Evaluation of the hanseniasis control program: a study by triangulation of methods

Gutembergue Santos de Sousa1, Rodrigo Luis Ferreira da Silva2, Marília Brasil Xavier2
1Municipal Secretary of Health
2Para State University


Aim: To evaluate the municipal program of hanseniasis control in Canaã dos Carajás, PA. Method: This is a quantitative study, for the evaluation of health services, whose evaluative proposal is the triangulation of methods, through the study of the structure, processes and results. Results: several weaknesses were found in the program structure. Although some attributes have not been positively evaluated in a general aspect, the scores found allowed a good rating of the municipality's performance in terms of leprosy control actions. The appraised indicators showed fluctuations over the time series. Conclusion: the city has poor structure, high guidance for the development of leprosy actions in primary care and regular quality indicators according to the established parameters.

Descriptors: Hansen's Disease; Health Evaluation; Nursing; Primary Health Care; Care Quality in Health.


In the year 2014, Canaã dos Carajás, Pará presented a leprosy incidence rate of 89.6/100,000 inhabitants(1).

Evaluating leprosy is extremely important because it is a priority condition in the health policy in Brazil, requiring actions aimed at strengthening the role of Primary Health Care (PHC) in its control. The use of appropriate tools, which enable analysis of knowledge of the attributes of the PHC that are being achieved, facilitates the planning of actions for the respective service, has a direct impact on its quality(2).


Evaluate the municipal program of leprosy control in Canaã dos Carajás, Para.


This is a quantitative study, for assessing health services, with the proposal of evaluating programs focused on hanseniasis. The evaluative proposal was the triangulation of methods based on the assessment of structures, processes, and results, thus allowing a detailed analysis of the object under study. The evaluation by triangulation of methods studies the structure, the process, and the results, since such components directly influence the development of professional practice in health(3).

Data were collected during the months of July 2015 to March 2016, in the city of Canaã of Carajás, Pará.

This study was submitted for assessment by the Ethics Research Committee of the NMT/UFPA, and was approved under opinion number 1,128,385.


In the evaluation of the structure it was possible to identify the presence of a multidisciplinary team, and the absence of the Municipal Plan for leprosy control. There was also the realization of an annual training for the health staff; the use of municipal resources in the acquisition of supplies and materials; the absence of proper protocol and detailed flowchart for the service; the presence of the basic kit for the diagnosis of leprosy; problems relating to the storage and dispensing of drugs and performing monitoring activities of patients; and the absence of alternative hours of operation of the health services.

On the analysis of attributes of PHC it was identified through the overall score that the city presents guidance for the development of leprosy control actions at the primary level of health care, although it has shown weaknesses in attributes such as access to community orientation, family counseling and vocational guidance.

The evaluation of the results showed that the indicators presented oscillatory behavior during the historic series, being mostly classified according to the parameter set as regular, demonstrating existing weaknesses in the implementation of the program in question.


It was identified that the majority of actions or services evaluated as unsatisfactory or regular could show improvement in case the city possessed its own protocol for the hanseniasis program.

A study in the city of João Pessoa, PB, aimed at analyzing the impact of the expansion of the operation time of the health facilities for the night shift, identified a significant improvement in terms of the demand for the service, mainly by male workers(4).

On the analysis of the essential and derived attributes, it was found that doctors, nurses, and managers realize the presence and performance of these respective attributes similarly.

Through statistical analysis with the Kruskal-Wallis test, it was observed that the evaluations of the PHC attributes in the leprosy control were not affected by the type of participant, since significant statistical differences were found for the value of p, suggesting that participants perceive similarly the development of leprosy actions in the PHC units.

A study in Paraná, with 2001-2010 data, identified a growing proportion of new leprosy cases with some degree of disability. Compared to Canaã dos Carajás, there are singularities in the oscillations over the years and in the performance ratings of this indicator(5).

As to the evaluation of other quality indicators in terms of hanseniasis, the data found, mostly converge with several studies on the subject in question, as detailed in the work.


According to the evaluation of the hanseniasis control program, the municipality of Canaã dos Carajás has a structure classified between poor and regular. It has high guidance for the conduct of leprosy control actions in the context of PHC, despite showing weaknesses in the performance of some attributes and showing fluctuating quality indicators over the time series, with regular classification regarding the standard adopted by the Ministry of Health.

Dissertation defense Board: Prof. Dr. Marilia Brasil Xavier (guidance counselor); Prof. Dr. Carla Andrea Avelar Pires (examiner); Prof. Dr. Laura Maria Vidal Nogueira (examiner); Prof. Dr. Maria da Conceição Nascimento Pinheiro (examiner).

Original reference

Sousa, GS, Silva RLF, Xavier MB. Avaliação do programa de controle da hanseníase no contexto da atenção primária em saúde: um estudo por triangulação de métodos no município de Canaã dos Carajás-Pará. [Dissertação]. Belém: Universidade Federal do Pará, Programa de Pós-graduação em Saúde na Amazônia; 2016.


  1. Ministério da Saúde (Brasil). Indicadores e dados básicos: indicadores de morbidade. [internet]. Brasília: Ministério da Saúde; 2014. [cited 2014 Mar 19]. Available from: http://tabnet.datasus.gov.br/cgi/idb2012/matriz.htm#morb.
  2. Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Instrumento para avaliação das ações de controle da hanseníase na Atenção Primária. Rev. bras. enferm. [Internet]. 2014 [cited 2016 Jun 14]; 67(3): 339-46. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672014000300339.
  3. Ayanian JZ, Markel H. Donabedian’s Lasting Framework for Health Care Quality. N Engl J Med [internet]. 2016 [cited 2016 Aug 14]; 375:205-207. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMp1605101.
  4. Cordeiro SVL, Fontes WD, Fonseca RLS, Barboza TM, Cordeiro CA. Male primary healthcare: possibilities and limits on night service. Esc. Anna Nery [internet]. 2014 [cited 2016 Fev 27]; 18(4):644-49. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452014000400644&lng=en&nrm=iso.
  5. Oliveira KS, Souza J, Campos RB, Zilly A, Silva-Sobrinho RA. Evaluation of leprosy epidemiological and operational indicators in priority municipalities in the state of Paraná, 2001 to 2010. Epidemiol. Serv. Saúde [internet]. 2015 [cited 2016 Mar 22]; 24(3):507-16. Available from: http://www.scielo.br/pdf/ress/v24n3/2237-9622-ress-24-03-00507.pdf.

All authors participated in the phases of this publication in one or more of the following steps, in According to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the versión submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf

Received: 06/02/2016 Revised: 08/14/2016 Approved: 08/16/2016