"O programa de controle da tuberculose em São José do Rio Preto-SP, 1985-2004: do contexto epidemiológico à dimensão social" / The Program for Control of Tuberculosis in Sao Jose do Rio Preto, 1985-2004: from the epidemiological context to the social extent.

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

This research has aimed to analyze the Program for control of Tuberculosis (PCT) in Sao Jose do Rio Preto – SP. Epidemiological, political, social and economical indicators, together with facts concerning the organization of health services and the structure of the program were taken for reference, reflections about the load of tuberculosis as a public health issue. In order to achieve this purpose, information from different Information Systems were used: the National Information System of Aggravations Notification (ISAN); the Notification of Tuberculosis (SINT) and Mortality (MIS); the State System of Data Analysis Foundation (SSDAF) and the Economical Conjuncture of Sao Jose do Rio Preto (from 1985 to 2004). Data related to the organization of the service and the program’s structure was obtained official documents and through interviews with the different social representatives. The information on the 432 census sectors of the urban area were provided by the Brazilian Institute of Geography and Statistics Foundation (BIGSF). In the period from 1985 to 2004, incidence and mortality coefficients, when standardized, were kept stable in the municipality. In relation to what was found for the State of Sao Paulo and country, there were lower risks of illness or death by tuberculosis in the municipality. The frequency was dislocated to the elderly age group and the results are compatible with those of developed countries. A high rate of ‘co-infection’ Tuberculosis/HIV (40% in 2004) was found. The implantation of the Supervised Treatment (ST) in 1998 made it possible to improve cure and dropout rates, and there was a greater detection of cases at hospital services (80% in 2003). The municipality is classified, according to the Index of Social Responsibility of Sao Paulo, as Group 1 in the State of Sao Paulo. It presents an IDH of 0.834, a Life Expectancy of 0.772, and a Gross Domestic Product of R$6.9 thousand/per capita. Political, social and economical indicators point towards a greater investment in the social area (dwelling, education and health), and the adoption of the Strategic Planning of Cities, which aims at promoting actions of social inclusion and better income distribution. However, 4% of the population live in conditions of extreme poverty (one dollar/per capita/ day). The decentralization in Full Administration of the Municipal System occurred in 1998, with: the strengthening of social control (election among the President’s equals, own budget); the reorganization of health services with the suggestion of changes in the care model and the delimitation of comprising areas; the creation of positions for technical coordination; the management through Health Units; and investments in the qualification of Human Resources (HR). The PCT is centralized in a Reference Unit and the TS implantation presented itself as an opportunity to its reorganization, tending to the decentralization of all actions towards the Basic Care. The risk of coming down with tuberculosis in the municipality is twice bigger in the area which presents worse social and economical levels than in that with better levels. Nevertheless, there was an improvement in the coefficients, with a smaller difference between the levels, in the period between 2003 and 2004. Thus, in spite of the existence of highly satisfactory social and economical indicators, there is a need to change the pattern of the current medical mentality and of the formation of human resources. Moreover, it is necessary to redirect public politics towards the areas which present the worst social and economical levels.

ASSUNTO(S)

tuberculosis epidemiologia life conditions tuberculose condições de vida epidemiology

ACESSO AO ARTIGO

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