estudio de un ejemplo de caso en Santa Catarina, Brasil, 2008 a 2011

This article analyzes evaluation capacity-building based on the case study of a State Health Secretariat participating in the Project to Strengthen the Technical Capacity of State Health Secretariats in Monitoring and Evaluating Primary Healthcare. The case study adopted a mixed design with information from documents, semi-structured interviews, and evaluation of primary care by the State Health Secretariat in 2008-2011. Process analysis was used to identify the logical events that contributed to evaluation capacity-building, with two categories: evaluation capacity-building events and events for building organizational structure. The logical chain of events was formed by negotiation and agreement on the decision-making levels for the continuity of evaluation, data collection and analysis by the State Health Secretariat, a change in key indicators, restructuring of the evaluation matrix, and communication of the results to the municipalities. The three-way analysis showed that the aim of developing evaluation capacity was achieved.O artigo analisa o desenvolvimento da capacidade avaliativa em um caso exemplar de uma Secretaria de Estado da Saude (SES) participante do Projeto de Fortalecimento da Capacidade Tecnica das Secretarias Estaduais de Saude em Monitoramento e Avaliacao da Atencao Basica. Estudo de caso de abordagem mista, com informacoes provenientes de documentos, entrevistas semiestruturadas e da avaliacao da atencao basica realizada pela SES no periodo de 2008-2011. Empregou-se a analise de processos para identificar os eventos logicos que contribuiram para o desenvolvimento da capacidade avaliativa, com duas categorias: eventos de construcao da capacidade avaliativa e eventos de construcao de estrutura organizacional. A pactuacao em instâncias deliberativas para a continuidade da avaliacao, a coleta e analise dos dados realizada pela SES, a iniciativa de mudanca de indicadores e reestruturacao da matriz avaliativa e a comunicacao dos resultados aos municipios formaram a cadeia logica de eventos. A analise triangulada demonstrou que o objetivo de desenvolver a capacidade avaliativa foi alcancado.

[The development of evaluation capacity in primary healthcare management: a case study in Santa Catarina State, Brazil, 2008-2011].

This article analyzes evaluation capacity-building based on the case study of a State Health Secretariat participating in the Project to Strengthen the Technical Capacity of State Health Secretariats in Monitoring and Evaluating Primary Healthcare. The case study adopted a mixed design with information from documents, semi-structured interviews, and evaluation of primary care by the State Health Secretariat in 2008-2011. Process analysis was used to identify the logical events that contributed to evaluation capacity-building, with two categories: evaluation capacity-building events and events for building organizational structure. The logical chain of events was formed by negotiation and agreement on the decision-making levels for the continuity of evaluation, data collection and analysis by the State Health Secretariat, a change in key indicators, restructuring of the evaluation matrix, and communication of the results to the municipalities. The three-way analysis showed that the aim of developing evaluation capacity was achieved.O artigo analisa o desenvolvimento da capacidade avaliativa em um caso exemplar de uma Secretaria de Estado da Saude (SES) participante do Projeto de Fortalecimento da Capacidade Tecnica das Secretarias Estaduais de Saude em Monitoramento e Avaliacao da Atencao Basica. Estudo de caso de abordagem mista, com informacoes provenientes de documentos, entrevistas semiestruturadas e da avaliacao da atencao basica realizada pela SES no periodo de 2008-2011. Empregou-se a analise de processos para identificar os eventos logicos que contribuiram para o desenvolvimento da capacidade avaliativa, com duas categorias: eventos de construcao da capacidade avaliativa e eventos de construcao de estrutura organizacional. A pactuacao em instâncias deliberativas para a continuidade da avaliacao, a coleta e analise dos dados realizada pela SES, a iniciativa de mudanca de indicadores e reestruturacao da matriz avaliativa e a comunicacao dos resultados aos municipios formaram a cadeia logica de eventos. A analise triangulada demonstrou que o objetivo de desenvolver a capacidade avaliativa foi alcancado.