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Background: In 2016, the Brazilian state of Minas Gerais (∼20 million people), implemented the ERAF policy (“Regionalization Strategy of Pharmaceutical Services”) in an effort to improve medicine procurement and distribution within primary care. We evaluated the impact of the policy on three main goals: price reductions, volume increases, and expansion of therapeutic options.Methods: We analyzed the procurement data from the Integrated System of Management of Pharmaceutical Services database in 2012 and 2018. We estimated the volume, drug mix, and expenditure indicators for all major therapeutic classes, and, in detail, for cardiovascular and nervous system drugs. We evaluated the expenditure drivers using decomposition analyses.Results: Overall, the expenditure increased by 14.5%, drug mix almost doubled, while the volume decreased by a third. Cardiovascular and neurological system drugs followed similar patterns. Decomposition analyses showed that prices and drug mix had positive effects while the volume had negative effects, resulting in an overall increase in expenditure.Conclusion: Our findings suggest that the ERAF policy cannot be considered effective as it has not fulfilled its intended purposes so far. Strategies to address the identified problems and to build a platform for a more sustainable long-lasting policy should be put in place by the government.

BackgroundThe main purposes of primary care-based pharmaceutical services (PHCPS) in Brazil are to provide free access to medicines and pharmaceutical care to patients. Several obstacles hinder achieving their goals; thus, MedMinas Project aimed to evaluate the PHCPS, the supply system, and the use of medicines. This paper reflects on our experience designing, planning, and conducting the project, describing the issues yielded in the field and lessons learned.MethodsThis work consists of a mixed-methods study conducted in Minas Gerais, Southeastern Brazil. We adopted the principles of Rapid Evaluation Methods, employing a multistage stratified sampling for the quantitative and a purposeful sampling for the qualitative components, respectively, and a documentary research. Data sources included individuals (patients and professionals), prescriptions, dispensed medicines, and policy documents collected between April and October 2019. The quantitative data described in this paper were analysed by descriptive statistics and the qualitative by Thematic Content Analysis.ResultsA total of 26 municipalities varying from 37,784 to 409,341 inhabitants were included. The field team spent, on average, 16 days in each location. We interviewed 1019 respondents, of which 127 were professionals and 892 patients. The participation rate varied from 92 to 100%, depending on the respondent subgroup. Most interviews lasted between 45 min and one hour. Fieldwork challenges included participants’ enrolment, field team, interview processes, and project budget. The participants provided positive feedback and five main themes emerged from the interview experience (self-awareness, sense of gratitude, research value, access to findings, and benefits of the research). Additionally, we collected copies of 1072 documents and 2070 pieces of data from prescriptions filled and medicines dispensed at the PCP.ConclusionWe demonstrated the viability of conducting the MedMinas Project in an extensive geographic area within effective time frames that provided meaningful, high-quality data from multiple actors. The methods and lessons learned are valuable for researchers across various disciplines in similar urban settings in Brazil and other countries of low- and middle-income (LMIC).

El presente artículo es derivado de la investigación que busca contribuir en la construcción de referentes teóricos sobre la realidad educativa en escuelas de Caldas Colombia, analizando la relación de los sujetos educables en el acto educativo estudiante-profesor, para generar inquietudes que lleven a la reflexión sobre:Cómo se evidencia el reconocimiento del sujeto educable en el acto educativo. Y la función de la escuela en la imperiosa necesidad de aprender a vivir juntos.¿Cómo el conocimiento y aceptación de las particularidades del sujeto educable desde su diversidad, es imprescindible para que el acto educativo y el proceso de enseñanza aprendizaje sean pertinentes al sujeto y al colectivo?En este sentido la investigación se diseñó metodológicamente a partir de un enfoque de investigación mixto y de la obtención de datos cuantitativos de carácter descriptivo a través de encuestas para triangularse con datos cualitativos, obtenidos a través de grupos de discusión. Se realizó con 62 docentes y 120 estudiantes de grados 5º y 10º de una Normal Superior y una Institución Educativa Oficial de dos municipios de Caldas, Colombia.

En este documento el interés está centrado en el estudio de la motivación que tiene la empresa de acueducto Aguas y Aguas para adquirir un acueducto comunitario como ACUCESDI, y las ventajas que ofrece a la comunidad tener el control de los recursos hídricos y económicos de la empresa.

A corelational descriptive, retrospective and transverse study was practiced. The population included were all of the students from I to VIII in the School Of Medicine of the University Of Manizales during the period of the second semester of the year 2002. The total population was 320 students of which 301 were included. Three questionnaire were applied : The first classified the type of consumption, ,the second was designed to essay internal risk factors and the third essayed external risk factors for the consumption of alcohol. All 3 questionnaires were applied at the same time to prevent the study from having errors or desertion. At the same time it was applied to the total of the popula-tion (320 students) but due to external factors such as not going to class, 301 who answered are considered the total popula-tion in the study. The information obtained thru this study was analyzed with data banks, pie charts, crossed analysis and contingency tables. The relationship between the type of consumption and the internal and external risk factors was verified thru a X2 assessment (square chi) with a significance level of 0.05%. Of the total the population (301), 163 were women (54.2%) and 134 (44.5%) were men. The age oscillated between 14 and 38 years. The distribution according to place of origin was 30.2 % from Manizales, 8.3 % from Ibague (Tolima), 7.3 % from Pereira (Risaralda), 6% from Armenia (Quindio) and 4% from Pasto (Narino). This allows us to determine that 69.8% are from outside the city of Manizales, Caldas. the data showed that the main risk factors for alcohol consumption in the mentioned population, in order of importance, were : Tendency to feel depressed, low academic scores, negative self image and suicidal ideas. The main type of consumption in the students belonging to the School of Medicine of the University Of Manizales was occa-sional (68.1%) according to our characterization. It was also determined that some risk factors like transgresive behavior are not a risk factor for alcohol consumption contrary to what was hypothesized before this study was performed.