Factors which influenced the decentralisation of leprosy control activities in the municipality of Betim, Minas Gerais State, Brazil.

摘要

This is the second part of a study conducted to evaluate the decentralisation of leprosy control activities in Betim, Minas Gerais, Brazil. OBJECTIVES: To identify factors which hindered or facilitated the decentralisation of leprosy control activities in Betim municipality and to evaluate the quality of care after decentralisation. DESIGN: The study comprised a 2 1/2 hour focus group discussion with 10 professionals who participated in the decentralisation process. The group included health service managers and professionals from different backgrounds and types of health services involved in leprosy control. RESULTS: The following factors were identified as having hindered decentralisation: staff attitude, lack of staff training, stigma and health system organisation and management. The facilitating factors were: staff training in Betim, existence of a Municipal Reference Centre. The group considered that quality of care improved after decentralisation. CONCLUSIONS: The problems identified cannot be addressed with simple, immediate solutions. They require coordination with partners both within and outside the municipal health secretariat. Ongoing staff training is essential and should be done using existing expertise in the municipality. An easily accessible reference centre is important as a place for training and backup for newly trained professionals.