Access to medicines is part of the right to health, which in turn must be promoted through the adoption of public policies and, in some cases, legislative mechanisms to ensure them [14, 15]. Nevertheless, there is an inequity in this guarantee, which reinforces the need to strengthen the Unified Health System for free supply of medicines with a view to reducing inequalities [16].
Among the respondents, 84.0% of diabetic patients and 83.4% of hypertensive patients were using drug treatment. It is known that the control of both chronic diseases is based on a series of precautions, which involve nutritional changes, physical activity and control of some risk factors [17, 18]. However, drug treatment becomes the most effective way to control and prevent complications of these morbidities, as adherence to lifestyle changes is always lower than adherence to treatment [19]. However, for this treatment to be effective, users must have access to it [20].
A study conducted with data from the 2011 VIGITEL survey showed a lower prevalence of medication use among diabetic and hypertensive patients, with 78.2 and 71.0%, respectively, compared to findings of the present article [21]. The National Health Survey (2013) showed that 80.2 and 81.4% used drugs to control diabetes and hypertension, respectively [22]. These results suggest a progression in the use of medications for these two chronic conditions. The increase in the use of medicines for these diseases may also reflect a less healthy behavior, which leads to an increase in the prevalence of hypertension and diabetes, and increases the number of people who need these medicines. However, data from the PNAUM study (21) [23], collected between September 2013 and February 2014, indicated greater access to medicines to treat hypertension (94.6%); when compared by region, such access was higher in the South and lower in the Midwest and Northeast, confirming the regional inequality found in this analysis, as for both hypertension and diabetes, access was greater in the South and lesser in the North and Northeast.
The general lack of access to medicines for diabetes and/or hypertension was approximately 10.0%. Although the findings indicate that the constitutional right of health may be compromised by a portion of the investigated participants, it should be noted that there is a considerable level of access to antihypertensives and antidiabetics in Brazil, and this is due to a series of public policies that have been adopted to guarantee universal and free access to medicines [24].
In 1998, Brazil instituted the National Medicines Policy [8] and adopted, among other guidelines, the National List of Essential Medicines [14]. Subsequently, the generic medicine policy was also implemented, whose objective was to expand access to medicines with guaranteed quality and at a more affordable price for the population. In 2004, the Popular Pharmacy Program (PFP) was created within the scope of the System Unified Health System (SUS) [25]. PFP emerged with the aim of expanding access to medicines to the entire population, aiming to prevent withdrawal of treatment, especially in low-income individuals who cannot afford to buy the medicines they need in private pharmacies [26]. In 2011, the program was redesigned to further increase the coverage of access to medicines and promote comprehensive health care, changing its name to “Health is priceless”, in which medicines for the treatment of diabetes, hypertension and asthma began to be provided free of charge [11].
After a separate analysis of the three sources of access to medicines, it was found that the main means of obtaining antihypertensive drugs in the North, Northeast and Midwest regions was the private pharmacy. This result is similar to the one reported in the VIGITEL 2011 study [21]. This finding may reflect a series of barriers that still exist, e.g., difficulty in scheduling a medical consultation to renew the prescription to be to obtain the medications, lack of knowledge about the list of medications available for free, prejudice against free medications provided by the government, and geographical limitations, among others [3, 10]. For diabetes medications (oral and insulin), it was found that the main means of obtaining them in the North was private pharmacies, suggesting regional disparities in access.
The problems with access to medicines were also reported in the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM- Services) [27], which pointed to statistically significant differences in access to essential medicines among regions of the country, as well as according to type of medicine. A study carried out on the basis of the VIGITEL survey (2011) showed that it is precisely in the capitals of Brazilian regions with less economic development and a greater number of socially vulnerable people that patients most needed to make direct disbursements to access treatment for hypertension and diabetes [21]. This finding points out how unequal health care is in a country with continental dimensions such as Brazil.
This study highlights the difficulties of obtaining medication in the North region, which clearly demonstrates geographical inequalities in the field of health, when compared with the South region. Access to medicines in that region is a challenge for patients and for the management of health services; in addition, the medicines are financed per capita, which is a disadvantage for the North region, where costs are higher [23, 28].
The idea of inequality caused by geographical difficulty in accessing medicines is further strengthened by analysing some of the different spaces for health care and access to medication prescriptions, such as the Family Health Strategies (FHS) [29]. While the North region has family health coverage of more than 63.0%, the Southeast region has less than 54.0% [30]. This finding converges with the hypothesis that it is not enough to guarantee access to health, if the ability of users or patients to obtain them is not considered. Also, another point to be considered is the hypothesis that the distribution of health services is not proportional to the distribution of demands [29].
Major limitations of this study, since it contains self-reported information, are the memory bias of the interviewees, possible differences in the understanding of some issues and the selection bias, since the survey did not include individuals living in households without a landline. In addition, it should be noted that the results are valid and comparable only capitals.
