RESUMO
BACKGROUND: On the back of its recent economic development and domestic success in the fight against HIV/AIDS, Brazil is helping the Government of Mozambique to set up a pharmaceutical factory as part of its South-South cooperation programme. Until recently, a consensus existed that pharmaceutical production in Africa was not viable or sustainable. This paper looks into practicalities and evolution of this collaboration to illustrate the characteristics of Brazilian development cooperation in health, with the aim of drawing lessons for the wider debate on aid and local production of pharmaceuticals in Africa. DISCUSSION: We show that the project process has been very long and complex, has involved multiple public and private partners, and cost in excess of USD34 million. There have also been setbacks in the process, and although production has already started, it is unclear whether all the project's original objectives will be met. SUMMARY: The Brazil-Mozambique's pharmaceutical factory experience illustrates positives as well as limitations of Brazil's unorthodox approach to health development cooperation, highlighting its contribution to pushing the boundaries of the debate on local production of pharmaceuticals in resource-poor settings.
Assuntos
Indústria Farmacêutica/organização & administração , Medicamentos Essenciais/provisão & distribuição , Cooperação Internacional , África , Brasil , Indústria Farmacêutica/economia , Medicamentos Essenciais/economia , Política de Saúde , Acessibilidade aos Serviços de Saúde , HumanosRESUMO
O Sistema Único de Saúde (SUS) é um sistema universal, de financiamento público, baseado em direitos sociais à saúde, concebido e implantado em uma era em que as reformas neoliberais em outras partes do mundo têm impulsionado a mercantilização dos serviços de saúde, oferece lições importantes para os futuros sistemas de saúde. Neste artigo, focalizamos os mecanismos institucionais inovadores para a participação popular e prestação de contas (accountability) que fazem parte da arquitetura de governança do SUS. Nós argumentamos que esses mecanismos de participação pública têm o potencial de sustentar um pacto entre Estado e os cidadãos e assegurar o impulso político necessário para ampliar o acesso aos serviços básicos de saúde e, ao mesmo tempo, fornecer um quadro para o surgimento de "parcerias reguladoras", capazes de administrar a realidade complexa da assistência plural e de multiplicar as fontes de especialidades em saúde de uma forma que assegure que as necessidades e os direitos dos pobres e dos cidadãos marginalizados não sejam relegados para a periferia de um sistema de saúde segmentado.
Assuntos
Responsabilidade Social , Sistema Único de SaúdeRESUMO
This article provides an overview of governance arrangements and changes in the Brazilian public health system since 1988, when the "Citizen's Constitution" declared health to be a universal right. Since then, population coverage has grown substantially and health indicators have improved. Despite these achievements, inequities in access remain an important barrier to universal coverage, in particular for marginalized groups such as indigenous peoples. This article discusses the innovation cycle that produced the gains and recent efforts to guarantee more equitable access to health services for the indigenous population in a continent-sized country historically plagued by great inequalities.
Assuntos
Acessibilidade aos Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Disparidades em Assistência à Saúde , Programas Nacionais de Saúde/organização & administração , Brasil , Política de Saúde , Humanos , Inovação Organizacional , Justiça SocialRESUMO
Brazil's Sistema Unico de Saúde (SUS), a universal, publicly-funded, rights-based health system, designed and put in place in an era where neo-liberal reforms elsewhere in the world have driven the marketization of health services, offers important lessons for future health systems. In this article, we focus on the innovative institutional mechanisms for popular involvement and accountability that are part of the architecture for governance of the SUS. We argue that these mechanisms of public involvement hold the potential to sustain a compact between state and citizens and ensure the political momentum required to broaden access to basic health services, while at the same time providing a framework for the emergence of "regulatory partnerships" capable of managing the complex reality of pluralistic provision and multiplying sources of health expertise in a way which ensures that the needs and rights of poor and marginalised citizens are not relegated to the periphery of a segmented health system.