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

Background: In 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 Findings: A 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/Significance: The 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. Author Summary: Brazil still has not achieved the goal of leprosy elimination established by World Health Organization. The diagnosis and treatment of leprosy is easy and the country is striving to fully integrate leprosy services into existing general health services. Access to information, diagnosis and treatment with multidrug therapy (MDT) remain key elements in the strategy to eliminate the disease as a public health problem, defined as reaching a prevalence of less than one leprosy case per 10,000 population. Thus, this study aimed to investigate the performance of a local health system to eliminate leprosy through a cross-sectional study with leprosy patients. One hundred and nineteen patients were recruited for the study, 50.4% of them (60) were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The health teams have invested only in the individual perspective and they do not coordinate the patients' care and, also, their practices are fragmented without perspectives of integration between different health services and social mobilization, an essential condition for the development of an effective and responsive system.