Performance Primary Health Care for Tuberculosis Treatment in Foz do Iguaçu, Brazil an International Triple Border: a cross-sectional study

INTRODUCTION:  The use of indicators to assess the organization of health in the treatment of tuberculosis (TB) services is still a challenge to the management process, especially in regions of international border due disparities in access to health services. The aim of this study was to evaluate structure and process of Primary Health Care (PHC) units after the first year after decentralization of TB treatment actions in Foz do Iguaçu located at the triple border between Brazil, Paraguay and Argentina. METHODS: Cross-sectional study conducted by appliance of a questionnaire based on the theorical evaluative concepts (structure-process-outcome) in 23 PHC units for 225 health professionals. From a total 70 questionnaire itens, an amount of 20 were validated for the development of 5 structure indicators; and 15 were validated for the development of 4 process indicators. Indicators were padronized for Z variable, corresponding to the mean value±standart deviation. RESULTS: The structure component of the city presented lower values when compared to the median value obtained for “professionals trained to TB care” indicator (Z= -8.0), regular values for “TB trainings” (Z= -1.0) and integration of PHC with other levels of care (Z= 0.9), and higher values for “record and reporting forms availability” (Z= 2.7) and “resources availability” (Z= 1.8). Process component presented median values for “DOT indicator” (Z= 0.4), “reference and counter-reference” (Z= -0.3) and  “TB information” (Z= -0.5); a lower value for “on the field actions for TB control” (Z= -9.4). CONCLUSIONS: The poor performance regarding structure may be related to lack of training before decentralizations, leading to low involvement of professionals in control TB. Process indicadores showed more frequently a poor evaluation, suggesting deficiencies in the TB patients follow-up. The variability among indicators showed that some actions are not completly implemented. Limitation, lack of reliable registration of foreign assisted in UAPS.