Assistência farmacêutica enquanto política pública no município de São Carlos-SP: um olhar a partir do campo CTS

Abstract

This thesis assumes that the practice of the actions of municipal pharmaceutical services is not articulated with the conception of public policies conquered to guarantee access and the rational use of medicines. The review of the historical trajectory of pharmaceutical services policies in Brazil indicated an attempt to change the conformation of the logistic arrangement, when the perspective of pharmaceutical care was instituted with the user, already established in other countries, as a right to comprehensive health care. The need to guarantee inputs and medicines for the country's care, especially in situations such as public health emergencies, as in the recent COVID-19 pandemic, waved to the importance of the pharmaceutical area in ensuring the biopsychosocial aspects. Several actions have been institutionalized by the Ministry of Health and other interconnected sectors, with investments and guidelines to set up pharmaceutical services management in all government spheres and levels of care of the Unified Health System. In São Carlos, in the state of São Paulo, observations and experiences have shown that many of these policies have not achieved their intended results. This study aimed to analyze the public policies for pharmaceutical assistance in this city, under the perception of its actors and the view of the Science, Technology and Society (STS) field, as a way to investigate the subjective meanings, little detected in this scenario. The qualitative health research method was used in two stages: the consultation of the information provided by the official website of the municipality and the fieldwork. As a data collection tool, it was used a semi-structured interview with twelve public service workers of municipal pharmacy, followed by a dialectical hermeneutic analysis. We obtained the approval of the Ethical Committee on Human Research of the Federal University of São Carlos for the survey. The results indicate that most participants are women and permanent employees of City Hall. Five categories of analysis emerged and were able to be visualized from a cloud of words with the corpus of interviews. Not much information was found on the official website, making the path of the citizen difficult. It emerged in this context the existence of deficient human resources, precarious physical structure, little polished computerized system, numerous demands, lack of orientation and care to the user, dissatisfaction with the way of working, delimitation in the adjustment programs, and not full adequacy to the norms imposed by the pandemic, causing risks to the workers and users. The Pharmacy and Therapeutics Commission and the Municipal List of Essential Medicines were achievements, with several pharmaceutical specialties, ensuring access to treatment for many health problems. They have also been ineffective as instruments for the rational use of medicinal products. The analysis reveals differences in the structure, organization, management, and practices of local pharmaceutical services concerning the guidelines that shape public policy in the region in Brazil. It is essential that the needs of the population have priority over political interests, and it is up to public managers to direct efforts towards this achievement. The configuration of the actors involved in a network, supported by multi-professional actions in primary care, participatory management in the system, and pharmaceutical care contribute to the strengthening and (re)orientation to an adequate practice, deconstructing the approach of pharmaceutical services, public policy as simple drug delivery, with activity planning, effective technical conducts, health education, defense of the integrality of assistance and the right to life.