An evaluation of governance capacity of the specialized component of pharmaceutical services in Brazil

Rover, Marina Raijche Mattozo; Peláez, Claudia Marcela Vargas; Faraco, Emília Baierle; Farias, Mareni Rocha; Leite, Silvana Nair

doi:10.1590/1413-81232017228.01602017

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ARTICLE • Ciênc. saúde colet. 22 (8) • Aug 2017 • https://doi.org/10.1590/1413-81232017228.01602017 copy

An evaluation of governance capacity of the specialized component of pharmaceutical services in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This paper presents application of an indicator protocol to assessment of current levels of governance capacity of the Specialized Component of Pharmaceutical Services (CEAF) in a state of the South of Brazil. We chose the theoretical referential of ‘governance capacity’ proposed by Carlos Matus, which reflects in the concepts of management capacity and pharmaceutical service management, due to the perception of a need to overcome the fragmentation and technicist reductionism that we believe has been imposed on the area of pharmaceutical services. Data was collected using the protocol in 74 municipal or state units. The results of the analysis indicate that the currently existing governance capacity needs improvement in all three dimensions that were evaluated, principally in relation to the aspects that seek sustainability of the governance. The model and the protocol used indicate a way forward for governance of pharmaceutical service by proposing a change from the technicist-logistical focus to an emphasis on strategic and political actions, or ones which foster greater participation and autonomy. With these results in hand, it will be possible to develop strategies for improvement of access to medicines in the SUS, in the sense that the CEAF becomes able to guarantee integrality of medicines treatments.

Health evaluation; Health management; Brazilian National Pharmaceutical Services; Specialized Component of Pharmaceutical Services

Color	Score*	What the score indicates
Green	76 to 100% of maximum	Maintain (or improve): Indicators in accordance with the target image which it is sought to build.
Yellow	50 to 75% of maximum	Caution: Shows progress, but still a need for improvement.
Orange	25 to 49% of maximum	Warning: Indicators that need to be improved.
Red	0 to 24% of maximum	Urgent attention: Indicators that need to be given priority.

Indicator	What does the indicator measure?	Maximum score	Data collected	Score	Color
Organizational dimension
Participation	1-Management participation in social participation bodies. 2-Existence of instances enabling participation of actors involved.	10	1- CES, CIB, State Health Conference and PES meetings. 2– None.	5	Yellow
Transparency	1-Publication of information about medicines shortages. 2-Publication of prices paid in acquisition of medicines.	10	1– None. 2– Yes, in the Health Prices Database.	5	Yellow
Planning	1-Inclusion of CEAF actions in the PES, PPA and the Management Report. 2-Existence of meetings specifically for planning.	10	1– Yes. 2– None.	5	Yellow
Monitoring and evaluation of actions	Existence of indicators and use of monitoring of them for planning of actions.	10	There are no indicators.	0	Red
Partnerships	Partnerships with other institutions for carrying out CEAF activities.	10	Yes, with municipalities (CIB 398/2014).	10	Green
Regulation	1-Existence of regulated flows for evaluation of requests. 2-Existence of guidelines on work processes in the units.	10	1- Yes - flows and ministerial orders. 2- Yes, in 41 units.	7.5	Yellow
Institutionalization	Existence of an institutionalized instance responsible for all the activities of CEAF.	10	Yes, but CAF and tenders are responsibilities of another directorate.	5	Yellow
Decentralized access	Service of users in their municipalities of residence.	10	Yes, in 100% of the municipalities.	10	Green
TOTAL, DIMENSION		80		47.5 (59.37 %)	Yellow
Operational dimension
Communication	Communication between the units.	10	Good or very good according to 77% of the units, mainly by email.	10	Green
Complementarity	Concern with compliance with lines of care.	10	100% of the listing in Group 3 is agreed in CIB (501/2013) and production of APAC is regulated for Group 2.	10	Green
Normative conditions	Units with legal and health-regulation conditions for exercise of the activity.	10	- There is no PGRSS. - 66.2% of the units have Health Operational Licenses and 88.7% have updated RT certificates. - 38% reported control by the state.	0	Red
Infrastructure	Existence of investments and minimum infrastructure conditions in the units.	10	-77.78% of the state units received investments. - 75% of the state units and 50.8% of the municipal units meet at least 75% of the minimal conditions.	8.5	Green
RS/Application centers	Existence of RS in various regions of the state.	10	Concentrated in the capital city of the state.	5	Yellow
Information systems	Existence of integrated information systems for carrying out of the activities.	10	Yes, although they do not feed the national database and they do not interoperate with other systems of the healthcare network.	3	Orange
Human resources	1-Availability of HR. 2-Concern with continuous training of HR.	10	1- 55.55% of the units of the state have a sufficient number of pharmacists. 2- 22.86% of the pharmacists report training taking place at least once a year.	2.5	Orange
Financing	1-Capacity to apply the strategies for maintaining financial equilibrium. 2-Availability of funds. 3-Funds lost by omitted APACs.	10	1- Yes – CAP and tax reliefs. 2- There is budget planning, but shortage of funds. 3- < 5% of the APACs are omitted.	6.25	Yellow
Logistics management	1-Existence of mechanisms that qualify the programming. 2-Existence of mechanisms that quality the acquisition.	10	1- There is an established method. 2- Only mechanisms for punishment of suppliers who do not meet the established criteria.	6	Yellow
Good logistics practices	1-Existence of mechanisms that qualify the distribution. 2-Existence of periodic control of stock of medicines.	10	1- There are no rules for good transport practices, but there is a distribution timetable. 2- 80% of the state units and 70.5% of the municipal units carry out monthly stock control.	6.5	Yellow
Availability of medicines	Concern with timely service to users.	10	There is evaluation for selection of the state listing, but there were shortages of medicines due to shortage of funds and delays in dispensing in 15.7% of the units.	3	Orange
TOTAL, DIMENSION		110		60.75 (55.23%)	Yellow
Sustainability dimension
Social control	Inclusion of the CEAF issues in the agenda of the State Health Council’s meetings in 2015	10	There are no agendas in the minutes of 2015.	0	Red
Profile of the manager	1-Condition of existence of the position of coordinator of pharmaceutical service, formally instituted, responsible for management of CEAF. 2- Qualification of the manager.	10	1- Formal job position, but not responsible for all the activities of the CEAF. 2- 9 years’ experience and specialist in management of pharmaceutical service.	7.5	Yellow
Accessibility	1-Deadline for serving users. 2-Existence of court demand and mechanisms for avoiding actions.	10	1- On average 50 days for first appointment in the pharmacy. 2- No information on % of actions, but there is a committee to provide legal support.	3.75	Orange
Relation between services	1-Existence of actions to monitor and periodically pass on orientations to the units. 2-Relationship of management with the other sectors of the healthcare network.	10	1– Manager - yes for both; pharmacists 67.14% answered that there are periodic orientations, but only 11.43% said there is monitoring. 2- Does not collect figures on the demands for discussion with other sectors.	3	Orange
Clinical aspects	1-Existence of monitoring of the treatments. 2-First consultation carried out by the pharmacist.	10	1- 32.3% carry out the monitoring. 2- Occurs in 67.7% of the units.	6.25	Yellow
Relationship with the users	Concern of management with satisfaction of users, through evaluations and ombudsmen function.	10	- 4.9% of units said they have at one time carried out a satisfaction survey. - There is an ombudsman’s department, but the data are not used in the planning of actions	0	Red
TOTAL, DIMENSION		60		20.5 (34.17%)	Orange
TOTAL SCORE IN THE PROTOCOL		250		128.75 (51.5 %)

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[1] Collaborations

MRM Rover: conception of the work, data collection, data analysis and interpretation, and drafting the article. SN Leite: conception of the work, data analysis and interpretation, critical revision of the article. CMV Peláez: data analysis and interpretation, drafting and critical revision of the article; EB Faraco: drafting the paper and critical revision. MR Farias: Critical revision of the article.