Public procurement of medicines: scoping review of the scientific literature in South America

摘要

Background Access to medicines is essential for materializing access to health as a fundamental human right. As such, it is included in the United Nations Sustainable Development Goals [ 1 ], and is recognized as key-element for scaling-up access to health services towards universal health coverage [ 2 ]. Pharmaceutical services are not restricted to the logistical component of medicines availability. They also include management and quality of services, and promotion of adequate use of medicines. Even though, the availability of medicines is an extremely important dimension for the assurance of access to these products [ 3 ]. The scenario of intensification of technological innovations, the price of medicines has been a barrier to access, especially in low- and middle-income countries. In a context of expanding social policies in South America in the first decade of the twenty-first century, public procurement imposed negotiation processes and strategies to reduce the price of medicines. Medicines have a major impact on governments, health care providers and household spending. Data from the Brazilian Health Satellite Account show that total government expenditures with medicines reached US$ 3,268,468 in 2015, representing a 54% increase over 2010 expenditures. Nevertheless, this represent around half of the household health expenditure, with a greater impact on the poorest families [ 4 ]. Barcelo et al. [ 5 ] estimated the per capita cost to treat diabetes mellitus in Latin America and the Caribbean (LAC) between US$ 1088 and US$ 1818 annually. In the same period, the average per capita of health care expenditure was US$ 1061 in LAC and medicines as a single item were responsible for a total of US$ 11–18 billion. Availability is directly related to the procurement of medicines. Although there are different models and configurations of health systems, government procurement is an activity performed by all of them. It is as a tool for the fulfillment of public assignments, such as providing services to society, and its attainment is fundamental to the managerial and financial rationality of public administration. Government procurement is a type of public purchase carried out by entities linked to the State such as public companies and mixed-capital companies, and is governed by specific regulations of each country or region [ 6 ]. The difficult balance between best quality and low price has been a challenge in most countries. One reason for that is the lack of a standardized set of key-quality criteria for procurement monitoring and evaluation that promote transparency and improve governance. In order to contribute to reduce this gap, it is worth analyzing how the scientific community has focused on this theme. The present work aims to map the scientific production regarding processes of medicines public procurement in South American countries, with the objective of identifying main aspects discussed in peer-reviewed articles. Main text Methods The method of scoping review systematized by Arksey and O’Malley [ 7 ] was used as tool for mapping scientific production, by including territorial and time variables. The present study covered 12?years, from 2005 - when it was held the second round of sub-regional antiretroviral (ARV) price negotiations in South America [ 8 ] - to 2017, of scientific production in articles published in English, Portuguese and Spanish in peer-reviewed journals. Given the importance of the above-mentioned price negotiation initiative, it is reasonable to expect that the event led to publication of studies in scientific journals. Research question What is the scope and aspects discussed in the peer-reviewed articles on processes of medicines public procurement in South American countries? Data sources and search strategies The search was carried out in the bibliographic databases SCOPUS, WEB OF SCIENCE (ISI), SCIELO, MEDLINE via PUBMED, EMBASE and Virtual Health Library (VHL), covering the fields of knowledge of health, social and human sciences. The Health Sciences Descriptors and keywords used in the study are listed in Table? 1 , with application of filtering per year of publication from 2005 to 2017. Table 1 Search strategy for scientific publications on procurement of medicines in South America, syntax by database, from 2005 to 2017 Full size table The selection of articles and extraction of data were performed independently by two of the authors; a third author resolved disagreements. Eligibility criteria The publications were selected when they focused on the procurement of medicines for public purposes and included at least one South American country at the regional, national and subnational levels. Consortium purchase cases were included regardless of population size, as well as studies of government expenditures and international price comparisons, as long as they included the public sector. It was decided to use the term “public purchase” to cover also the purchases made b