Luz Tatiana Chama Borges, Tavares Noemia Urruth Leão, Marques Isabela Cristina, de Castro Ana Karine Sarvel, Cota Betania Barros
GETESA (Grupo de Estudos Transdisciplinares em Tecnologias em Saúde e Ambiente), René Rachou Institute (IRR), Oswaldo Cruz Foundation (FIOCRUZ), Belo Horizonte, Brazil.
Strathclyde Institute of Pharmacy and Biomedical Sciences (SIPBS), Strathclyde University, Glasgow, United Kingdom.
Front Pharmacol. 2022 Oct 17;13:953329. doi: 10.3389/fphar.2022.953329. eCollection 2022.
Essential Medicines Policy (EMP) has been adopted in Brazil to improve the provision and use of pharmaceuticals. This mixed methods study aims to bring evidence of the EMP implemented in municipalities in the context of primary care in Minas Gerais (20,997,560 inhabitants), Southeast Brazil. We analysed the core output of the EMP, i.e., the municipal essential medicines lists (MEML) and the effects of the policy on the procurement and availability of medicines. Data sources included a sample of 1,019 individuals (patients, health managers and health professionals), 995 prescriptions, 2,365 dispensed medicines and policy documents from 26 municipalities. Data were collected between April and October 2019. Document analysis and thematic content analysis were performed, and four availability indexes were estimated. The findings suggest an overall lack of standardised and methodologically sound procedures to elaborate the MEML. Funding and public purchasing processes were found to be the major obstacles to medicine procurement. Only 63% of medicines were available at public community pharmacies and just 46.2% of patients had full access to their pharmaceutical treatment. This study reveals weaknesses in the implementation of EMP and a clear disconnection between medicines selection, procurement, and availability, the three core elements of the supply system. These findings contribute to informing future policy improvement actions to strengthen this system. Other countries aiming to advance towards universal health coverage may learn from the challenges that primary care in Brazil still needs to address.
巴西已采用基本药物政策（EMP）来改善药品的供应和使用。这项混合方法研究旨在提供在巴西东南部米纳斯吉拉斯州（20,997,560名居民）初级保健背景下各城市实施EMP的证据。我们分析了EMP的核心产出，即城市基本药物清单（MEML）以及该政策对药品采购和供应的影响。数据来源包括来自26个城市的1,019个人（患者、卫生管理人员和卫生专业人员）样本、995份处方、2,365份配药以及政策文件。数据收集于2019年4月至10月之间。进行了文件分析和主题内容分析，并估算了四个供应指数。研究结果表明，制定MEML总体上缺乏标准化且方法合理的程序。资金和公共采购流程被发现是药品采购的主要障碍。只有63%的药品在公共社区药房有供应，只有46.2%的患者能够完全获得药物治疗。这项研究揭示了EMP实施中的弱点，以及供应系统的三个核心要素——药品选择、采购和供应之间明显的脱节。这些发现有助于为未来加强该系统的政策改进行动提供信息。其他旨在推进全民健康覆盖的国家可能会从巴西初级保健仍需应对的挑战中吸取教训。
