Implementação da Política Municipal de Assistência Farmacêutica: uma Análise sob a ótica da administração política

Abstract

Introduction (with objective): Conducting studies on the management of Pharmaceutical Assistance (PA) policies is essential to understand causal factors and guide strategic actions that improve this important sector of health. From this perspective, Political Administration Theory (PA) offers important conceptual and methodological bases to broaden the understanding of public policy management. PA defines the concept of management as the act of conceiving (gestating) a policy, while administration assumes the function of implementing (managing) the conceived policy. Considering that these are two inseparable fields, this work aims to evaluate the capacity of municipalities in a Brazilian state to implement the PA Policy, from the perspective of Political Administration. Material and Method: ‑A descriptive-exploratory study was carried out with qualitative and quantitative data. An analysis matrix based on the dimensions validated by Andrade (2022) was developed and validated for PA to assess the capacity for implementing public policies in light of PA. The dimensions Institutional Policy Design and Social Participation represent management capacity, while Resources for Implementation, Implementing Bureaucrats, and Local Context reflect the policy's management capacity. The survey was a census, conducted in July 2025, with an electronic questionnaire sent to the institutional emails of the Pharmaceutical Assistance (PA) departments of all municipalities in the state, targeting pharmacists in Primary Care. The statements sought to capture perceptions about municipal PA. Confirmatory Factor Analysis (CFA) was applied along with robust statistical methods, such as the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Standardized Root Mean Square Residual (SRMR). All participants signed the Informed Consent Form, and the study was approved by the Local Ethics Committee (no. 7,522,750). Results: The statistical tests validated the instrument with 21 management and administration indicators to assess the municipal capacity for implementing the PA policy. A total of 163 pharmacists from all macro-regions participated, with 88% from municipalities with fewer than 40,000 inhabitants. In 63% of the municipalities, the Pharmaceutical Assistance Policy is not institutionalized, and 25% of respondents are unaware of its existence. Among the management indicators, positive perceptions stood out regarding the clarity of Pharmaceutical Assistance actions in the Municipal Health Plan (64%) and accountability to the Municipal Health Council (63%). Negative perceptions focused on user participation (59%), approval of projects by the Municipal Health Council (44%, with 24% unaware), and the existence of a Pharmaceutical Assistance ombudsman (55%). In terms of management, positive highlights included physical and technological resources (65%), financial resources (79%), support network (80%), autonomy in medication management (90%), and appreciation by the population (60%), mayors (73%), and health secretaries (64%). Negative perceptions were associated with the number of professionals (58%), the physical structure of pharmacies (52%), and the availability of training (68%). Finally, better evaluations were observed in the field of management, indicating a predominance of more technical practices, prevailing over strategic actions (management capacity). Conclusions: This study makes a relevant contribution by presenting the results of a new validated methodological instrument, based on the concepts of management and administration of Public Administration Theory, making it possible to deepen the investigation into the capacity for implementing the Family Farming policy in municipalities.