Implantação da estratégia DOTS no controle da tuberculose na paraíba: Entre o compromisso político e o envolvimento das equipes do programa saúde da família (1999-2004)

Abstract

The scope of this paper is to analyze theimplementation of the Directly Observed TreatmentShort-Course (DOTS) strategy in the controlof tuberculosis, from the standpoint of thecoordinators of the Tuberculosis Control Program(TCP) in six priority municipalities in the stateof Paraíba, Brazil. Semi-structured interviewswere conducted with seven TCP coordinators.Five municipalities proved to be DOTS successpoints achieving a 90% cure rate. Among theDOTS weak points in the political dimension, thefollowing aspects were identified: lack of continuityof the TCP coordinator position; lack of preparednessof the local team; precarious technicaladministrationstructure and insufficiency of thelaboratory network. In the operational dimension,the search for respiratory symptoms by theFamily Health Teams is still low. Changes of anepidemiological, operational and political naturehave been incorporated, though the implementationand guarantee of the sustainability of DOTSin the State depends on the way the health servicesare organized and on the manager's politicalcommitment to support the strategy.