Research Project Spotlight: The impact of subsidy policies on access to and use of medicines in Brazil - ISAUM-BR

Disparities in pharmacy coverage remain among the regions

Research Project Spotlight: The impact of subsidy policies on access to and use of medicines in Brazil - ISAUM-BR

Principal Investigator: Isabel Emmerick, MS, PhD

This project is an international collaboration among Oswaldo Cruz Foundation (Fiocruz), the Federal University of Pelotas in Brazil and the Department of Population Medicine at Harvard Medical School in the United States, funded by Alliance for Health Policy and Systems Research. The goal is to describe and evaluate impacts of the Brazilian government medicines subsidy policies implemented between 2002 and 2012 on access to and use of medicines for diabetes, hypertension and asthma, using multiple sources of data. Using segmented regression analyses of interrupted time series (ITS) data, we are assessing changes in levels and trends of different outcome measures of interest.

Accomplishments of the project to date result from the partnership among stakeholders in different sectors sharing their knowledge and perspectives. Each partner is bringing important input to a fragmented set of pictures, which are being assembled into a coherent movie telling us the story about the Farmácia Popular Program evolution and its impacts on access to and use of medicines in Brazil.

During the two years of the project development, the research group faced challenges in securing data, organizing and preparing the analysis, analyzing data and reporting project findings. Challenges were addressed together with the Ministry of Health (MoH), which coordinates the research program. The research group organized two ISAUM-Br workshops, held at Fiocruz in May and December 2014 for representatives from the Department of Pharmaceuticals in the MoH and the research team.

These workshops were extremely important in the project development. The presentation of preliminary results to the entire team brought great value to the project, allowing a better view of the goals to be achieved and redirecting some approaches. Farmácia Popular managers in the MoH actively participated and were enthusiastic to analyze data they routinely collected and to discuss using the performance indicators proposed by our project, such as the medication adherence indicator (percentage of days covered with medication) and the individual user medication profiles over time. We expect that their participation increases the likelihood that project results will be translated to policy and incentivise the use of other routine data to inform decision making by the MoH.

In December 2014, the MoH invited the research team to present ISAUM-Br preliminary results in the 10th National Forum of Pharmaceutical Services held in Brasília. Researchers, health system managers and civil society (professional organizations) constituted the audience. At this time, the MoH designated the ISAUM-Br research team as an expert group on Farmácia Popular and charged it to lead a publication summarizing the findings from different research projects on Farmácia Popular policies.

The ISAUM-Br project’s first paper, “Farmácia Popular Program: Changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil”, was published in a thematic series of the Journal of Pharmaceutical Policy and Practice on medicines in countries moving toward universal health coverage. It reported a substantial increase in the number of pharmacies participating in the Farmácia Popular program over time. This has led to greater program coverage and has potentially improved access to selected medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.

This Research Project Spotlight is part of the upcoming Medicines in Health Systems Quarterly newsletter.

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