Comprehensiveness in heathcare and medicines provision by the HIV/AIDS program in Brazil
C.D.B. Santos-Pinto, C.G.S. Osorio-de-Castro
FIOCRUZ/ENSP, Center of Pharmaceutical Policies (NAF), Rio de Janeiro, Brazil
Background: Comprehensiveness, universal access and equity are Brazilian Health System principles. Comprehensiveness encompasses a broad scope of aspects related to the health system and to the individual, involving preventive and curative health actions. The Brazilian HIV/AIDS Program was designed within this paradigm. During its development and implementation considerable effort was dedicated to the practice of comprehensive healthcare for PLWHA. The aim of this work is to discuss the concept and its application to the Program medicines´ provision stategies in order to verify Program experience.
Methods: A search of the literature covered the various definitions and dimensions related to comprehensiveness as well as the diverse applications of this concept in different health settings. Documents pertaining to the Brazilian HIV/AIDS Program were scanned for events and practices related to comprehensiveness and to medicines provision. A discussion on how well the Program has incorporated comprehensiveness, in its various forms and in medicines provision ensues.
Results: The Brazilian HIV/AIDS Program has acted politically to adhere to and to incorporate comprehensiveness in its guidelines and practices, presumably more so than most other health programs in Brazil. Free universal access has been guaranteed by law, since 1996 and much has been accomplished in order to supply ART and medicines for oportunistic infections. The Program features a separate supply chain, including procurement and distribution. Although comprehensive medicines provision has been guaranteed, this is mostly true for ART. Other aspects of comprehensiveness, such as those related to the integration of all health efforts has not yet been achieved.
Conclusions: In its 25 years of existence, the Brazilian HIV/AIDS Program has made important efforts in the direction of comprehensive medicines provision for PLWHA, perceived as one of the reasons behind its success. Nevertheless, lack of integration with other health system networks and structures may compromise comprehensiveness.
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