title: Patients' perceptions on the performance of a local health system to eliminate leprosy,Paraná State, Brazil.
abstract: 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.
  
  
  RESULTS
  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
  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.
authors.affiliation: Department of Nursing, Universidade Estadual de Londrina, Londrina, Paraná, Brazil.
authors.forename: Flávia Meneguetti
authors.initials: FM
authors.lastname: Pieri
authors.affiliation: Nursing and Public Health Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Michelle Mosna
authors.initials: MM
authors.lastname: Touso
authors.affiliation: Department of Medicine, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso, Brazil.
authors.forename: Ludmila Barbosa Bandeira
authors.initials: LB
authors.lastname: Rodrigues
authors.affiliation: Nursing and Public Health Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Mellina
authors.initials: M
authors.lastname: Yamamura
authors.affiliation: Department of Maternal-Infantile Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Ione Carvalho
authors.initials: IC
authors.lastname: Pinto
authors.affiliation: Department of Nursing, Universidade Estadual de Londrina, Londrina, Paraná, Brazil.
authors.forename: Elma Mathias
authors.initials: EM
authors.lastname: Dessunti
authors.affiliation: Nursing and Public Health Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Juliane de Almeida
authors.initials: Jde A
authors.lastname: Crispim
authors.affiliation: University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Antônio Carlos Vieira
authors.initials: AC
authors.lastname: Ramos
authors.affiliation: University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Luiz Henrique
authors.initials: LH
authors.lastname: Arroyo
authors.affiliation: Center of Social Science, Health and Technology, Universidade Federal do Maranhão, Imperatriz, Maranhão, Brazil.
authors.forename: Marcelino Santos
authors.initials: MS
authors.lastname: Neto
authors.affiliation: Nursing and Public Health Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Maria Concebida da Cunha
authors.initials: MC
authors.lastname: Garcia
authors.affiliation: Nursing and Public Health Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Marcela Paschoal
authors.initials: MP
authors.lastname: Popolin
authors.affiliation: University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Tatiane Ramos dos Santos
authors.initials: TR
authors.lastname: Silveira
authors.affiliation: Department of Maternal-Infantile Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Ricardo Alexandre
authors.initials: RA
authors.lastname: Arcêncio
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003153:Community Health Services; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007918:Leprosy / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires