Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-21T12:46:29Z No. of bitstreams: 1 renanguimaraesdeoliveira.pdf: 1178389 bytes, checksum: 4f7091f7d89e9f1f8fd1be5664331816 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T18:45:11Z (GMT) No. of bitstreams: 1 renanguimaraesdeoliveira.pdf: 1178389 bytes, checksum: 4f7091f7d89e9f1f8fd1be5664331816 (MD5) / Made available in DSpace on 2016-01-25T18:45:11Z (GMT). No. of bitstreams: 1 renanguimaraesdeoliveira.pdf: 1178389 bytes, checksum: 4f7091f7d89e9f1f8fd1be5664331816 (MD5) Previous issue date: 2014-02-21 / O presente trabalho visou compreender a judicialização do direito à saúde pública no município de Leopoldina-MG sob o ponto de vista dos usuários do Sistema Único de Saúde (SUS), atores do Executivo municipal e das instituições jurídicas. Foi um estudo descritivo cuja referência metodológica decorre dos princípios de um estudo de caso numa pesquisa qualitativa. Este estudo de caso levantou dados dos processos judiciais que tinham como réu o município de Leopoldina, assim como foram realizadas entrevistas com sujeitos relacionados a esses processos, tais como: usuários, atores do Executivo municipal e das instituições jurídicas. Os resultados demonstram um perfil de ações judiciais voltado para os atendimentos ambulatoriais, hospitalares e de assistência farmacêutica. Os usuários questionaram o direito à saúde e a assistência à saúde e indicaram a judicialização como um caminho positivo para a solução de problemas de acesso. Os atores do Executivo municipal questionaram as limitações em prover o direito à saúde e à assistência e retrataram uma realidade ameaçadora das ações judiciais quando relacionadas ao interesse coletivo. Os atores das instituições jurídicas mostraram a realidade da judicialização e ponderaram sua existência, responsabilizando o poder público. A ausência do poder público fortaleceu a atuação do órgão Judiciário para a garantia do direito constitucional à saúde. Portanto, a judicialização tem sido um caminho adotado para o exercício do direito na prática. / This study aims to understand the judicialization of the right to public health in the city of Leopoldina/MG from the point of view of the Sistema Único de Saúde (SUS) - SUS´s users, subjects of the municipality and the legal institutions. This was a descriptive study with methodological reference derived from the case study principles in a qualitative research. This case study gathered data from lawsuits who had the city of Leopoldina as a defendant and interviewed subjects related to these processes as users, actors of the municipality and the legal institutions. The results showed profile lawsuits aimed at ambulatory, hospital and pharmaceutical care consultations. SUS´s users asked the law, health care and set judicialization as a positive way to solve problems in access. The actors of municipality asked the limitations of the municipality in providing the right to health, healthcare and portray a threatening reality of lawsuits when related to collective interest. The actors of the legal institutions reported the reality of judicialization, ponder their existence, they liable the government. The lack of government strengthen the role of the performance of the judiciary agency to ensuring the constitutional right to health. Therefore the judicialization has been an approach adopted for this right in practice.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-26T12:49:01Z No. of bitstreams: 1 alicekappelroquemunck.pdf: 1734027 bytes, checksum: 8ea46596fa0ece3fd7cc704bd3798743 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-27T10:54:36Z (GMT) No. of bitstreams: 1 alicekappelroquemunck.pdf: 1734027 bytes, checksum: 8ea46596fa0ece3fd7cc704bd3798743 (MD5) / Made available in DSpace on 2016-01-27T10:54:36Z (GMT). No. of bitstreams: 1 alicekappelroquemunck.pdf: 1734027 bytes, checksum: 8ea46596fa0ece3fd7cc704bd3798743 (MD5) Previous issue date: 2014-12-10 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A saúde no Brasil é estabelecida constitucionalmente como direito de todos e dever do Estado, sendo o Sistema Único de Saúde o conjunto de ações e serviços de saúde por meio do qual o Estado se propõe a garantir a todos os cidadãos o direito aos serviços de atenção à saúde e o acesso a medicamentos. No entanto, a reclamação por medicamentos na justiça tornou-se fenômeno expressivo no Brasil, não necessariamente se traduzindo em garantia da saúde do autor da ação. Por isso, o presente trabalho objetivou estudar as ações judiciais no município polo da Zona da Mata de Minas Gerais, com enfoque nas características médico-sanitárias. Foram analisados todos os processos judiciais deferidos com pedidos de medicamentos impetrados contra a Prefeitura de Juiz de Fora, em 2012 e 2013, arquivados na Secretaria de Saúde. Foi observado que 62,5% das prescrições que respaldaram a ação judicial eram provenientes de estabelecimentos públicos de saúde, 55,7% dos medicamentos demandados foram prescritos pela Denominação Comum Brasileira e 26% das prescrições analisadas utilizaram exclusivamente o nome genérico. Os principais diagnósticos que motivaram as demandas judiciais foram condições crônicas como neoplasias, doenças do olho e transtornos mentais, havendo coerência entre os diagnósticos e os medicamentos demandados. Verificou-se que 3,2%, 14,3% e 21,9% dos medicamentos solicitados eram considerados essenciais pela Remume, Rename 2010 e Rename 2012/2013, respectivamente; 0,7% dos medicamentos não apresentavam registro na Anvisa; 9,8% dos medicamentos faziam parte do elenco do Componente Básico, 0,7% do Componente Estratégico, 4,0% do Componente Especializado e 70,9% não fazia parte do elenco de nenhum componente de financiamento da Assistência Farmacêutica. Dos medicamentos mais demandados, 85% foram prescritos para indicações terapêuticas diferentes daquelas registradas em bula. Frente ao custo da judicialização da saúde e distorção do conceito de medicamentos essenciais utilizado na Rename vigente, torna-se imprescindível restabelecer as prioridades para a atenção à saúde, o conceito de medicamentos essenciais e o grau de exigibilidade do direito à saúde e ao acesso a medicamentos realmente essenciais. / Health in Brazil is constitutionally established as a right and duty of the State and the Health System's set of actions and health services through which the State proposes to guarantee all citizens the right to care health services and access to medicines. However, the claim for medicines in courts has become a significant phenomenon in Brazil, not necessarily translating into ensuring the health of the plaintiff. Therefore, this work aimed to study the lawsuits in a hub city of Minas Gerais State, with a focus on medical and health characteristics. The analysis was concentrated on all deferred lawsuits with request of medicines against the municipality of Juiz de Fora during 2012 and 2013, filed with the Department of Health. It was observed that 62.5% of prescriptions that supported the lawsuit were from public health establishments, 55.7% of the medicines were prescribed by the Brazilian Common Denomination and 26% of the prescriptions analyzed exclusively used the generic name. The main diagnoses that motivated lawsuits were chronic conditions such as cancer, eye diseases and mental disorders; there is consistency between the diagnoses and the medicines. It was found that 3.2%, 14.3% and 21.9% of the requested medicines were considered essential for Municipal Register of Essential Medicines, National Register of Essential Medicines 2010 and National Register of Essential Medicines 2012/2013, respectively; 0.7% of the medicines had no registration on Anvisa; 9.8% of the drugs were part of the cast of the Basic Component, 0.7% of the Strategic Component, 4.0% of the Specialized and 70.9% of the cast were not part of any component of the Pharmaceutical Assistance funding. 85% of the most medicines were prescribed for different indications than those registered in drug leaflet. Facing the cost of the judicialization of health and distortion of the concept of essential medicines used in current National Register of Essential Medicines, to restore the priorities for health care, the concept of essential medicines and the degree of enforceability of the right to health and access to essential medicines in fact becomes indispensable.

Objetivos. Describir el modelo de supervisión de las Instituciones Prestadoras de Servicios de Salud (IPRESS) de la Superintendencia Nacional de Salud (SUSALUD) y evaluar los factores asociados al porcentaje de cumplimiento normativo ajustado a riesgo (%CNAR) en las IPRESS del Sistema de Salud Peruano (SSP). Materiales y Métodos. Se realizó un estudio de caso sobre el desarrollo e implementación de un modelo de supervisión ajustado a riesgo basado en la norma ISO 31000-2009. Con la IPRESS como unidad de análisis, se calcularon los %CNAR (un puntaje continuo entre 0 a 100) de las supervisiones integrales (SI) y supervisiones selectivas efectuadas durante los años 2013 al 2015. Un mayor %CNAR implica un menor riesgo operacional. Se estimaron coeficientes β con IC95% mediante modelos lineales generalizados para valorar la asociación entre el %CNAR (variable de respuesta) y el subsector, la región, el nivel de complejidad y el año de supervisión (variables de exposición). Resultados. Se ejecutaron 1444 supervisiones. En las SI, solo la Seguridad Social en Salud (ESSALUD) tuvo mayor %CNAR que los centros privados [(β=7,7%;IC95%(3,5 a 11,9)]. Las IPRESS de la Costa [β=-5,2;IC95%(-9,4 a -1,0)], Sierra [β=-12,5;IC95%(-16,7 a -8,3)] y Selva [β=-12,6;IC95%(-17,7 a -7,6)] tuvieron menor %CNAR que aquellas ubicadas en Lima Metropolitana. El %CNAR fue superior en el año 2015 [β=10,8IC95%(6,4 a 15,3)] en relación al año 2013. Conclusiones. El %CNAR difiere por subsector, región y año de supervisión. En las SI las IPRESS supervisadas en ESSALUD, Lima Metropolitana y el año 2015, tuvieron mejores puntuaciones. Se sugiere la puesta en marcha de acciones orientadas a mejorar el %CNAR con el propósito de favorecer el ejercicio de los derechos en salud en el SSP. / Objectives. To describe the monitoring model of the Health Care Service Institutions (HCSI) of the National Health Authority (NHA) and assess the factors associated with risk-adjusted normative compliance (%RANC) within the Peruvian Health System (PHS). Materials and Methods. We carried out a case study of the experience of the NHA in the development and implementation of a monitoring program based on the ISO 31000-2009. With HCSI as the units of analysis, we calculated the %RANC (a scorein continuous scale ranging from 0 to 100) for comprehensive monitoring (CM) and for specific evaluations made from 2013 to 2015. A higher score in the %RANC means lower operational risk. Also, slope coefficients (β) and their 95% confidence intervals (95% CI) were estimated using generalized linear models to estimate the association between %RANC as outcome, and health subsector, region, level of care and year, as explanatory variables. Results. The NHA made 1444 evaluations. For CM, only the Social Security Administration had higher %RANC than private centers (β=7.7%; 95% CI 3.5 to 11.9). The HCSI of the coastal region (β=-5.2, 95% CI -9.4 to -1.0), andean region (β=-12.5; 95% CI -16.7 to -8.3) and jungle region (β=-12.6, 95% CI% -17.7 to -7.6) had lower %RANC than those located in Lima Metropolitan area. %RANC was higher in 2015 than 2013 (β=10.8; 95% CI 6.4 to 15.3). Conclusions. The %RANC differs by health subsector, region and year of supervision. For CM, the HCSI in the Social Security Administration and in the Lima Metropolitan area had better scores, and scores improved over time. The implementation of actions aimed at improving %RANC in order to foster the full exercise of health rights in the PHS is suggested. / Revisión por pares

This research explores the international and national (such as Kenya, South Africa, Uganda, Tanzania and the OAPI region) standards of trademark law as well as the international rules promoting free flow of goods and how these two legal systems safeguard the consumers’ right to health. Focuses on the following two specific aspects of trademark law: counterfeiting which includes infringement, and licensing of a trademark in relation to consumers’ protection. / Thesis (LLM (Human Rights and Democratisation in Africa))--University of Pretoria, 2007. / Dissertation submitted to the Faculty of Law University of Pretoria, in partial fulfilment of the requirements for the degree Masters of Law (LLM in Human Rights and Democratisation in Africa). Prepared under the supervision of Dr Atangcho N Akonumbo Senior Lecturer, Catholic University Yaounde, Cameroon. / http://www.chr.up.ac.za/ / Centre for Human Rights / LLM

LLM / Department of Public Law / Human rights are those inalienable rights of an individual by virtue of being a human being. They are guaranteed by various domestic and international instruments. This research argues that despite the existence of these instruments and wide acceptances of international human rights standards that seek to protect the right to healthcare, the people infected with Ebola Virus Disease (EVD) are victims of a wide range of constraints to their right to healthcare as a result of the failure by the governments of the respective nations where the impacts of the EVD are mostly felt to discharge their obligations under those instruments. The rights of the people infected with EVD are often violated because of their presumed or known EVD status, causing them to suffer both the burden of the disease and the social burden of discrimination and stigmatisation which could deter the infected persons from accessing available treatment. This would invariably contribute to the spread of the disease. The research further exposes the dilemma posed by the EVD to the healthcare system, where healthcare providers are caught between the rock of selfpreservation from a highly virulent disease and the hard place of discharging their Hippocratic Oath which prescribes ethical guidelines for the discharge of the duties of the medical profession. The present research, which is novel in the field of medico-legal research, seeks to proffer answers to this conundrum.

La circulation en ligne des médicaments est une réalité de notre monde numérique. Elle s’exprime entre autres à travers la circulation des informations, des services, des idées, des produits. Au regard du rôle du médicament dans le cadre de la thérapie de soins, ce nouveau mode de distribution ne peut être régi uniquement par le cadre juridique d’ordre général applicable au commerce électronique. Le médicament, avant d’être un produit du commerce, est un produit de santé publique ; et l’accès à ce dernier un « droit humain ». En raison de cet ensemble d’éléments, l’entrée du médicament dans le « marché numérique » soulève plusieurs enjeux juridiques ; et justifie la réticence du législateur (au sens classique) qu’il soit national ou international. Cette réticence qui remet en cause le principe de libre circulation des biens et des services, est due à un certain nombre de défis que pose la création d’un circuit de distribution fiable dans le cyberespace. Ces défis sont liés à la définition des normes devant régir la création d’une architecture au sein de laquelle il est facile d’effectuer les contrôles qui garantissent la qualité des produits pharmaceutiques. En outre, la création du « marché électronique » du médicament suppose la définition des acteurs aptes à assurer le bon fonctionnement de cette architecture. Bien plus, il s’agit de la capacité de nos systèmes juridiques à définir un corpus normatif capable de réguler les incidences de la numérisation du circuit de distribution sur les pratiques et les relations entre les différents acteurs. L’objectif visé est de favoriser la disponibilité du « bon médicament pour le bon patient et au bon moment ». Or dans une analyse pragmatique et à l’heure actuelle du développement de la connaissance du cyberespace, la définition d’un tel corpus normatif n’est pas aisée en raison du caractère sans cesse changeant du « marché électronique » qui ne permet pas d’avoir des cadres de références stables. L’idée que nous avons partagée dans le cadre de cette analyse est celle selon laquelle ces défis ne devraient pas nous empêcher de travailler à la création d’un système légal de distribution en ligne qui définit le statut juridique des différents acteurs intervenant dans le circuit de distribution. En bref, un système qui fixe les cadres de références qui régissent l’architecture au sein duquel se font les opérations en ligne; et qui protège les cyberpatients tout en les transformant en « actients ». Pour ainsi dire, des « cyberconsommateurs » outillés sur les procédures de contrôle et de recours possibles en cas de préjudice subi, car dans le déni de construire un système de distribution légal, on laisse la place à la prolifération d’un réseau illégal de distribution en ligne. / The online circulation of medicines is a reality of our digital environment. It is a fact in our digital world through the flow of information, services, ideas, and products. It cannot be governed only to the general legal scope applicable to the e-commerce because of the function of drug within the framework of care therapy. Since, before being a commercial product, the drug is a public health product and access to it is part of the right to health. That is the reason why its insertion into the digital market raises several legal issues; and justifies the reluctance of the legislator (in the classical sense), whether national or international, to promote its entry into the “electronic market”. This reluctance, even if it calls into questions the principles of free movement of goods and services, is due to a number of challenges raised by the establishment of a trustable distribution channel in cyberspace. The challenges are linked to defining the standards that should govern the creation of an architecture within which it is easy to perform the necessary control useful to ensure the quality of pharmaceutical products. The creation of the “electronic market” of drug equally suppose, the definition of actors capable to sustain the good functioning of that architecture and having well legal defined status. Besides, it takes to the capacity of our legal systems to define a nominative corpus able to regulate the issues of the digitization of the distribution process over the practices and relations between actors. However, in a pragmatic analysis and at the current time of the development of the cyberspace, the definition of such a normative corpus is not that easy due to the fast changing character of the cyberspace that does not allow to have stables framework of references necessary to define the normative corpus. The idea shared in this analysis is that these challenges should not prevent us from working to create a legal online distribution system. A system that defines the different actors who intervene in the distribution and sets the frames of reference that govern the architecture within which online operations take place. But above all, which protects cyber patients, while transforming them into real “active patient” capable of making informed choices online. Cyber consumers equipped with the control procedures and possible recourse in the event of damage suffered. Because, in the denial of building a legal distribution system, there is space for the proliferation of an illegal network.

[pt] O presente trabalho tem como objetivo de analisar como se constitui o processo de desospitalização em um hospital federal do Rio de Janeiro. A desospitalização geralmente envolve usuários com alguma condição de dependência que necessitam acessar o direito à saúde em sua integralidade e, muitas vezes, são impossibilitados e continuar o cuidado, devido aos aspectos relacionados à determinação social da saúde. Nessa perspectiva configuram como objetivos específicos deste trabalho: 1) Compreender quais são os desafios, potencialidades e estratégias utilizadas pelos profissionais ao trabalhar com a rede de serviços, tanto na política de saúde quanto intersetorialmente; 2) Entender quais as principais redes acionadas pela equipe e em que medida tem proporcionado o direito à continuidade do cuidado de usuários desospitalizados e 3) Refletir sobre a contribuição de uma equipe multiprofissional para a construção do trabalho em rede, visando a integralidade do cuidado. Essa pesquisa teve como lócus a Equipe de Apoio à Desospitalização e Educação em Saúde (EADES) do Hospital Federal de Bonsucesso, localizado no município do Rio de Janeiro. Como procedimentos de investigação, utilizamos duas técnicas: entrevista não estruturada com roteiro pré-elaborado, que foi realizada individualmente com sete profissionais da EADES, e a observação participante. Os resultados apontam que o trabalho em rede abarca as redes internas e externas, sendo as principais dificuldades ao trabalhar em rede a precarização das políticas públicas associadas ao modelo neoliberal, a pessoalidade presente neste trabalho e as dificuldades de comunicação entre as equipes. Destacamos a necessidade de pensar a desospitalização a partir da ótica de políticas públicas e o cuidado garantido como um direito. / [en] The present work aims to analyze how the dehospitalization process is constituted in a federal hospital in Rio de Janeiro. Dehospitalization usually involves users with some condition of dependency who need to access the right to health in its entirety and are often unable to return home and continue care due to social and economic aspects. From this perspective, the main objectives of this work are: 1) to understand what are the challenges, potentialities and strategies used by professionals when working with the service network, both in health policy and intersectorally; 2) understand the main networks triggered by the team and the extent to which it has provided the right to continuity of care for hospitalized users; and 3) reflect on the contribution of a multiprofessional team to the construction of networking, aiming at comprehensive care. This research had as its locus the Decentralization and Health Education Support Team (EADES) of the Federal Hospital of Bonsucesso, located in the city of Rio de Janeiro. As investigation procedures, we used two techniques: open interview, with pre-elaborated script, which was conducted individually with seven professionals who compose EADES and the participant observation. The results indicate that the main difficulties in working in networks are associated with the precariousness of public policies, the personality present in this work and the difficulties between the teams. In this sense, we highlight the need for a public agenda to think about dehospitalization, so that care is thought as a right.

The purpose of this thesis is to understand the impact of the covid-19 pandemic on the right tohealth for female refugees living in Athens. The paper is based on data derived from semi-structured interviews with female refugees and aid-workers working on the field in Athens. The interviews are complemented with a field study as a participant observer in a small school run by an NGO in Athens. The theoretical framework for the analysis of the empirical data is social exclusion.The conclusion is that the covid-19 pandemic has had a severe impact on the right to health for female refugees living in Athens. Covid-19 restrictions and regulations are keeping people without papers out from the health care system and making it harder for approved refugees to get health care. Refugee women are experiencing extra difficulties through the restrictions, due to intersectional discrimination of gender and race of the host society and through traditional gender roles within their culture. Refugees access to social networks has decreased, especially the possibility to get help from NGO:s that are dependent on private funding, which has decreased incident to the pandemic. NGO:s also had to shut down the social parts of their work due to lockdowns. This has increased social isolation and made mental health problems and poverty worse. Some NGO:  s has restrictions about vaccines or negative covid-tests which have an impact on refugees without possibility to get vaccinated or tested. The pandemic has also increased racism towards refugees and enhanced the possibilities of abuse of power from the police.

<p>This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing/expenditure and staffing at the primary health care level between different districts of the Northern Cape.</p>

Dans les sociétés anciennes et modernes, la santé a été et est aujourd'hui encore une préoccupation capitale. Elle est le signe du niveau de bien être de la collectivité et de la personne. Dans le cadre de l’accès à la santé qui constitue un droit pour tous, le médicament occupe une place importante en France et au Japon, deux pays où l’espérance de vie et le niveau de vie sont élevés et ne cessent d’augmenter. C’est au vu de ces considérations que nous nous interrogeons à travers cette thèse sur la véritable place de l'usager dans la régulation du médicament en France et au Japon qui sont deux pays différents par leur culture mais qui convergent à certains moments dans le droit. L'on pourrait valablement soutenir qu’un bon système de santé se reconnaît par le niveau de protection qu'il accorde à l'usager du médicament. Cela n'est pas aussi simple car divers intérêts sont en jeu. Il est aussi important de savoir comment se solde le traitement des conflits d'intérêts dans la régulation du médicament : protection de l'être humain ou protection de la science? S'il est soutenable que la protection d'un "humain scientifique" existe, il nous appartient de rechercher la réalité de l'existence d'un ensemble de règles permettant d'assurer une "Science plus Humaine". Nous savons et il a été reconnu que le monde de la santé, émotionnel, individualiste, structuré en groupes de pressions très forts et souvent très capitaliste, est difficile à appréhender. / In former and modern societies, health has been and still is a crucial concern. It is the sign of the community’s and the individual’s well-being. In the setting of access to health that is a right for all, the drug has an important place in France and in Japan, which are countries where life expectancy and level of life are high and keeps on increasing. It is in consideration of this, that we are asking ourselves, through this thesis, about the drug user's right place in drug regulation in France and Japan which are countries different by their culture but sometimes converging in law.We can validly hold up that a good health system can be recognized by the level of protection given to the drug user. But this is not so easy because various interests are at stake. It is important to know how these kinds of conflicts are solved in drug law: is it human or science which is protected? If we can hold up that the protection of the "scientific human" exists, we have to research the reality of the existence of rules insuring a “more human” science. We know and it has been said that the field of health, emotional, individualistic, structured in strong lobbies and often capitalistic, is very difficult to comprehend.