Assessment

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(No Transcript)
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Brazil Assessment State of Minas Gerais
Francisco Acurcio Josiano Gomes Chaves
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Minas Gerais, Brazil
UNDP 1998, World Bank 2000
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Health Care Delivery System

• Public
• 1989 Unified Health System (SUS)
• 70 of total health expenditures
• Democratization, accessibility, equity
• Decentralized management model

Federal policy, planning, assessment State
service coordination, distribution of financial
resources Municipal goods and services delivery
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Pharmaceutical Sector

• 5th largest in the world
• 1997 Patent Law, 1998 National Drug Policy, 1999
  Generics Law
• MOH expenditures on drugs US 691 million, plus
  municipal resources
• Exceptional, Strategic, Mental Health, Drugs
  Programs
• Basic Pharmacy Program

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Geographic Accessibility
Average number of facility operating hours per day
Hours
Less then 1 of the population did not
receive care due to problems with transportation
or distance
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Availability
Percent
Set of un-expired tracer items in stock
Prescribed items that are dispensed
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Affordability

• 25 of the population covered by a risk sharing
  scheme
• 1.13 of the population reporting a problem with
  affordability
• 0.82 days of work required to pay for treatment
  of ARI
• Average percentage difference between most and
  least expensive unit prices within private
  pharmacies 105
• Average percentage difference of lowest prices
  between private pharmacies 326

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Acceptability

• 5 of the top 10 most sold prescription
  drugs are on RENAME
• 97.6 respondents evaluated service as good or
  very good

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Quality of Products and Services
Tracer drugs that failed quality testing

• Drugs tested
• Amoxicillin
• Captopril
• Co-trimoxazole
• Hydrochlorothiazide
• Mebendazole
• Metronidazole
• Paracetamol
• Rifampicin/Isoniazid

Percent
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Quality of Products and Services (2)

• Percentage of facilities reporting access
  to at least one source of information
• SUS (Public) 52
• NGO facilities 85
• Private facilities 77
• Pharmacies 100

• Percentage of medications for which patients
  received information from a SUS (Public)
  physician
• 86 (name)
• 88 (use)

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Quality of Products and Services (3)
Percent
Drugs prescribed by generic name
Encounters prescribed antibiotics
Simulated patients prescribed antibiotics
Drugs on RENAME
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Quality of Products and Services (4)

• Patient knowledge of medications

• SUS (Public) facilities (patient exit
  interviews)
• Name of medication identified 59.7
• Reason for use of medication 79.5
• Information on use of medication understood
  88.3
• Pharmacies (simulated patients)
• 42 medications for which use information given
  (simulated patients)

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Access Gaps

• Availability
• SUS (public) patients buy drugs
• Inefficient procurement at municipal level
• Quality
• Prescribing and dispensing RENAME drugs
• Patient/consumer information
• Product quality
• Patient compliance

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Potential Strategy
SUS Outpatient Clinics Writing Prescriptions
Microregional Health Admin.
Essential Medications to Patients with SUS card
Manufacturer/ Importer
Wholesaler/ Distributor
Retail Pharmacies
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Viability

• Facilitators
• SUS maturity
• SUS technology (card and data base)
• Interest, capacity on part of private sector
• Barriers
• Lack of contract management capacity
• Resistance from local managers/politicians