Farmácia Popular Program: changes in geographic accessibility of medicines during ten years of a medicine subsidy policy in Brazil.
OBJECTIVE
The Brazilian constitution guarantees the right to health, including access to medicines. In May 2004, Brazil's government announced the "Farmácia Popular" Program (FPP) as a new mechanism to improve the Brazilian population's access to medicines. Under FPP, a selected list of medicines is subsidized by the government and provided in public and private pharmacies. The aim of this study is to describe the historical stages of the FPP and to identify associated changes in the geographical accessibility of medicines through the FPP over time.


METHODS
It was performed documentary review and an ecological study assessing program coverage in terms of number of facilities and a FPP Pharmacy Facilities Density (PFD) index at national and regional levels from 2004 to 2013, using the FPP database. We used geographic information system mapping to depict a pharmaceutical facilities density (PFD) index at the municipality level on thematic maps.


RESULTS
A growth of the PFD index coincident with the phases of the FPP was noticed. In the public sector, the program started in 2004; by 2006, there was a sharp increase in the numbers of participating pharmacies, stabilizing in 2009. In the private sector, the program started in 2006; by 2009 the PFD ratio had increased substantially and it continued to grow through 2011. There was an increase in FPP coverage in most regions between 2006, when the private pharmacy component started, and 2013, but participating pharmacies remain unequally distributed across geographical regions. Specifically, the wealthy areas in the South and Southeast have higher coverage, with lower coverage mostly in the North and Northeast, relatively poorer areas with greater need for access to medicines, health care, and other basic services such as potable water and sanitization.


CONCLUSIONS
There has been a substantial increase in the number of pharmacies participating in the FPP over time. This has led to greater program coverage and has potentially improved access to FPP medicines in the country. Nevertheless, disparities in pharmacy coverage remain among the regions.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA ; Nucleus for Pharmaceutical Policies, National School of Public Health, Oswaldo Cruz Foundation, 1480, Rua Leopoldo Bulhões # 624, Manguinhos, 21021-000 Rio de Janeiro, RJ Brazil.
Isabel Cristina Martins
IC
Emmerick
Departamento de Assistência Farmacêutica/Secretaria de Ciência Tecnologia e Insumos estratégicos - Ministério da Saúde - Brasil - DAF/SCTIE/MS Esplanada dos Ministérios, Bloco G, 8º andar, CEP: 70058-900 Brasília, DF Brazil.
José Miguel
JM
do Nascimento
Departamento de Assistência Farmacêutica/Secretaria de Ciência Tecnologia e Insumos estratégicos - Ministério da Saúde - Brasil - DAF/SCTIE/MS Esplanada dos Ministérios, Bloco G, 8º andar, CEP: 70058-900 Brasília, DF Brazil.
Marco Aurélio
MA
Pereira
Nucleus for Pharmaceutical Policies, National School of Public Health, Oswaldo Cruz Foundation, 1480, Rua Leopoldo Bulhões # 624, Manguinhos, 21021-000 Rio de Janeiro, RJ Brazil.
Vera Lucia
VL
Luiza
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215 USA.
Dennis
D
Ross-Degnan
Access; Brazil; Co-payment; Essential medicines; Government programs