Evidence suggests that employment for women can reduce poverty and inequality resulting in improved living standards. The garment industry is an important source of income for Indian women. This thesis tested the effects of garment work as an income source on women’s health-care utilization practices and decision-making in comparison to both agricultural labourers and general women in India. Cross-sectional data collected from India’s National Family Health Survey-3 was used to generate descriptive statistics. Statistical modeling was used to test the effect of garment work on a) barriers to health care services and b) decision-making abilities of Indian women. Results suggest garment workers are younger, more educated, urban, and wealthier, make more cash earnings, and have more access and control over their own money as compared to agricultural labourers. Results indicate female garment workers report facing fewer barriers to accessing health care services. As well, access to cash earnings increases their decision-making abilities.

Since the early 1990s, the Estonian health sector has been undergoing a number of reforms. At the same time, a number of legislative acts have also been established, forming a new legal basis for the health system. The introduction of a social health insurance in 1992 was the first reform in the Estonian health sector reorganisation, followed by a primary health care (PHC) reform, a hospital reform and a number of public health reforms. The aim of this thesis is to analyse these health sector reforms in Estonia, focusing on the outcomes of the health system from the population’s perspective. Proceeding from this general aim, the specific objectives of the thesis are as follows: 1) To analyse the PHC reform in terms of the access to the health services and the acceptability and satisfaction with these services. 2) To analyse the health insurance reform in terms of the acceptability and satisfaction with the new system. 3) To analyse the public health reforms and their impact on the health of the population. The empirical data were gathered with the following research methods: reviews of official health statistics and population surveys in 1998, 2002 and 2005 based on face-to-face interviews using structured questionnaires. The main results can be summarised in relation to the objectives of the thesis: 1) The primary health care reform has been implemented and most of the objectives have been achieved. In general, people accept the changes in the PHC system and the satisfaction with the family doctors has increased. Access to the PHC services is good. Based on the results of a population study in 2002 and 2005, more than half of the respondents could see the family doctor on the same day they made an appointment. Almost a half of the respondents (49%) were satisfied with the access to the health services. Satisfaction with the PHC services and family doctors were found to have positive effects on satisfaction with access to health services. Although people with chronic conditions were less satisfied with the access to the health services they did not experience organisational barriers in their access to such services. 2) The health insurance reform has been implemented and a high level of financial protection has been maintained. The solidarity principle of the health insurance system guarantees access to health services for all the insured people. About half of the population is satisfied with the present system. Compared to 2002, the percentage of satisfied people has increased in 2005, while the percentage of very dissatisfied persons has decreased. The most important predictor of satisfaction with the health insurance was the satisfaction with the existing PHC system. The satisfaction with the health insurance was higher in 2002 as well as 2005 among those respondents who had visited a family doctor or a specialist or were admitted in a hospital during the last 12 months before the survey, but lower among those who had visited a dentist. A small majority preferred the solidarity principles and comprehensive financing of health service by health insurance. The attitudes regarding financing principles were related to the personal contacts with the health services. The respondents who had used the PHC or ambulance services preferred a more comprehensive financing of health services, while those who had had contacts with a specialists or dentists would prefer less comprehensive financing if the waiting lists were short. More than three quarters of the respondents were informed about their rights concerning the access to the health services. Personal contacts with family doctors and specialists had positive impact on the level of awareness. 3) Some progress has been made in connection with the public health reforms. A number of national programs and projects to prevent the most essential health risks have been initiated. As a result, there is some evidence of a positive impact on the health of the population – positive trends in dietary habits and decreasing infant mortality, number of abortions, and incidences of sexually transmitted infections and tuberculosis. At the same time, however, the proportion of smokers and consumers of strong alcohol has not decreased. Moreover, there has been an explosive increase of new cases of HIV-infections in 2000, which is one of the most serious public health problems today. Greater progress has been achieved in the areas where health promotion and health education activities have been supported by political decisions to make a healthy choice for the population easier. However, a comprehensive national health policy and strategy is still lacking in Estonia. In public health, this is evidenced by a lack of long-term planning and understanding of the significance of intersectoral co-operation. Discussion. Up to now, the major reforms in the Estonian health system have been implemented. However, the environment is changing and the health system has to respond to these changes. The next step should therefore be to reach a public agreement about the common values of the health system and setting long-term health policy goals. To improve the effectiveness of policy implementation and reform, the importance of systematic research and evaluation should also be stressed.

It has long been argued that the organization of the U.S. health care system is shaped by the struggles between capital and labor, and this relationship is of increasing significance today. Transformations from an industrial to a service economy, rising insurance costs, neoliberal social policies, and decreased labor union power have increased the number of Americans with reduced access to health care, especially for service workers and women. This dissertation is an ethnographic study of how workers in two leading unions in the “new” unionism movement, the Retail, Wholesale, and Distribution Service Union (RWDSU) and the United Steelworkers (USW) in urban Central Appalachia, characterize union membership and economic (and benefit) transformations that threaten security for working and middle class families. Using health care as a case study, this dissertation demonstrates the ways in which economic transformations are making health care less affordable for working and middle class families. Through a discussion of the importance of union membership that highlights job protection in the face of the expansion and increasing feminization of service work and the decline in work sponsored benefits, this dissertation details how these processes reduce access to and affordability of health care. In so doing, this research highlights individual pragmatic action and broader union activism in seeking economic and health security for their families. More broadly, new unionism tactics are described in the actions of a Central Labor Council as it seeks to renew community alliances and link rank-and-file concerns of job security to current labor issues, including the Employee Free Choice Act and Right-to-Work legislation, on local, state, and national levels. This dissertation links access to health care problems in this community to broader national issues (e.g. job protection, service work, and outsourcing) and highlights how union members, individually and collectively, are participating in “new” unionism tactics to maintain job security and secure resources, including health care, for their families.

Objetivos: Apresentar características do processo migratório de Bolivianos no Município de São Paulo, explorando, num contexto de saúde global, a relação entre os Sistemas de saúde do Brasil e da Bolívia; destacando os respectivos processos históricos, noções de acesso universal e semelhanças que possam vir a ser fundamentais na compreensão da problemática específica da alta incidência de Tuberculosos entre bolivianos residentes na capital do Estado de São Paulo. Métodos: Trata-se de um estudo de abordagem qualitativa e exploratória em que foi realizado um levantamento teórico bibliográfico capaz de apresentar a problemática do tema. Dentre os métodos foi utilizado o descritivo e a pesquisa histórica para caracterizar os processos de implementação e reforma dos sistemas de saúde do Brasil e da Bolívia. Resultados: As fortes correntes migratórias internacionais levam a uma discussão do papel do Estado na garantia dos direitos do migrante, dentre eles, o acesso universal a saúde. Neste trabalho foi possível caracterizar a dinâmica do mundo em constante modificação e ausência de fronteiras no contexto da saúde globalizada. Usando como base o imigrante Boliviano com Tuberculose no Município de São Paulo, analisou-se os Sistemas de Saúde Universal Brasil e Bolívia. Por fim, através deste trabalho foi possível perceber que após o processo migratório há uma combinação de fatores que propiciam o aumento de TB nesta comunidade. / Objective: We attempted to present some of the characteristics of the migratory process of Bolivians in São Paulo. We attempted to observe the relationship between the health systems of Brazil and Bolivia. We observe the historical processes of creation of two health systems; highlight how countries perceive universal access to healthcare. And we highlight the similarities and differences of the two health systems. The purpose is that this will serve to help understand the high incidence of tuberculosis in the Bolivian citizens living in Sao Paulo. Methods: This is a qualitative and exploratory study. This study conducted a bibliographical theoretical research. This served to explore the issue of Bolivians in São Paulo. The main method used was a descriptive and historical research. This allowed the characterization of the processes of implementation and reform of health systems in Bolivia and Brazil. Results: This study shows that international migration flows have resulted in a renewed discussion of the role of the state in ensuring the rights of migrants. This discussion was particularly seen in the problem of universal access to healthcare. In this work it was possible to characterize the dynamics of the ever-changing world. We also observed the lack of geographical boundaries in the context of global health. When looking at the case of Bolivian immigrants with tuberculosis in São Paulo, we analyzed the relevance of the differences between Universal Health Systems in 9 Brazil and Bolivia. Finally, this worked allowed to realize that the migratory process of Bolivians to Sao Paulo consists of a combination of factors that potentiate the increase of tuberculosis in this immigrant community.

Orientador: Carmen Maria Casquel Monti Juliani / Resumo: INTRODUÇÃO: A regulação de acesso é compreendida como importante ferramenta de gestão do sistema de saúde. OBJETIVO: Conhecer o perfil e demanda de urgência e emer-gência encaminhadas a um serviço de alta complexidade antes e após um sistema de regulação. MÉTODO: Estudo transversal, avaliando, por meio de análise estatística, dois períodos o primeiro de março de 2015 a setembro de 2016 e o segundo de outubro de 2016 a abril de 2018. RESULTADOS: Houve predominância dos moradores de Botucatu sendo 82% adultos e as especialidades mais buscadas foram oftalmologia, clínica médica e ortopedia. 10450 casos foram regulados pela Central de Regulação de Ofertas de Serviços de Saúde, em análise comparativa do período anterior e posterior da implantação da plataforma notou-se aumento na demanda de atendimento dos municípios e na distribuição das especialidades solicitadas. Das solicitações aceitas e encaminhadas ao Hospital das Clínicas prevaleceu o público mascu-lino e as principais hipóteses diagnósticas foram relacionadas à fratura, trauma, afecções car-díacas e acidente vascular cerebral. Após realizou-se um cálculo amostral que evidenciou 12,5% a realização de contrarreferência, analisando a amostra a maioria eram homens com média de idade de 40 anos e o tempo médio de regulação dos casos foi de 1 hora, 43 minutos e 48 segundos com as principais queixas relacionadas à fratura, dor abdominal, infarto agudo do miocárdio e dispneia. CONCLUSÃO: Houve diferença significativa comparando o... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: BACKGROUND: Access regulation is understood as an important health system manage-ment tool. AIM: To know the profile and demand of urgency and emergency sent to a high complexity service before and after a regulation system. METHOD: Cross-sectional study, evaluating, through statistical analysis, two periods from March 2015 to September 2016 and the second from October 2016 to April 2018. RESULTS: Population of Botucatu was predo-minantly 82% and specialties most sought were ophthalmology, medical clinic and orthope-dics. 10450 cases were regulated by the Central of Regulation of Health Service Offerings, in a comparative analysis of the period before and after the implementation of the platform, there was an increase in the demand for care of the municipalities and in the distribution of the spe-cialties requested. Of the requests accepted and sent to Hospital das Clínicas, the male public prevailed and the main diagnostic hypotheses were related to fracture, trauma, cardiac affecti-ons and stroke. After a sample calculation that showed a 12.5% counterreference, the sample was mostly men with a mean age of 40 years and mean time to regulate the cases was 1 hour, 43 minutes and 48 seconds with the main complaints related to fracture, abdominal pain, acute myocardial infarction and dyspnea. CONCLUSION: There was a significant difference comparing the two periods, evidencing the increase after the insertion of the platform, contri-buting to the regulation and flow of the patien... (Complete abstract click electronic access below) / Mestre

Orientador: Carmen Maria Casquel Monti Juliani / Banca: Sandra Thomé / Banca: Nilce Emy Tomita / Resumo: O Sistema Único de Saúde (SUS) atualmente passa por grandes transformações e conquistas, acompanhadas por algumas dificuldades na consolidação dos seus princípios. O funcionamento do sistema de referência e contrarreferência em saúde, proposto para contribuir com a garantia dos princípios de integralidade, equidade e universalidade, é um desafio que enfrentamos. Faz-se necessário um sistema de referência e contra-referência que funcione de forma a promover a integração entre os serviços, para que em rede possam oferecer uma assistência de qualidade ao usuário. O objetivo desta pesquisa foi compreender a organização do sistema de referência e contra referência no contexto do Sistema Único de Saúde na Estratégia Saúde da Família no município de Bauru/SP, a partir da experiência dos gestores que vivenciam essa prática. A pesquisa, qualitativa, utilizou o referencial da fenomenologia. Foram entrevistados gestores da ESF do município e chefias das unidades, totalizando seis entrevistados. Emergiram dos depoimentos três categorias: Categoria A: O sistema de saúde, com os temas: política de Saúde, não garantia da integralidade, resolubilidade, lógica/modelo dominante no sistema e cultura da população; Categoria B: O funcionamento do sistema de referência e contra-referência, cujos temas foram a visão do sistema de referência e contrareferência, operacionalização da referência no município, importância da reorganização da referência, importância da contrarreferência e desafios da comunicação entre os níveis de atenção e usuários; Categoria C: Fatores estruturais do sistema local de saúde. abrangendo os temas demanda reprimida, organização dos serviços, atenção básica insuficiente, priorização das vagas urgências/emergências, retrabalho e custos para o sistema, perspectivas de melhoria da rede de atenção a saúde, perspectivas... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Unified Health System (SUS) has undergone great changes. It has also made great achievements that have been accompanied by difficulties in the consolidation of its principles. The functioning of the health referral and counter-referral system, which has been proposed in order to contribute so as to ensure the principles of integrality, equity and universality, is a challenge that has been faced. A referral and counter-referral system that works so as to promote integration between the services is necessary in order to provide quality care to users in the form of a network. This study aimed at understanding the organization of the referral and counter-referral system in the context of the Unified Health System in the Family Health Strategy in the city of Botucatu/SP based on the experience of managers who live such practice. The qualitative research used the phenomenology framework. ESF managers in the city as well as health unit managers were interviewed, totaling 06 respondents. Three categories emerged from their statements: Category A: The health system, with the following themes: health policy, non-guarantee of integrality, resolubility, logic/dominant model in the system and the population's culture; Category B: the functioning of the referral and counter-referral system, whose themes were the view of the referral and counter-referral system, referral operationalization in the city, importance of referral re-organization, importance of counter-referral and communication challenges between care levels and users; Category C: structural factors of the local health system, including the following themes: repressed demand, service organization, insufficient primary care, prioritization of places for emergencies, re-work and costs for the system, perspectives of improvement in the health care network, perspectives for matrix-based strategies. The data show a system that... (Complete abstract click electronic access below) / Mestre

Atà 2000, o controle da hansenÃase no Brasil foi verticalizado. Desde entÃo, o processo de descentralizaÃÃo dessa doenÃa deu inÃcio a aÃÃes que priorizaram o nÃvel primÃrio de atenÃÃo à saÃde. Entretanto, a assistÃncia ainda permanece centralizada em algumas unidades de saÃde, como o Centro Nacional de ReferÃncia em Dermatologia SanitÃria D. LibÃnia (CDERM), em Fortaleza, CearÃ. O referido centro responde por 84% da detecÃÃo dos casos de hansenÃase do MunicÃpio. O objetivo deste estudo foi investigar os fatores associados à demanda excessiva de casos, em nÃvel secundÃrio de atenÃÃo, representado por esse centro de referÃncia. Um estudo transversal foi realizado com 600 usuÃrios, selecionados aleatoriamente nos ambulatÃrios do CDERM. Foram coletados dados socioeconÃmicos e demogrÃficos sobre o conhecimento da doenÃa e a percepÃÃo dos serviÃos. Oitenta e dois por cento dos participantes tinham baixa situaÃÃo socioeconÃmica, 90% vieram encaminhados por outras unidades de saÃde e 87% tinham a forma multibacilar. Sessenta e nove por cento receberam atendimento prÃvio em outras unidades de saÃde, 49% jamais ouviram falar de hansenÃase, 24% referiram sentir medo da doenÃa ou terem sofrido discriminaÃÃo, 39% dos usuÃrios referiram que o atendimento ininterrupto no horÃrio do almoÃo favorece a permanÃncia no CDERM, 57% e 27%, respectivamente, referiram que a medicaÃÃo complementar nunca faltou no CDERM e nas Unidades BÃsicas de SaÃde (UBS). Sessenta e um por cento consideraram que o compromisso dos profissionais no CDERM foi Ãtimo, contra 14% nas UBS. Os atores relatados pelos usuÃrios, especialmente logÃsticos e de qualidade de atendimento e dos profissionais, poderiam explicar a concentraÃÃo de usuÃrios nesse centro de referÃncia. / Until 2000, the Leprosy control in Brazil was a vertically integrated program. After this date, the program was considered a priority for primary care. However, the program remained centralized in some reference centers such as the D. LibÃnia National Reference Center for Sanitary Dermatology, located in Fortaleza, CearÃ, Brazil (CDERM), responsible for 84% of the case detection in this municipality. The goal of this study was to investigate the factors associated with use of these services, and the potential for integration into primary health care. A cross-sectional survey was conducted with 600 users randomly selected in the outpatient clinic of the CDERM with the objective of determining the factors associated with demand for these services. Social, economic and demographic data, knowledge about the disease and perception about the services were collected. Eighty two percent of the participants had low social and economic status, 90% were referred from other health units; 87% had the multibacillary form. Sixty-nine per cent reported previous visits to other health units (HU). Fortynine per cent have never heard about leprosy, 24% reported fear of being discriminated against or suffering discrimination. Complementary medication was never missed for 57% treated in the CDERM and for 27% in other HUs. The commitment of the professionals was considered exemplary by 61% in the CDERM and by 14% in the other HUs. These facts reported by users, especially logistic ones and those related to the quality of the assistance and of the professionals might explain the concentration of users in this reference center.

As aÃÃes de controle da tuberculose (TB) encontram-se no Ãmbito da AtenÃÃo PrimÃria à SaÃde e visam interromper a cadeia de transmissÃo e possÃveis adoecimentos na comunidade. O objetivo desse trabalho foi dimensionar o acesso ao diagnÃstico e ao tratamento da tuberculose, as aÃÃes de controle desenvolvidas pelas equipes da SaÃde da FamÃlia (SF) em Fortaleza e o grau de conhecimento dos profissionais de saÃde. Trata-se de um estudo transversal descritivo. Foram selecionados oito Centros de SaÃde da FamÃlia entre os que mais atenderam casos de tuberculose no primeiro trimestre de 2011. A populaÃÃo de estudo foi constituÃda de enfermeiros, mÃdicos, agentes comunitÃrios de saÃde (ACS) e usuÃrios portadores de TB em tratamento. Foram realizadas entrevistas com os usuÃrios e os profissionais enfermeiros e mÃdicos. Um questionÃrio de conhecimento acerca da transmissÃo, diagnÃstico, prevenÃÃo, tratamento e acompanhamento da tuberculose foi aplicado com ACS, enfermeiros e mÃdicos. Os profissionais de nÃvel superior eram formados por 31 enfermeiros e 17 mÃdicos, sendo 39 do sexo feminino. A idade mÃdia foi de 38,4 anos. A maioria (n= 135) dos ACS, 81,8%, possuÃa o ensino mÃdio completo. Trabalhar na funÃÃo hà trÃs anos ou mais foi significativo para participaÃÃo em treinamentos (p= 0,0001). O atendimento inicial do tratamento de TB foi conseguido em atà uma semana. A consulta de acompanhamento do mÃdico e do enfermeiro foi classificada, pelos doentes, como boa, clara e esclarecedora acerca da doenÃa, do tratamento, das medicaÃÃes e seus efeitos adversos. A oferta de vale transporte era irregular e nÃo havia cesta bÃsica. Houve discordÃncia das respostas dos usuÃrios e profissionais nas aÃÃes de exame e investigaÃÃo de contatos domiciliares. Entretanto, eles concordaram quanto à nÃo realizaÃÃo de busca ativa de sintomÃticos respiratÃrios e trabalhos educativos na comunidade. Enfermeiros, mÃdicos e ACS apresentaram proporÃÃo de acerto superior a 70% do questionÃrio acerca da tuberculose. NÃo houve diferenÃas estatisticamente significantes entre enfermeiros e mÃdicos no nÃmero total de acertos, por questÃo ou bloco temÃtico. Os ACS que atuavam hà trÃs anos ou mais apresentaram maior mÃdia de acertos (p= 0,0414). As fragilidades no controle da tuberculose na Ãrea das equipes estudadas envolvem as aÃÃes voltadas Ãs famÃlias e à comunidade, como a investigaÃÃo de contatos, trabalhos educativos na comunidade, busca de sintomÃticos respiratÃrios, prejudicando o acesso ao diagnÃstico precoce da doenÃa. / Actions to control this disease lie within the Primary Care/ Family Health Program and aim to break the chain of transmission and possible illnesses in the community. The aim of this study was to measure the access to diagnosis and treatment of tuberculosis, the control measures developed by Family Health teams in Fortaleza and the degree of knowledge of health professionals. This was a cross-sectional study. Eight Family Health Centers that served more cases of tuberculosis in the first quarter of 2011 were selected. The study population consisted of nurses, physicians, community health worker and TB patients on treatment. Interviews were conducted with TB patients and nurses and doctors. Moreover, nurses, doctors and community health workers answered a survey of knowledge about transmission, diagnosis, prevention, treatment and monitoring of tuberculosis. High level professionals were composed of 31 nurses and 17 doctors. There were 39 women. Mean age was 38.4 years. The most (81.8%) of community health workers had completed high school. Working in the service for three years or more was significant for participation in trainings (p= 0,0001). The initial care of TB treatment was achieved within one week. The follow-up care by doctor or nurse was classified by patients as good, clear and informative about the disease, treatment, medications and their adverse effects. The provision of bus passes was irregular and there was no food aid. There were disagreement responses of users and professionals in the actions of examination and investigation of household contacts. However, they agreed not to perform an active search for respiratory symptoms and educational work in the community. Nurses, doctors and community health workers had ratio of greater than 70% correct answers in tuberculosis. There were no statistically significant differences between nurses and physicians in the total number of correct answers, per question or thematic group. The community health workers who had work up to three years or more had a higher average (p= 0,0414). The weaknesses in tuberculosis control in the teams studied area occurred in actions aimed to involve families and the community, such as research of contacts, educational work in the community, search for respiratory symptoms, hampering access to early diagnosis.

Made available in DSpace on 2015-09-25T12:23:47Z (GMT). No. of bitstreams: 1 ValkeniaAlvesSilva.pdf: 2095017 bytes, checksum: e1266e96d8079940733091b12b37e198 (MD5) Previous issue date: 2011-08-08 / This study aimed to evaluate the actions of tuberculosis control in Campina Grande-PB. This is a study performed by the adaptation of instruments of the Primary Care Assessment Tool (PCAT), prepared by Satrfield (2002), adapted and validated to Brazil by Macincko and Almeida (2006), adjusted for TB by Villa and Ruffino-Netto (2009). The study included 116 TB patients diagnosed from May/2010 to January/2009 living in the city of Campina Grande- PB. Interviwees answered each question using a questionary with Likert scales of five scores. Data were analyzed using the nonparametric Kruskal-Wallis (H Test), which is a non- parametric ANOVA with a criterion of classification. As a posteriori test was used Dunn's method to compare in pairs the matters referred and check the statistical differences. There were more male, incomplete elementary education and masonry housing . Patients do not seek the APS as a gateway to the health system, most diagnosis of TB was made by secondary care services and tertiary. About the variables of access to diagnosis, 43.2% of TB patients had no difficulties of getting access to care (3.91), 49.4% always managed medical consultation within 24 hours (3.65); 56.7% never or rarely had difficulty on getting around (3.67), 44.5% of patients always lost days of work (2.87), 62.9% used motorized transport (2.68), 56, 8% had to pay for transportation (2.69) to go to the SS and 53.1% did not seek the nearest health unit to their home when they started to show the first symptoms of TB, the only variable that is statistically significant. It was observed that the conformation that are organized as health services have weaknesses in the decentralization of TB diagnosis process for the APS, that is necessary to adopt strategies that enable people's access measures to control the disease. / O presente estudo objetivou avaliar as ações de controle da tuberculose no município de Campina Grande-PB. Trata-se de um estudo transversal realizado a partir da adaptação do instrumento componente do Primary Care Assessment Tool (PCAT), elaborado por Starfield (2002), adequado e validado para o Brasil por Macincko e Almeida (2006), sendo adaptado para a atenção à TB por Villa e Ruffino-Netto (2009). Participaram do estudo 116 doentes de TB diagnosticados no período de janeiro/2009 a maio/2010, residentes no município de Campina Grande-PB. Os entrevistados responderam cada pergunta do questionário segundo uma escala do tipo Likert com 5 escores. Os dados foram analisados através do teste não-paramétrico de Kruskall-Wallis (Teste H), que é uma ANOVA não-paramétrica a um critério de classificação. Como teste a posteriori foi usado o método do Dunn para comparar aos pares as questões referidas e verificar diferenças estatísticas. Houve predomínio do sexo masculino, baixa escolaridade e adulto jovem. Os doentes não buscaram o nível de Atenção Primária à Saúde como porta de entrada do sistema de saúde, a maioria dos diagnósticos de TB foi realizado nos serviços de atenção secundária e terciária. Com relação às variáveis de acesso ao diagnóstico, 43,2% dos doentes de TB não apresentaram dificuldades de acesso para conseguir atendimento (3,91); 49,4% sempre conseguiram consulta médica no prazo de 24 horas (3,65); 56,7% nunca ou quase nunca tiveram dificuldade de deslocamento (3,67); 44,5% dos doentes sempre perderam dia de trabalho (2,87); 62,9% utilizaram transporte motorizado (2,68); 56,8% tiveram que pagar pelo transporte (2,69) para deslocar-se ao SS e 53,1% não procuraram a unidade de saúde mais próxima de seu domicilio quando começaram a apresentar os primeiros sintomas da TB, sendo a única variável que apresentou diferença estatística significativa. Observou-se que a conformação como estão organizados os serviços de saúde apresentam fragilidades no processo de descentralização do diagnóstico da TB para à Atenção Primária à Saúde, sendo necessária a adoção de estratégias que viabilizem o acesso da população as ações de controle da doença.

In the U.S., the number of persons who cannot afford health care continues to rise. Providing a "safety net" for such persons is becoming increasingly important. Medical professional volunteerism provides access to health care for people who have little or no access to health care otherwise. At a not-for-profit free health clinic in Tampa, Florida, hundreds of physicians have volunteered their time in an attempt to reduce the health care gap in their community. The clinic sees thousands of persons who have very limited options in regards to their health care. This study investigates the reasons physicians volunteer and the barriers physicians face when providing free medical service. Through a survey, shadowing sessions, and focused in-depth videotaped interviews with volunteer physicians concerning the risks, rewards, experiences, and barriers of professional volunteering, a greater understanding of this important topic was obtained. This applied visual anthropological project was developed in collaboration with the free clinic in order to provide a product which would be of use to the organization at the end of the research process. This research led to an enhanced understanding of this population as well as recommendations in volunteer physician recruitment strategies.