Abstract
BackgroundIn the Brazilian public health system, primary health care (PHC) is provided by the municipalities and is considered the entry level of the Unified Health System (SUS). Governmental pharmaceutical services (PharmSes) are part of the SUS, including PHC, and are the most significant way in which patients access medicine and services. Considering the diversity of the country, the municipalities have the autonomy to decide how PharmSes are implemented. Even though policies and procedures should be implemented as expected by policy makers and experts, municipality characteristics may interfere with implementation fidelity. Therefore, this study evaluated the degree to which the PharmSes in PHC were delivered as intended in Brazilian municipalities.MethodsWe analysed data from a secondary database originating from a cross-sectional nationwide study carried out by the Ministry of Health and the World Bank from 2013 to 2015. Data on 465 municipalities and the Federal District were collected from 4939 governmental PharmSes. A rating system comprising 43 indicators was developed and applied to the dataset to obtain the implementation degree (ID) of each PharmSe. Additionally, the IDs of the two PharmSes dimensions and the nine components were measured.ResultsOverall, the ID of the PharmSes in Brazilian PHC was evaluated as critical. The ID was critical in 81% of the municipalities (n = 369), incipient in 14% (n = 65) and unsatisfactory in 4.8% (n = 22). Regarding the PharmSes dimensions, the ‘medicine management’ (MM) ID was considered critical (Mean = 46%), while the ‘care management’ (CM) ID was incipient (Mean = 22%). In terms of the PharmSes components, the highest ID was achieved by ‘forecasting’ (58%). In contrast, ‘continuing education and counselling’ showed the lowest figure (ID = 11%) in the whole sample, followed by ‘information and communication’ and ‘teamwork’.ConclusionsThe degree to which PharmSes were implemented was critical (ID< 50%). This analysis demonstrated that PharmSes were implemented with low fidelity, which may be related to the low availability of medicine in PHC. Although the care management component requires more attention, considering their incipient ID, all components must be reviewed. Municipalities must increase their investment in PharmSes implementation in order to maximize the benefits of these services and guarantee the essential right of access to medicine.
Highlights
In the Brazilian public health system, primary health care (PHC) is provided by the municipalities and is considered the entry level of the Unified Health System (SUS)
The general characteristics of the 4030 PharmSes are presented in Table 1 and indicate wide geographic and demographic diversity
We found that PharmSes implementation degree (ID) in Brazilian PHC is at a critical level
Summary
In the Brazilian public health system, primary health care (PHC) is provided by the municipalities and is considered the entry level of the Unified Health System (SUS). Pharmaceutical services (PharmSes) are part of the health system, including PHC They are provided free of charge in the SUS and are the most significant way in which patients access medicine and services [3]. PharmSes are defined as a set of actions in the health system aiming to guarantee continuous attention to the population’s health needs, both individually and collectively, through promoting equitable access to medicine and its adequate use. These actions must be developed by a pharmacist or under his or her supervision, always in cooperation with a PHC team, to improve people’s quality of life [4]
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