Abstract
Introduction: Health litigation is a significant factor to consider in the implementation of health policies within the Unified Health System (Sistema Único de Saúde, SUS), as judicial intervention affects the management of the healthcare sector, particularly in granting health products, services, and medications. The Defensoria Pública (Public Defender's Office) of the State of Sergipe, through its Health Litigation Resolution Chamber, ensures the population's right to health by securing access to public health products, services, medications, and available therapeutic alternatives. Understanding the profile of these judicial demands can assist in planning and executing public policies within SUS. Objectives: To understand the profile of health litigation demands in the state of Sergipe. Methods: A cross-sectional study was conducted from January to December 2021 at the Health Litigation Resolution Chamber of the Defensoria Pública of Sergipe. The chamber comprises public defenders, physicians, nurses, and pharmacists. Data from the Health Litigation Resolution Chamber database were evaluated, and the following variables were extracted: procedures, products, medications requested, number of requests standardized in SUS, and number of litigations. Data were tabulated using Microsoft Office Excel® and expressed through descriptive statistics. Results: A total of 356 requests were received, including medications, procedures, consultations, supplies, orthotics/prosthetics, nutritional supplements, and diapers. The most requested items were procedures (n=130, 36.51%) and medications (n=70, 19.66%). A small percentage of requests were standardized in SUS (n=19, 5.33%), and less than half of the administrative processes were litigated (n=177, 49.71%). Conclusion: The profile of health litigation demands in Sergipe displayed heterogeneous characteristics, with a higher prominence of requests related to health products and services. Consequently, the Health Litigation Resolution Chamber managed to prevent the filing of lawsuits and healthcare expenditures in the majority of cases. Understanding these characteristics contributes to the enhancement of planning and management of SUS flows and processes.Introduction: L-asparaginase, a drug used in hematologic cancer treatment, faced shortages in Brazilian public hospitals. Efforts by the Ministry of Health to replenish stocks sparked criticisms and significant media coverage, involving the National Health Surveillance Agency (ANVISA), the legislature, and Brazilian oncology associations. Objective: To identify and discuss the positions of social actors regarding the developments in the acquisition of L-asparaginase during the period of 2017-2018. Methodology: This study is part of the Health Policy Analysis Observatory (OAPS) focusing on Medicines Policies, Pharmaceutical Assistance, and Health Surveillance at ISC/UFBA in collaboration with UNEB. Data from news sources covering statements by the Ministry of Health, ANVISA, the Chamber of Deputies, and health-related entities during 2017-2018 were analyzed and organized for discussion. Results and Discussion: Faced with the unavailability and shortage of L-asparaginase in the Brazilian market, the Ministry of Health decided to procure it through international bidding, selecting a Chinese pharmaceutical company based on the criterion of lowest price. This decision led to a report by the Fantástico program of Rede Globo Television, alleging the presence of impurities in the Chinese-manufactured drug, which the Ministry of Health contested by presenting safety and efficacy reports from six laboratories. ANVISA clarified its role in conducting pre-importation document analysis. The legislature demanded explanations from the Ministry of Health, which justified its decisions regarding the change in suppliers. The Public Prosecutor's Office filed a civil action based on the Fantástico report and expert testimonies, seeking the recall of batches of the Chinese medication. The Federal Court issued a preliminary injunction prohibiting the purchase of the drug by SUS. Oncology societies expressed concerns about potential health risks associated with the medication. Legislative bodies expressed interest in overseeing the actions of the Executive Branch. The Ministry of Health, responsible for public health plans and policies, communicated its decisions to the media and reconsidered the procurement of the drug. However, the shortage of L-asparaginase persists. Conclusion: The repercussions of this case revealed conflicts between branches of government, the healthcare needs of the public, medical practices, and highlighted market interests conflicting with public health priorities.
