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Brazil is renowned worldwide for its remarkable reforms in pharmaceutical regulation, as the Generic Drug Act that have enhanced access to essential medicines while lowering drug costs. In contrast with analysis of pharmaceutical regulation that invokes international guidelines as inspiration for countries to reformulate their norms or argues that regulations emerge in order to serve the interests of powerful interest groups; this paper focuses on actors' preferences and demands to explain how Brazil promoted this large-scale regulatory policy. Paradoxically, the generic drug regulation introduced in the name of patients and opposed by local firms given the high cost to adapt its plants and processes, is today opposed by important patient advocacy groups but solidified by the strong support of local and multinational pharmaceutical firms. The paper concludes that the state still matters for pharmaceutical regulation and that pharmaceutical regulation is only partially influenced by non-state actors. [ABSTRACT FROM AUTHOR]

This paper contributes to the growing body of research on participatory democracy and the literature on associational democracy by exploring the impact that institutional reforms have on local-level configurations of civil society. In the 1980s a wide range of participatory experiments were initiated in Brazil, most notably Participatory Budgeting in municipal governance. Municipios that adopted PB in principle devolve much or all of the decision making on new investments to decentralized participatory forums. In this paper we consider the results of an eight-city matched-pair analysis conducted in 2004. in which we selected municipios that adopted PB in 1997-2000, and matched them with a similar municipio that did not in the same period, drawing from the full sample of municipios over 20,000 inhabitants. Building on relational theories of civil society, we show that PB has clear but limited effects on civil society. It moves civil society practices from clientelism to associationalism, but does not contribute to the capacity of civil society to self-organize, at least in the time-frame considered. We also show that this democratizing effect on civil society practices and networks is conditioned by pre-existing state-civil society relations. [ABSTRACT FROM AUTHOR]

The advantages of established intergovernmental decision-making arenas for the implementation of health policies in decentralized settings are not well known. This paper presents the case of the joint health management committee, known as the Tripartite Committee, created to formalize intergovernmental decisions about the implementation of policies of the Brazilian Unified Health System. This paper adopts a descriptive approach for the strategic analysis of decision process among governmental actors from three federative levels, as well as of mechanisms for the negotiation of their interests in the formalization of health policy agreements. The roles and positions of governmental actors within the Tripartite Committee were analysed, together with the definition of decision agendas and strategies. The data come from normative documents and proceedings of the Tripartite Committee, interviews with their governmental actors and observations of their meetings. The distinct governmental actors from the Tripartite Committee employed cooperation strategies with permanent negotiations oriented towards interchanges and political mediation. The power of the federal Government is also pre-eminent for the constitution of decision agendas and in the shaping of negotiation processes and priorities. The Tripartite Committee formalized agreements between unequal administrative and political powers to ensure a systemic integration of governmental policies and a self-regulation of the political autonomies. There are some divergences within the governmental actors interpretation of key policies and processes in this decision arena; the primacy of political or technical criteria as well as the applicability of laws or ad hoc norms. Although such cooperation strategies may slow down the decision-making process and render it more complicated, they also define more clearly areas of institutional responsibility and ensure a broader support from different levels of government for the implementation of public health policies. [ABSTRACT FROM AUTHOR]

Background: The State of São Paulo, the most populous in Brazil, was virtually free of measles from 1987 until the end of 1996 when the number of cases started to rise. It reached alarming numbers in the middle of 1997 and local health authorities decided to implement a mass vaccination campaign.Methods: Fuzzy Decision Making techniques are applied to the design of the vaccination campaign.Results: The mass vaccination strategy chosen changed the natural course of the epidemic. It had a significant impact on the epidemic in the metropolitan area of São Paulo city, but a second epidemic in the State's interior forced the public health authorities to implement a second mass vaccination campaign 2 months after the first.Conclusions: Fuzzy Logic techniques are a powerful tool for the design of control strategies against epidemics of infectious diseases. [ABSTRACT FROM AUTHOR]