Patients' Perceptions on the Performance of a Local Health System to Eliminate Leprosy, Paraná State, Brazil

Abstract

BackgroundIn Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income.Methodology/Principal FindingsA cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community.Conclusions/SignificanceThe patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem.

Perceived Stigma towards Leprosy among Community Members Living Close to Nonsomboon Leprosy Colony in Thailand

“…The evidence of integrated health approach in reducing stigma is shown by a study in India where 50% reduction in level of stigma was found with community participation in leprosy control program [ 27 ]. Furthermore, a study in Brazil shows the main challenges in leprosy control program as lack of leprosy care at local health services and social mobilization of the community to leprosy control program [ 30 ].…”

Improving Treatment Outcomes for Leprosy in Pernambuco, Brazil: A Qualitative Study Exploring the Experiences and Perceptions of Retreatment Patients and their Carers

“…This study's ndings promote location-speci c nancial support schemes for leprosy patients and their carers, to shield from continuous nancial setbacks. Food vouchers in other Brazilian states, [104] and direct income replacement in Nigeria and China [105,106] have shown promise, and therefore could be trialled in Pernambuco. Superior to nancial or material help, vocational skills and disability-friendly workplace environments may enable patients and carers to permanently escape this socioeconomic vicious cycle, improving TOs [107].…”

Perceptions of people with leprosy about disease and treatment

“…Cross-sectional study carried out in Londrina, Brazil, showed that people with leprosy had used the primary health care services, but did not receive the diagnosis of leprosy in these services (4) . Although there were advances in protocols of care for people with leprosy, there is the absence of collective action and involvement of families of people with the disease and the community.…”

“…Although there were advances in protocols of care for people with leprosy, there is the absence of collective action and involvement of families of people with the disease and the community. Therefore, besides the difficulty of diagnosis and treatment in primary care services, they also highlight perspectives limited to individual care and that does not cause social mobilization for disease control (4) .…”