Ensuring access to essential medicines is one of the most complex challenges for all health systems, including the medicines supply chain. Dedicated policies need to be put in place to achieve this aim [1]. In primary health care, access to essential medicines means resolving the care process for most health conditions [2].
More than a problem related to the pharmaceutical market and the high prices, the health system definitions in terms of patients’ rights, financial support, and the organization of the pharmaceutical services are crucial to ensure access to essential medicines in an efficient manner to address the population’s health needs [3].
Access to well-known and newer essential medicines for priority health problems depends on a certain minimal level of medical and pharmaceutical services. This includes inexpensive diagnostic tests to confirm diagnosis, and well-informed trained clinicians, pharmacists, nurses and other health staff to help patients, especially those with chronic illnesses, to adhere to their treatments. An overall capacity strengthening of the health and supply systems is a prerequisite to respond adequately to the increased medical and pharmaceutical population’s needs [4].
However, ensure equitable access to these medicines is still one important problem to be surpassed. Vogler et al. [5] defined that equitable access to and use of medicines should be determined by health care needs and no other potential factor. The authors argue that the policies and the literature related to this issue involves three major topics: measuring the extent of the inequalities, identifying the factors that determine inequalities, and addressing measures that help reduce existing inequalities.
Health equity is realized when all people can attain their full potential for health and wellbeing. Health inequity and social exclusion have been usually associated with an individual’s age, gender, social class, race, skin colour, ethnicity, religious beliefs, educational status, living standards, political views, appearance, physical or mental ability, sexuality, or sexual orientation [6]. However, the postcode can be an additional factor related to health inequality: the postcode lotteries in health refer to variations in health care between different geographical areas that appear arbitrary and unlinked to health need [7] In Brazil, in contrast, the postcode may gain a more predictable meaning, due to great economic and social inequalities between the different regions of the country and between neighboring municipalities.
The structuring of the Brazil’s public health system began in 1990, with the creation of the Unified Health System (SUS), defining access to comprehensive health care as a citizens’ right, and equity as a principal. The National Pharmaceutical Policy (2004) also determined actions to strengthening the pharmaceutical services capacity at local and national health system levels [8].
The SUS is organized in levels of complexity of care and all the 5,560 municipalities are responsible for the organization and delivery of primary health care services, including essential medicines. The public health is financed primarily through taxes and is shared by a tripartite alliance for public health care provision (i.e., the national, state, and municipal governments) [9]. Estimates indicate that the SUS would serve, exclusively, 114.6 million people [10]. SUS expansion allowed Brazil to respond quickly to the population’s changing health needs [11], with a dramatic increase in health service coverage in just three decades. Nevertheless, despite its successful operation, the analysis of future scenarios suggests urgent need to address persistent geographic inequalities, insufficient funding, and improvement of its management capacity [12].
The SUS is the largest public health care system in the world and has more than 44,000 public primary care centers, where the patients have access to health care and medicines [13]. According to national studies, there was a high prevalence of full access to medicines in the country in 2014: more than 47% all medicines prescribed for chronic diseases were accessed through Primary Care centers [14]. However, despite advances, weaknesses in the development of pharmaceutical services persist in the country [15–20] strongly related to management capacity [21–23].
In Brazil, the number of registered pharmacists surpasses 210,000 (about 10/10,000 inhabitants), and more than 30,000 work in PHC and are hired by the SUS. This number grew by 75% from 2008 to 2013 [24–25]. Brazilian pharmacists play a fundamental role in the health system organization because, unlike most countries, medicines provided by the public system are mostly funded, purchased, distributed, and provided by public health establishments [24–26].
PS in the municipal health system comprises an open subsystem characterized by complexities related to the organizational culture, the structure of services, procedures and workforce, and also the political and economic context in which it operates [27]. As PS is part of this complex arrangement of municipal health management, it is understood that it is necessary to analyze which contextual factors are involved in its development capacity and which can collaborate so that investments in PS can meet local needs [3–5, 10–19, 23, 26, 28–32], considering PS within the socioeconomic environment in which it is inserted. In this context, it is necessary to question the relationship between the PS department’s management capacity and the local socioeconomic system, measured from macro indicators [33–34].