Ciencia & saude coletiva最新文献

Public Health is a fundamental social right, and the State is responsible for ensuring universal and equitable access through public policies. This duty is shared among the Federal Government, states, the Federal District, and municipalities, which hold legislative and administrative powers to safeguard health. With the creation of the Unified Health System (SUS), comprehensive care, including pharmaceutical therapy, became a guaranteed right. Intergovernmental coordination, through agreements and fund transfers, seeks to promote equity in access to medicines in Primary Health Care. Challenges related to funding, resource distribution, and the roles of each governmental entity still spark debates among managers and researchers. This article examines the advances and perspectives in access to medicines in Primary Health Care, discussing the combination of decentralization and centralization, along with cooperation among governmental entities, and its importance in ensuring universal and comprehensive access to Brazilian health services. Intermunicipal consortia, such as the Paraná Saúde Consortium®, exemplify successful solutions for coordinating access to medicines, showing the need for flexibility in addressing regional diversity and ensuring system comprehensiveness.

[This corrects the article doi: 10.1590/1413-81232025307.05232023EN].

Chronic non-communicable diseases (NCDs) significantly contribute to global mortality and diminished quality of life, placing a growing burden on healthcare systems. The World Health Organization has developed cost-effective strategies to manage these diseases, entitled "best buys", by addressing major risk factors for NCDs, such as smoking, alcohol use, unhealthy diets, and physical inactivity. Pharmacies, as accessible healthcare facilities, are well-positioned to support preventive care and behaviour change, including tobacco and alcohol cessation, dietary modifications, and physical activity promotion. Legislation in some countries, like Portugal, empowers pharmacies to deliver health promotion services to the communities they serve. Strengthening collaboration between pharmacies, other healthcare services, and public health authorities can amplify the impact of these initiatives, improving population health outcomes.

The Stork Network (SN) strategy was created to guarantee comprehensive care and address high maternal and infant mortality rates. The aim of this study was to assess the actions developed by the SN across municipalities in the state Pernambuco and the association between these actions and prenatal care quality indicators. We conducted a multi-group ecological study of Component I of the SN in Pernambuco using data from audits conducted under the state component of the National Audit System for the period 2017 to 2020. We explored the association between ten actions and the prenatal care quality indicators. The indicators with the highest ratings were "improved access to high-risk prenatal care", "rapid syphilis/HIV testing" and "laboratory testing for low and high risk pregnant women". The indicator with the strongest association to mean congenital syphilis rate was rapid testing for syphilis/HIV. Two indicators showed a statistically significant association with mean perinatal mortality rate: "improved access to high-risk prenatal care" and "support for travel". We conclude that the organizational management of the SN in Pernambuco and provision of services under component I did not meet the objectives of strategy. Our findings demonstrate the potential of auditing for supporting policy implementation.

The integrality of care is one of the core principles of the National Policy of Pharmaceutical Assistance (Política Nacional de Assistência Farmacêutica - PNAF) and underpins two tools that guide the use of medicines: clinical protocols and therapeutic guidelines (protocolos clínicos e diretrizes terapêuticas - PCDT) and the lists of essential medicines. municipalities are encouraged to use these for healthcare management, but the development of municipal lists (relações municipais de medicamentos essenciais - Remume) presents weak points. The aim is to describe potential impacts on the implementation of PCDT from the perspective of the unavailability of medicines from the Basic Component of Pharmaceutical Assistance (Componente Básico da Assistência Farmacêutica - CBAF) in Remume. The CBAF medicines included in the PCDT until June 2023 were extracted. Forty-eight municipalities were selected for the Remume search and verification of the medicines of interest. Each PCDT was analyzed according to the lack of the least found medicines. The Remume contained, on average, 60% (44-75%) of the listed medicines, and the average coverage of each PCDT ranged from 2% to 100%. Of 62, 11 PCDT were impacted by the low availability of medicines. A lack of coverage of CBAF medicines in Remume was identified, which may challenge the implementation of PCDT.

The oil spill disaster that affected 11 states along the Brazilian coast in 2019/2020 is considered the largest in Brazil's history, with approximately five tons of oil residues collected. Small-scale fishers (SSF) were the group at greatest risk of exposure. This article describes the study design and questionnaire validation of the first epidemiological study in Brazil aimed at investigating the potential health effects of this disaster on SSF. The questionnaire was validated using the Delphi method and consists of 325 questions organized into 13 sections: identification and control, general information, socioeconomic conditions and living situation, work history and organization, fishing activities during the spill, exposure related to spill cleanup, seafood consumption, perceived impacts of the spill, clinical measurements, additional health information, lifestyle, quality of life, and COVID-19. The study design incorporated community engagement approaches. The results will enable the assessment of associations between oil exposure and health outcomes, the monitoring of long-term health effects in this population, and the analysis of the occupational and socioeconomic impacts of the disaster.

This study aimed to analyze the evolution in the incorporation of psychotropics into National List of Essential Medicines (Relação Nacional de Medicamentos Essenciais - RENAME) and whether the current list meets the burden of mental disorders in Brazil. Requests for psychotropics sent to National Commission for the Incorporation of Technologies in the SUS (Comissão Nacional de Incorporação de Tecnologias no SUS - CONITEC) between 2012 and December 2024 were collected and the number of psychotropics for mental disorders in the last eight versions of RENAME was analyzed, as compared to the World Health Organization (WHO) list. Next, the relationship between the number of psychotropics in RENAME 2024 and the burden of disease in Brazil according to the DALY indicator was analyzed. Eleven requests for psychotropics were sent to CONITEC, equivalent to 1.0% of the total, while 90.9% of the demands referred to the incorporation and 9.1% to the expansion of use. Between 2010 and 2014, an increase was observed in the incorporation of psychotropics in RENAME, but the following RENAMEs were not changed. RENAME 2024 includes 18 psychotropics, and 66.7% are funded by the Basic Component. There is a disproportionate relationship between the number of medications for anxiety and depression in RENAME and the high burden of these diseases in Brazil. The findings indicate that the lack of review of RENAME may be impacting the mental health needs of the Brazilian population.

The National Pharmaceutical Policy (Política Nacional de Assistência Farmacêutica - PNAF) takes regional priorities into account. In the Amazon region, social and geographic accessibility indicators are crucial for improving access and ensuring health equity. This study analyzed the organization of pharmaceutical management in 18 municipalities in the countryside of the state of Amazonas. Social, demographic, and structural indicators were described. Medicines accessibility settings (Unidades de Acessibilidade a Medicamentos - UAM), medicine accessibility support settings (Pontos de Apoio à Acessibilidade de Medicamentos - PAAM), and pharmacists were identified. Coverage factors related to Health Centers, territory and population, as well as pharmacists per UAM and per inhabitant, were calculated and suported by selected statements. Access to both the capital city and the most distant village was analyzed. There was at least one UAM in each municipality, and 74% of the establishments stocked medicines. This figure varied between more centralized and decentralized municipalities, with integration with other structures increasing medicine accessibility. The 91 PAAMs serve as a strategy to further increase accessibility, particularly in remote areas with limited infrastructure. The workforce is diversified, with at least one pharmacist in each setting. The synergy between primary health care and pharmaceutical services proved crucial.

This study analyzes the regulatory mechanisms governing the integration of pharmaceutical services between high-complexity oncology care and primary health care within the Brazilian Unified Health System. The fragmented care levels undermine treatment continuity, particularly for oncology patients who require ongoing follow-up across both settings. A document analysis of federal regulations in effect from 1990 to 2024 was conducted to identify barriers and facilitators to this integration. The findings indicate that, although normative guidelines are in place, significant challenges persist, including unequal access to expensive medicines, the lack of integrated health information systems, and discontinuous pharmacotherapeutic follow-up. The study advocates for shared care, emphasizing greater collaboration among healthcare teams as a strategy to streamline pharmacotherapy management and ensure care continuity. It concludes that updated regulatory frameworks and coordinated practices are essential to overcoming a fragmented system and ensuring comprehensive and equitable care within the Brazilian Unified Health System.