Table 1

Farmácia Popular Program in a health system perspective (Brazil, 2002–2013)

Potential effectsFindingsSource
I. Individual, household and community health service delivery
Profile of target populationControversial findings on actual users’ profile regarding the target population of FPPLiterature review
ISAUM data set
Availability of medicinesNo direct information, but found as highly satisfied patients with availabilityLiterature review
User satisfactionSatisfaction with FP service and interventions over timeLiterature review
Affordability and expendituresLower spending in regard to private pharmacies and to AFP-private; zero copayment from users after SNP for covered medicinesPatient share of copayment increased with the implementation of AFP-private-2, following decrease of the reference price, and decreased with SNP (zero copayment for patients).ISAUM data set
Equitable access to medicinesNo gender difference in access to FPISAUM data set
Changes on medicines-seeking behaviourIncreased number of dispensations over time, but SUS-DF remained the most important source for medicines, especially for HTN and DMLiterature review
Adherence to treatmentsNo informationPDC decreased after AFP-private2 and increased with SNPISAUM data set
II. Health service delivery
Pharmaceutical sector information systemAn information system for FRG but not so detailedAFP-private has a huge information system able to identify information at the patient level.Literature review
Availability of medicinesGood availabilityLiterature review
Quality of pharmaceutical servicesPharmaceutical services better than in SUS-DF and in private pharmaciesNo improvements on pharmaceutical services providedLiterature review
Changes on prescribing behaviourThe inclusion of medicines in FP reference list increased its use in the whole market.ISAUM data set
Geographical accessibilityFPG-public is more present in the north and north-east regions, poorest regions in Brazil.More present in big municipalities rather than in small and poorest onesISAUM data set
Changes on healthcare-seeking behaviourNo informationHospitalisation for HTN and DM decreased in all studied period, and it is not possible to determine the contribution of FP since there were important changes on PHC and health promotion in Brazil in the last years.
Outpatient healthcare increased for both HTN and DM as well, but again it is not possible to isolate the contribution of FP.
ISAUM data set
III. Health sector
Effects on pharmaceutical marketLow effect in the pharmaceutical market because of the low number of facilitiesThe inclusion in FP increased sales volume of medicines included in the reference list, especially losartan.ISAUM data set
Generics represent the biggest market share within FPP sales.
Government expenditures on medicinesLow prices for medicinesGovernment expenditure increased for anti-HTN and anti-DM treatments in FP. This increase was followed by patients’ entrance in the programme. Despite the increase, the cost per treatment was reduced after the AFP-private implementation.ISAUM data set
Financial sustainabilityThis arm was interrupted in 2017; MoH justified this decision because of administrative costs.Government cost on FP is higher than in SUS-DP.ISAUM data set
IV and V. National and international context
Alignment with national health policies and cross-cutting policiesIt is argued by some authors that Farmácia Popular plays a role as part of the MoH strategy to contain the pharmaceutical industry’s commercial deficit by encouraging the link between national production of pharmaceuticals and SUS network management.Literature review
Alignment with national politics environmentFarmácia Popular constituted an important government programme during Lula mandate.Literature review
  • AFP-private, here we have Farmácia Popular (Aqui tem Farmácia Popular); AFP-private 2, implemented in 2009; AFP-private1, implemented in 2006; DM, diabetes; FPG, Programa Farmácia do Brasil - Rede Própria (Governmental Farmacia Popular); FPP, Farmácia Popular Program; HTN, hypertension; ISAUM, Impact of consecutive subsidies policies on access to and use of medicines in Brazil; MoH, Ministry of Health; PDC, proportion of days covered; SNP, health has no price (Saúde Não Tem Preço); SUS-DF, Unified Health System dispensing facilities.