Strategies to improve the availability of medicines in primary health care in Brazil: findings and implications

Barbosa, Mariana Michel; Nascimento, Renata Crm; Garcia, Marina Morgado; Acúrcio, Francisco de Assis; Godman, Brian; Guerra, Augusto Afonso; Álvares-Teodoro, Juliana

doi:10.2217/cer-2020-0125

Cited by 4 publications

(2 citation statements)

References 36 publications

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“…Accordingly, our findings provide support for the need to appraise and implement evidencebased and cost-effective strategies that help to reduce the burden of diabetes-related microvascular complications. Such strategies may include those for optimizing lifestyle management [36], addressing the non-uniformity of access to and availability of essential medicines within the SUS [37,38], for example through programs such as the Pharmacy Network of Minas (Rede Farmácia de Minas [RFM]) [39], and strategies to improve suboptimal treatment adherence among patients with diabetes [40].…”

Section: Discussionmentioning

confidence: 99%

Cost of microvascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil

Julian¹,

Pititto²,

Miresashvili

et al. 2021

Journal of Medical Economics

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Section: Discussionmentioning

confidence: 99%

Cost of microvascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil

Julian¹,

Pititto²,

Miresashvili

et al. 2021

Journal of Medical Economics

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“…Despite significant incentives and guidance included in the Brazilian medicines-related legal framework throughout more than 20 years of the BNMP publication ( Bermudez et al, 2018 ), there is still great difficulty in achieving the goals of the PCHPS in the country, especially regarding medicine supply and logistics. A nationwide study found an average availability of tracer medicines in PCHPS of only 52.9% ( Nascimento et al, 2017 ), while a state-level study found an availability index verified by stock levels of 61.0% ( Barbosa et al, 2021 ). To 9.7% of Municipal Health Secretaries the financial resources are perceived as sufficient to cover medicines demanded by patients ( Faleiros et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

An analysis of the essential medicines policy in primary care: Findings from MedMinas project

et al. 2022

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Background: 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.Methods: 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.Results: 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.Conclusion: 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.

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Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives

Hemmeda,

Koko,

Mohamed

et al. 2023

Int J Equity Health

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Background Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn’t well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients’ perceived affordability of essential medicines, and accommodation and acceptability of the public facility. Methods A cross-sectional study was carried out at 30 primary healthcare facilities’ drug dispensaries across three districts in Khartoum state. Within each Centre’s dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan’s national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26. Results Participants’ ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets. Conclusion Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients’ access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients’ satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan.

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Strategies to improve the availability of medicines in primary health care in Brazil: findings and implications

Cited by 4 publications

References 36 publications

Cost of microvascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil

Cost of microvascular complications in people with diabetes from a public healthcare perspective: a retrospective database study in Brazil

An analysis of the essential medicines policy in primary care: Findings from MedMinas project

Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives

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