Ciencia & saude coletiva最新文献

[This corrects the article doi: 10.1590/1413-812320242911.08022023] [This corrects the article doi: 10.1590/1413-812320242911.08022023EN].

[This corrects the article doi: 10.1590/1413-812320242911.16402023] [This corrects the article doi: 10.1590/1413-812320242911.16402023EN].

[This corrects the article doi: 10.1590/1413-812320242911.14452023].

Tuberculosis continues to be a severe public health problem in the country, with high incidence and mortality rates, especially among vulnerable populations. The introduction of bedaquiline into the Unified Health System (SUS) in 2021 represented significant progress, but it also reveals the need for a comprehensive approach to ensure equitable access to treatment. This longitudinal case study, carried out from 2018 to 2024, analyzes the barriers that prevent the public production of bedaquiline in Brazil. The study describes the epidemiological scenario of tuberculosis and characterizes the bedaquline market, with data on medicine marketing authorization, production, acquisitions, and patent landscape. The study explores the barriers that prevent the public production of bedaquiline, discusses intellectual property issues, and analyzes the impact of a monopoly on prices and access to the medicine. The analysis concludes that the public production of bedaquiline is essential for the sustainability of access to drug-resistant tuberculosis treatment in Brazil, reducing costs and ensuring the availability of the medicine for all patients.

Through a scoping review conducted using the PRISMA-ScR framework, this study sought to identify and analyze the scientific literature on the regulation of access to specialized elective services in the SUS between 2013 and 2022. Searches were performed in the PubMed/MEDLINE and LILACS databases in the Virtual Health Library (VHL) and in the SciELO database. A total of 25 publications were identified after applying eligibility criteria and excluding duplicates. To organize and analyze the results, three analytical categories were used: the concept of regulation; regulatory processes and practices; and regulation as a producer of care. The concepts of health regulation identified in the literature are primarily associated with normative acts, with no significant conceptual advances observed over the past decade. The articles describe and discuss tools, work processes, and regulatory practices aimed at promoting comprehensive care and equitable, timely access. However, few studies address the potential of regulatory processes in the actual production of care. The findings point to the need for theoretical developments and the implementation of public policies that advance a conception of regulation as a producer of comprehensive care, capable of overcoming the fragmentation of health systems.

The National Pharmaceutical Care Policy (Política Nacional de Assistência Farmacêutica - PNAF) is defined by the National Health Council as essential to the realization of the constitutional right to health. It is a cross-cutting and intersectoral policy that coordinates state and municipal managers at different levels of care in the Unified Health System (SUS). The objective was to identify and analyze the aspects of Pharmaceutical Care (PC) in the fight against COVID-19 in the state of São Paulo from the perspective of local and regional SUS managers, based on the PNAF. This is a mixed-method, multiple-case study with structured quantitative questionnaires and semi-structured qualitative interviews. Responses were obtained from 255 municipal managers (39.5%), representing 29,039,968 inhabitants (65.4% of the state population), and 14 regional health directors (82% of the Health Regions). This study identifies and analyzes 'What are the contributions of the PNAF to addressing the COVID-19 pandemic in the state of São Paulo?' The results revealed: joint action by federal entities, decentralization of PC, access to and rational use of medicines, irrational use of medicines from the COVID kit, tensions between managers, prescribers, pharmaceutical professionals and users, and supply difficulties.

The National Pharmaceutical Services Policy (PNAF) was the first public policy created through social oversight. The consolidation of the National Health Council as a democratic, pluralistic, and activist space, especially in the approval of the PNAF, coincides with a strategic moment in Brazilian foreign policy and health diplomacy, focused on reconfiguring global geopolitics, especially in North-South relations. This article analyzes how Brazilian foreign policy has been coordinated with the defense of Health on the international stage over the past 20 years, especially in negotiations that affect access to safe, effective, high-quality, and affordable medicines. This qualitative, descriptive study is grounded in Brazilian Foreign Policy (BFP), innovation, and intellectual property rights. It concludes that the decolonization of Health in the Global South, especially in the post-pandemic backdrop, requires a renewed commitment to equity, social justice, and the human right to health. Brazil, with its experience in Public Health policies and local medicine production, can spearhead this transformation.

The aim of this study was to assess the trend in cesarean section rates in three birth cohorts conducted in Ribeirão Preto, São Paulo, Brazil, in different years (1978/79, 1994, and 2010), and to investigate the sociodemographic and economic factors associated with cesarean delivery in these cohorts. Data were obtained from the database of the cohorts. Women were interviewed shortly after delivery and information was collected from their medical records. The chi-square test was used to compare the proportion of covariates between modes of delivery. Unadjusted and adjusted Poisson regression models were applied to evaluate the association between cesarean section and the covariates studied in the three cohorts, with the significance level set at α < 0.05. There was a marked upward trend in cesarean delivery across the cohorts. The increase was more pronounced among women with higher educational levels, older age, and better socioeconomic conditions. In adjusted analyses, sociodemographic and economic variables remained significantly associated with a higher likelihood of cesarean delivery in all cohorts.

Ensuring access to medicines is a state human rights obligation derived from the right to health, interdependent and interrelated with other human rights, such as the right to enjoy the benefits of scientific progress and the right to protection of intellectual property. The structures and relationships of international politics have been affected by intense global trade flows, rules, and institutional dynamics that reduce the responsiveness of states and increase vulnerability to preventable disease and death. The study critically analyzes the regulations of the United Nations International Health System, responsible for monitoring, in three categories: Innovation, scientific research, and intellectual property; Market, price, and affordability; Interventions in health systems. The ethical-political perspective of human rights in protecting vulnerable individuals and populations, the social function of intellectual property, and scientific progress in access to medicines are minimized. Although the regulations address human rights concerns, they adopt liberal measures focused on economic efficiency and rationing to ensure the system's sustainability. However, these measures have proven ineffective at guaranteeing access to healthcare.

The price of antiretrovirals (ARVs) continues to be a challenge to guarantee universal, comprehensive, and equitable pharmaceutical services. This article aimed to analyze the acquisition of the most widely used ARV in Brazil, comparing national and international prices. Our study conducted a documentary analysis of the history of the national procurement of dolutegravir (DTG) from 2017 to 2023. The price comparison was based on reports from the Clinton Health Access Initiative (CHAI), considering exchange rate and inflation variations. In 2022, generic versions from Farmanguinhos and Lafepe were distributed, but a patent barrier restricted the procurement from Lafepe. A major difference was found between national and international prices, even with the entry of generics into the Brazilian market; in 2023, the price of international generics was almost 12 times lower than that of the national procurement. The DTG case highlights the importance of monitoring prices, patent barriers, and local production, and of becoming familiar with the structure of production costs in order to negotiate fair prices and ensure the sustainability of the national pharmaceutical assistance policy.