FIRSTHAND EXPERIENCE

Public-private partnership for the integral approach of Chagas disease from the primary care level - Strategic approach experience in the Municipality of Pilar

The members of this public-private partnership for the approach of Chagas disease, which is aimed mainly at the primary care level, are Mundo Sano Foundation and the Municipality of Pilar. A strategic approach was designed to tackle this problem from the Municipality. Initially, the intention was to locate four strategic Primary Care Centres distributed at an equal distance from the areas of greatest prevalence and in the Maternity Hospital, which was the place where this pathology would be directly addressed.

Mundo Sano Foundation was in charge of training these professionals in the topic. In turn, the Foundation performs the administrative follow-up of the cases and coordinates the testing interventions.

The approach path and the methodology:

  • Patients are detected through the Maternity Hospital, where data are centralized into an Excel file; thus, data are also available to the health centres. 
  • The Health Centres are also detection sites, mainly through obstetricians and then gynaecologists and generalist physicians that are in charge of the monitoring of pregnancy.
  • Mass interventions (i.e. rapid tests) that are performed with the Foundation, at different strategic sites.

We ask them to provide information, like phone number and address, and tell them to come on a given day without a settled appointment. If the patient does not come, from the Health Centre we inform the Health Promoter, the administrative worker; they call the Social Worker so that those patients can be found and finally be attended at the centre. Thus, we can see what has happened to them, why they have not come, and how we can help facilitate access to consultation. 

Health care sites

The Foundation is in charge of training and follow-up of the interventions. Regarding administrative follow-up, we present the cases so that the Foundation helps and complements us in the calling of the patients, as well as in their record “well, we have a given number of patients in follow-up, a given number of patients in treatment, a given number of discharged patients ". All this administrative work, which very often may be laborious or difficult in some institutions, the Foundation makes this part available and speeds up and organizes the schedules.

Statistics and results

Let me try to help you understand the context: about 4,000 deliveries are attended annually at our Maternity Hospital, of which prevalence of Chagas disease is 1.2%. We have on average two births with congenital Chagas a year, which are treated at the moment, at the Chagas unit of the Maternity Hospital. We have performed about 30 treatments, 11 children have been treated, and 3 have been diagnosed at the Maternity Hospital. About 33% of the patients presented an adverse effect, one was a moderate neurological effect. This is always important because the percentage of adverse effects is high, most of them are mild; so the fact that we can give the phone number to the patients makes the situation easier, since at the onset of symptoms, such as dermatological ones, we can start to support the patients, to calm them down. Regardless of the fact that we are going to provide all the information necessary to start the treatment, direct and close contact makes treatment more familiar and personal. 

I’d like to convey the message that it’s not difficult, it’s not impossible. If the approach advances slowly and gradually, the truth is that it should not have further difficulties. This is a pathology that can be tackled simply by talking with the neighbour to raise awareness of the importance of treatment, talking with the actors involved in the circuit (zoonosis, the Foundation, the Municipality). It is very feasible, simple and transferable.