Health systems research training as a tool for more effective Hansen's disease control programmes in Brazil.

In Brazil, Hansen's disease (HD) is still a public health problem. Although much progress has been made in Hansen's disease control (HDC) at all levels of government over the past 20 years, efforts have been hampered by information gaps related to specific areas of the disease, exacerbated by an absence of appropriate evaluation instruments and routine systematic analysis. Health Systems Research (HSR) aims to collect the necessary data to provide the most relevant information to policy makers and health managers to take more informed decisions. In Brazil, four HSR courses on HDC were organized by two non-governmental organizations (NGOs), Netherlands Leprosy Relief (NLR) and the British Leprosy Relief Association (LEPRA) between 2001 and 2005. Key personnel working in HDC from various states were invited to participate in the courses. The research proposals were developed during an HSR workshop and carried out in the field. The research topics of the projects included the following: the integration of HDC programmes into the primary health care system; the high percentage of the new patients diagnosed and treated at state referral centres; the psychological and social impact of surgical rehabilitation; the efficacy of neurolysis; the quality of the national health information system and the effectiveness of new case detection and health education campaigns. Following the completion of the field work, the data were analysed and a research report written. The results and recommendations were later presented to key stakeholders and policy makers in the states. Practical outcomes of the HSR courses include the drafting of new HDC guidelines; improvement of health information system databases and the revision of epidemiological data. These results have been presented at national and international congresses and published in peer-reviewed jornals. HSR has had a positive impact on the working routines of trainees through the process of learning the research methodology, collecting relevant data and implementing the recommendatons that originate from the findings. We conclude that HSR is an important vehicle for human resource development and a practical tool to improve the effectiveness of HDC programmes, primarily at the state and municipal levels. HSR also is an example of a successful cooperation between NGOs and governmental organizations working in HDC.