Evaluation of social protection for people affected by tuberculosis: development of an indicator matrix for Brazil

BACKGROUND: In the context of tuberculosis elimination, social protection seeks to mitigate multiple forms of vulnerability experienced by people affected by the disease, addressing both biological and social factors and directly targeting the social determinants of health. However, in Brazil, the absence of standardized conceptual tools and process indicators to assess the operationalization and implementation of intersectoral actions and services related to social protection for tuberculosis control highlights the need for an instrument capable of evaluating how the social protection network functions for people affected by tuberculosis. METHODS: This methodological study was conducted in Brazil to develop and validate an instrument comprising indicators for measuring and assessing the implementation of social protection actions for people affected by tuberculosis. In the first stage, a literature review and document analysis were carried out, resulting in the development of a Logic Model to guide the construction of the Evaluative Matrix. The second stage involved content validation of the matrix using the Delphi method, with the aim of reaching satisfactory Content Validity Indices (CVI > 0.80) through expert consensus. Nine experts participated in the first round and seven in the second. RESULTS: The Evaluative Matrix was validated with satisfactory CVI scores, demonstrating significant expert consensus. It offers a comprehensive mapping of the national landscape of social protection for people affected by tuberculosis. The instrument comprises 20 evaluative categories and 53 indicators, each with defined parameters and data sources, distributed across 11 subdimensions derived from four main dimensions of the Logic Model: (I) the right to health; (II) the right to social assistance; (III) the right to social security; and (IV) shared responsibilities. CONCLUSIONS: This study presents an innovative evaluation tool to support managers and decision-makers in designing and improving social protection strategies within health policies for people affected by tuberculosis, while accounting for diverse local contexts. It aims to accelerate progress toward tuberculosis elimination by addressing poverty and other social determinants, and by protecting the human rights of people with tuberculosis and their families.