Brazil: Family Health Teams Make DOTS Work

As he bicycles past his neighbors, the young man waves and smiles. He has no time to chat-he is on a mission. Five days a week and without fail, he arrives at Brazil's Saracuruna Municipal Health Center in Rio de Janeiro state to take his tuberculosis (TB) medications under the watchful eye of the family health team. Thanks to the new TB diagnosis and treatment program established in this municipality in 2003, this young patient is motivated to complete his treatment. The clinic is close to his home and the staff knows him and encourages him.

In the past twelve years, Brazil's TB detection and cure rates have plunged. Rio de Janeiro accounts for 20% of Brazil's notified TB cases and has the highest mortality from TB and the highest treatment default rates. Aiming to reverse the trend, MSH's Management and Leadership Program helped state health authorities integrate DOTS (the directly observed treatment short-course strategy backed by the World Health Organization) with the primary care delivered by family health teams at public clinics, the setting in which most Brazilians receive their care.

By establishing sound management systems and training clinic staff in proper diagnosis and treatment of TB with an emphasis on DOTS (Directly Observed Treatment, Short-course strategy), clinics have found a cost-effective way to ensure that TB patients complete their treatment close to home and by medical staff they already know and trust. As a result, the clinic in the impoverished Duque de Caxias municipality was able to implement the program in just three months. Further, patients like the motivated young man bicycling to the clinic for treatment, offer indication that the strategy is working.