title: Towards a theoretical model on medicines as a health need.
abstract: Medicines are considered one of the main tools of western medicine to resolve health problems. Currently, medicines represent an important share of the countries' healthcare budget. In the Latin America region, access to essential medicines is still a challenge, although countries have established some measures in the last years in order to guarantee equitable access to medicines. A theoretical model is proposed for analysing the social, political, and economic factors that modulate the role of medicines as a health need and their influence on the accessibility and access to medicines. The model was built based on a narrative review about health needs, and followed the conceptual modelling methodology for theory-building. The theoretical model considers elements (stakeholders, policies) that modulate the perception towards medicines as a health need from two perspectives - health and market - at three levels: international, national and local levels. The perception towards medicines as a health need is described according to Bradshaw's categories: felt need, normative need, comparative need and expressed need. When those different categories applied to medicines coincide, the patients get access to the medicines they perceive as a need, but when the categories do not coincide, barriers to access to medicines are created. Our theoretical model, which holds a broader view about the access to medicines, emphasises how power structures, interests, interdependencies, values and principles of the stakeholders could influence the perception towards medicines as a health need and the access to medicines in Latin American countries.
authors.affiliation: Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil; WHO Collaborating Centre for Pharmaceutical Policy & Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), David de Wied Building, Universiteitsweg 99, Utrecht, The Netherlands. Electronic address: cmvargasp@unal.edu.co.
authors.forename: Claudia Marcela
authors.initials: CM
authors.lastname: Vargas-Peláez
authors.affiliation: Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - Univille, Rua Paulo Malschitzki, 10 - Bom Retiro, Joinville, Santa Catarina, Brazil. Electronic address: soaresgnosia@gmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Soares
authors.affiliation: Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil. Electronic address: marinarover@yahoo.com.br.
authors.forename: Marina Raijche Mattozo
authors.initials: MR
authors.lastname: Rover
authors.affiliation: Departamento de Farmacociências, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245 - Cidade Baixa, Porto Alegre, Rio Grande do Sul, Brazil. Electronic address: carine.blatt@gmail.com.
authors.forename: Carine Raquel
authors.initials: CR
authors.lastname: Blatt
authors.affiliation: WHO Collaborating Centre for Pharmaceutical Policy & Regulation, Utrecht Institute for Pharmaceutical Sciences (UIPS), David de Wied Building, Universiteitsweg 99, Utrecht, The Netherlands. Electronic address: a.k.mantel@uu.nl.
authors.forename: Aukje
authors.initials: A
authors.lastname: Mantel-Teeuwisse
authors.affiliation: Fundación IFARMA, Colômbia, Carrera 13 # 32-51, Torre 3 Oficina 1116, Bogotá, Colombia. Electronic address: frossi@ifarma.org.
authors.forename: Francisco Augusto
authors.initials: FA
authors.lastname: Rossi Buenaventura
authors.affiliation: Fundación IFARMA, Colômbia, Carrera 13 # 32-51, Torre 3 Oficina 1116, Bogotá, Colombia. Electronic address: luisguirestrepo@gmail.com.
authors.forename: Luis Guillermo
authors.initials: LG
authors.lastname: Restrepo
authors.affiliation: Fundación IFARMA, Colômbia, Carrera 13 # 32-51, Torre 3 Oficina 1116, Bogotá, Colombia. Electronic address: latorremariacristina@yahoo.com.
authors.forename: María Cristina
authors.initials: MC
authors.lastname: Latorre
authors.affiliation: Departamento de Farmacia, Universidad Nacional de Colombia, Carrera 30 No. 45-03, Edificio 450, Oficina 214, Bogotá D.C., Colombia. Electronic address: jjlopezg@unal.edu.co.
authors.forename: José Julián
authors.initials: JJ
authors.lastname: López
authors.affiliation: Independent researcher. Electronic address: tereburgin@yahoo.com.ar.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Bürgin
authors.affiliation: Escuela Latinoamericana de Postgrados (ELAP) - Universidad de Artes y Ciencias Sociales (Arcis), Erasmo Escala 2728, Santiago, Chile. Electronic address: consuelo1silva@gmail.com.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Silva
authors.affiliation: Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil. Electronic address: silvana.nair@hotmail.com.
authors.forename: Silvana Nair
authors.initials: SN
authors.lastname: Leite
authors.affiliation: Programa de pós-graduação em Farmácia, Universidade Federal de Santa Catarina, Campus Universitário Trindade - Florianópolis, Santa Catarina, Brazil. Electronic address: marenif@yahoo.com.br.
authors.forename: Farias
authors.initials: F
authors.lastname: Mareni Rocha
mesh_terms: D004992:Ethics, Medical; D006291:Health Policy / Q000191:economics; D006297:Health Services Accessibility / Q000941:ethics* / Q000639:trends; D006301:Health Services Needs and Demand / Q000941:ethics*; D006801:Humans; D007843:Latin America; D008509:Medication Systems / Q000191:economics* / Q000941:ethics; D008962:Models, Theoretical
keywords: Access to medicines; Essential medicines; Health needs; Human needs; Theoretical framework