Financing of Pharmaceutical Services in the municipal management of the Brazilian Unified Health System

ABSTRACT OBJECTIVE To discuss factors related to the financing of the Basic Component of Pharmaceutical Services within the municipal management of the Brazilian Unified Health System. METHODS The Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services) is a cross-sectional, exploratory, and evaluative study that performed an information survey in a representative sample, stratified by Brazilian regions It considered different study populations in the sampling plan, which represent primary health care services in the cities. Data were collected in 2015 by two methods: in person, by applying direct observation scripts and interviews with users, physicians, and professionals responsible for the dispensing of medicines in primary care services; by telephone interviews with municipal health managers and municipal professionals responsible for Pharmaceutical Services. The results were extracted from the questionnaires applied by telephone. RESULTS Of the sample of 600 eligible cities, we collected 369 interviews (61.5%) with secretaries and 507 (84.5%) with pharmaceutical services managers. 70.8% of the cities have a computerized management system; and 11.9% have qualification/training of professionals. More than half (51.3%) of the cities received funds for the structuring of pharmaceutical services, and almost 60% of these cities performed this type of spending. In 35.4% of cases, municipal secretaries of health said that they use resources of medicines from the Componente Básico da Assistência Farmacêutica (CBAF – Basic Component of Pharmaceutical Services) to cover demands of other medicines, but only 9.7% believed that these funds were sufficient to cover the demands. The existence of a permanent bidding committee exclusively for acquiring medicines was reported in 40.0% of the cities. CONCLUSIONS We found serious deficiencies in the public financing of medicines, as well as little concern about the formality in the use of public resources, expenses that meet individual demands to the detriment of the community, insufficient resources allocated to the Basic Component of Pharmaceutical Services, and exhaustion of the financing model.摘要 研究目的：探讨巴西统一卫生系统（Brazilian Unified Health System）市级管理框架下，药学服务基本组分（Basic Component of Pharmaceutical Services, CBAF）的筹资相关影响因素。 研究方法：本研究采用巴西全国药物可及性、使用及合理用药推广调查——服务模块（Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil – Serviços，简称PNAUM——National Survey on Access, Use and Promotion of Rational Use of Medicines – Services），属于横断面、探索性及评价性研究，以巴西各区域分层的代表性样本开展信息调研。抽样方案涵盖多类研究人群，代表各城市的基层医疗卫生服务机构。数据采集工作于2015年完成，采用两种方式：一是现场调研，通过直接观察量表以及对基层医疗卫生机构的使用者、医师、药品配发负责人进行访谈；二是对市级卫生管理者及市级药学服务负责人开展电话访谈。本研究结果均源自电话访谈回收的问卷。 研究结果：在600个符合纳入标准的城市样本中，共回收369份卫生局长访谈问卷（回收率61.5%）以及507份药学服务管理者访谈问卷（回收率84.5%）。其中70.8%的城市配备了信息化管理系统，11.9%的城市开展了专业人员资质培训。超过半数（51.3%）的城市获得了药学服务体系建设专项经费，其中近60%的城市落实了此类经费支出。在35.4%的受访城市中，市级卫生局长表示其使用药学服务基本组分（CBAF）的药品经费填补其他药品的需求缺口，但仅9.7%的管理者认为该经费足以覆盖相关需求。仅40.0%的城市设立了专门的药品采购常设招标委员会。 研究结论：本研究发现，药品公共筹资存在严重不足，同时存在对公共资源使用规范性重视不足、经费优先覆盖个体需求而非社区公共需求、药学服务基本组分拨款不足以及筹资模式难以为继等诸多问题。