ABSTRACT
Resumo Este artigo analisa a ação de atores nacionais e internacionais na Assistência Farmacêutica (AF) em Moçambique, no período de 2007 a 2012, com foco na provisão pública de medicamentos para HIV/Aids, malária e tuberculose. Descreve-se o funcionamento da AF no país; os atores que atuam nesse âmbito e as relações entre eles; discutem-se questões relevantes sobre o modus operandi dos parceiros de cooperação. A metodologia combinou: revisão bibliográfica, levantamento e análise documental e entrevistas. O marco teórico e analítico utilizou a análise de políticas públicas com foco no papel do Estado e suas inter-relações como os demais atores na ajuda externa na área farmacêutica e a abordagem de redes. Conclui-se que a interação entre os atores envolvidos é complexa, caraterizada pela fragmentação operacional e sobreposição de atividades entre diversos entes; centralização da aquisição de medicamentos na mão de poucos agentes; by pass das estruturas nacionais e desconsideração do necessário fortalecimento do sistema nacional de saúde para a construção de sua autonomia. A despeito de alguns avanços na provisão e disponibilidade de medicamentos para essas doenças, existe forte dependência externa nesse âmbito, o que obstaculiza a sustentabilidade da AF em Moçambique.
Abstract This article examines the activities of national and international actors in Pharmaceutical Services (PS) in Mozambique from 2007 to 2012, focusing on the public provision of HIV/Aids, malaria and tuberculosis medicines. It describes how PS functions in the country, what actors are involved in this area and the relations among them, pursuing salient issues in the modus operandi of partners in cooperation. The methodology combines literature review, document survey and analysis and interviews. The theoretical and analytical framework was given by the policy analysis approach, focusing on the role of the State and its interrelations with other actors in foreign aid in PS, and also by the networks approach. It was concluded that the interactions among the actors involved is complex and characterised by operational fragmentation and overlapping of activities between entities, centralised medicine procurement in the hands of few agents, bypassing of national structures and disregard for the strengthening needed to bolster national health system autonomy. Despite some advances in the provision and availability of medicines for these diseases, external dependence is strong, which undermines the sustainability of PS in Mozambique.
Subject(s)
Humans , Pharmaceutical Services/organization & administration , International Cooperation , Tuberculosis/drug therapy , HIV Infections/drug therapy , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/supply & distribution , Health Policy , Malaria/drug therapy , Mozambique , Antimalarials/administration & dosage , Antimalarials/supply & distribution , Antitubercular Agents/administration & dosage , Antitubercular Agents/supply & distributionABSTRACT
Se analizó el estado actual del conocimiento sobre el consumo de agua como medida higiénico-dietética para la enfermedad del reflujo gastroesofágico, desde la perspectiva del conocimiento clásico de la medicina occidental de esta afección y la visión de la medicina natural y bioenergética. Se realizó una búsqueda bibliográfica sobre el tema en Medline, en la Biblioteca Virtual de Salud y en los sitios de especialidades de Infomed de Medicina Natural y Gastroenterología. La información recolectada se estructuró en siete acápites: enfermedad de reflujo gastroesofágico, fisiología gástrica, equilibrio hidromineral, modelos de ingestión de bebidas y comidas, alimentación y obesidad, terapias hidropónicas e implicaciones en gastroenterología. No se encontraron publicaciones cubanas que aborden la temática sobre la modificación del consumo de líquidos como medida higiénico-dietética para esta enfermedad. Se recomendó realizar investigaciones que permitan obtener evidencias del estudio del tema, así como desarrollar un modelo de consumo de agua para pacientes con enfermedad de reflujo gastroesofágico.
A literature review was carried out aimed at updating about water consumption as a hygienic and dietary measure and its relation to the esophageal reflux disease. Taking into account the classical knowledge about this condition, the theoretical aspects of the bioenergetics and traditional natural medicine were included. Bibliography published in the last five year by MEDLINE and Health Library and specialty sites of INFOMED and Natural Medicine and Gastroenterology. The opinions were classified into: gastroesophageal reflux disease, gastric physiology, hydro mineral balance, food and liquid consumption patterns, feeding and obesity, hydroponic therapies and implication in gastroenterology. There were no Cuban publications on the topic. The authors recommended to carry out investigations on this topic and to develop a design of water consumption for those patients with gastroesophageal reflux disease.