1. WHO Meeting of Interested Parties
Scaling-up access to medicines within the Brazilian National Health System
WHO Meeting of Interested Parties
Geneva, 3 to 7 November 2003
(Presentation by
Jorge Bermudez, MD, PhD, Director, National School of Public Health, Brazilian Ministry of Health)

2. The main principles of the Brazilian National Health System (SUS 15 years)
Universal care
Strongly based on Alma Ata Declaration, 1978 and guided by WHO guidelines
Health as a citizenship right and State duty (1988 Constitution)
Principles of universality, integrality, equity, decentralization and social control
Adequated legal framework (Constitution, Law 8,080 and 8,142, Operational Norms 1991, 1993, 1996, 2001, 2003)

3. Relevance of the Brazilian National Health System (SUS 15 years)
90% of population is covered
28,6% of population exclusively use the SUS
63,650 out-patient units
5,794 hospital units, with 441,045 beds
1 million millions (1,000,000,000) of basic health care procedures yearly
251 million laboratory exams yearly
21,000 Family Health teams attending more than 73 million people in 90% of the Brazilian cities (in expansion 2003)

4. Ministry of Health guidelines for 2003
Expansion of access to health services and actions, including pharmaceutical care, ensuring quality
Intensification of endemic diseases control and strengthening of health surveillance actions
Formulation and implementation of a Human Resources policy
Strengthening of the democratic management in the system

5. Ministry of Health guidelines (scaling-up of access to medicines)
Setting NDP and the revision of the Essential Medicines List, following WHO guidelines
Decentralization of Basic Pharmaceutical Care
The new Regulatory Agency in 1999 (ANVISA)
The Generics Law in 1999 regulating Bio-availability and Bio-equivalence with interchangeability of medicines
A comprehensive system: central and decentralized procurement of medicines ensuring universal access
IPR, Innovation and access to medicines in Brazil (actions related to universal access to ARV and the patent Law)
Economic Regulation of the pharmaceutical sector (Medicines Chamber: Ministries of Health, Justice, Financing and the Civil House): monitoring OTC, price regulation.

6. Cathegories of medicines provision (Estimated values [R$])
Strategic programmes (Tuberculosis, leprosy, HIV/AIDS [ARV], endemic diseases, diabetes, blood factors, hypertension
Medicines for Basic Pharmaceutical Care, corresponding to R$ 2,00/inhabitant/year, with half funded by the Federal Government and the other half shared by the State and Municipal managements, coordinated previously within each State
High cost medicines with sharing of the Federal Government and States (Chronic renal disease, hepatitis, Gaucher Syndrome, others), all with STG
Hospital care, estimated (MAT/MED)
TOTAL ANNUAL
Source: Fernando Cárdenas (Apresentação no Seminário Internacional “Os desafios para uma assistência farmacêutica integral”, Brasilia, 1 de Outubro 2002)

7. State manufacturing facilities in Brazil (data from the Ministry of Health, 2003)

9. Participants in the National Conference (Brasilia, 15 to 18 September 2003)
Segment
Requests
Present
Absent
% of Presents
Health service delivery/Private provider
292
209 83
71,58%
Health Professional
301
234 67
77,74%
User (Consumer)
606
472
134
77,89%
TOTAL
1199
915
284
76,31%

10. Brazilian insertion in ongoing global initiatives with PAHO and WHO
PAHO, WB and IDB Shared Agenda Pharmaceutical Clearinghouse for the Americas
PAHO Public Health Virtual Campus
Medecins Sans Frontiers, OXFAM and WHO Drugs for Neglected Diseases project and initiative
Health Action International, Rockefeller Foundation and WHO Pricing Methodology Manual
MDG task forces and access to medicines
Development of joint PAHO and WHO International Seminaries for Latin American and African participants

11. National School of Public Health as a PAHO/ WHO Collaborating Centre (core activities)
Access to medicines (methodology, indicators, evaluation and assessment in the Americas)
Rational Use of Medicines (RUM), including translation of WHO documents for Portuguese-speaking countries
TRIPS Agreement and access to medicines monitoring network, assessing the Region of the Americas
Access to care for PLWHA network (joint project with UNAIDS and the French MAE)