PAGE 1State Pharmacy Brazil namePracticum in Health Administration MHA 690Pfeiffer University November 7, 2013 Professor: Table of Contents Introduction ……………………………………………………………… Brazilian Health Care System………………………………………………………….14 The State Pharmacy Exceptional Drugs ……………………………………….…20 Activities…………………………………………………………………………………24 I. Participation in Activities Developed in Sector Screening and Social Services ………………………………………………………………...33 II. Participation in the Passwords Distribution ………………………………………………………………34 III. Participation in the Activities of Pre-Dispensation:……………………………………………………………....35 IV. Participation in the Activities Performed in Pharmaceutical Care ……………………………………………………………36 V. Participation in the Activities of the Internal Pharmacy after the Service Conclusion………………………………………………………………………38 Bibliography………………………………………………………………….………….……..39 1. INTRODUCTION The internship was in the State Pharmacy of Curitiba – Brazil. The internship aims to enter the student in daily SUS to analyze the role of the pharmacist in this system with the opportunity to combine theory with practice, to develop time responsibility and competence expected of the pharmacist, and improve theoretical, technical, ethical, and political understanding for the student. Brazilian Health Care System The public health system (SUS) is one of the largest public health systems in the world.  It ensures universal, comprehensive health care and it is free to the entire population of the country.  The public health system was created in 1988 by the Brazilian federal constitution to be the health care for all Brazilians.  Besides offering consultations, tests, and hospitalizations, the system also promotes vaccination campaigns, prevention, and sanitary surveillance. The SUS was created to provide equal service and care, and promote the health of the entire population.  The system is a unique social project that materializes through health promotion, prevention, and Brazilians' health care. For nearly 22 years of existence, the National Health System (SUS) has established itself as a major public policy in Brazil promoting social inclusion and seeking to continuously strengthen their basic pillars of full health care, and universal and equal access. It is the only access to health services for 160 million Brazilians (80% of the population), SUS is developing mechanisms to improve management and expand its scope. In 2009, it performed 3 billion outpatient visits, 380 million medical visits, 280,000 heart surgeries, and 10 million procedures in radiotherapy and chemotherapy. In addition, SUS is one of the largest public organ transplant programs in the world, won international recognition for the success of mass vaccination campaigns, and is the only developing country to guarantee free comprehensive treatment for people with HIV (Brasil, pp 11-13). The Unified Health System (SUS) was creat.

1. PAGE
1State Pharmacy Brazil
namePracticum in Health Administration
MHA 690Pfeiffer
University
November 7, 2013
Professor:
Table of Contents
Introduction
………………………………………………………………
Brazilian Health Care
System………………………………………………………….14
The State Pharmacy Exceptional Drugs
……………………………………….…20
Activities……………………………………………………………
……………………24
I. Participation in Activities Developed in Sector Screening and
Social Services
………………………………………………………………...33
II. Participation in the Passwords Distribution
………………………………………………………………34
III. Participation in the Activities of Pre-
Dispensation:…………………………………………………………
…....35
IV. Participation in the Activities Performed in Pharmaceutical
Care ……………………………………………………………36

2. V. Participation in the Activities of the Internal Pharmacy after
the Service
Conclusion……………………………………………………………
…………38
Bibliography…………………………………………………………
……….………….……..39
1. INTRODUCTION
The internship was in the State Pharmacy of Curitiba – Brazil.
The internship aims to enter the student in daily SUS to analyze
the role of the pharmacist in this system with the opportunity to
combine theory with practice, to develop time responsibility and
competence expected of the pharmacist, and improve
theoretical, technical, ethical, and political understanding for
the student.
Brazilian Health Care System
The public health system (SUS) is one of the largest public
health systems in the world. It ensures universal,
comprehensive health care and it is free to the entire population
of the country. The public health system was created in 1988
by the Brazilian federal constitution to be the health care for all
Brazilians. Besides offering consultations, tests, and
hospitalizations, the system also promotes vaccination
campaigns, prevention, and sanitary surveillance.
The SUS was created to provide equal service and care, and
promote the health of the entire population. The system is a
unique social project that materializes through health
promotion, prevention, and Brazilians' health care.
For nearly 22 years of existence, the National Health System
(SUS) has established itself as a major public policy in Brazil

3. promoting social inclusion and seeking to continuously
strengthen their basic pillars of full health care, and universal
and equal access. It is the only access to health services for 160
million Brazilians (80% of the population), SUS is developing
mechanisms to improve management and expand its scope. In
2009, it performed 3 billion outpatient visits, 380 million
medical visits, 280,000 heart surgeries, and 10 million
procedures in radiotherapy and chemotherapy. In addition, SUS
is one of the largest public organ transplant programs in the
world, won international recognition for the success of mass
vaccination campaigns, and is the only developing country to
guarantee free comprehensive treatment for people with HIV
(Brasil, pp 11-13).
The Unified Health System (SUS) was created from the Federal
Constitution of 1988 stating that the entire population has
access to the public health. Previously, National Institute of
Medical Welfare (INAMPS) was in charge of healthcare. It was
restricted to the employees who contributed to social security;
others were attended to only through philanthropic services
(Brasil, pp22).
Health posts, hospitals (including university laboratories),
blood banks, services of Sanitary Surveillance, Epidemiological
Surveillance, environmental monitoring, foundations, State
Pharmacy and research institutes such as FIOCRUZ – Fundacao
Oswaldo Cruz and the Instituto Vital Brazil, are part of the
Sistema Unico de Saude (Brasil, pp 30-32).
The State Pharmacy
The State Pharmacy is the unit responsible for drug dispensing
for exceptional users and the Metropolitan Region of Curitiba.
Its main purpose is to ensure the necessary safety, efficacy, and
quality of medicines, promoting the rational use of drugs, the
universal access to essential medicines, and is an integrated part
of the Pharmaceutical Care. (HEALTH-2008)

4. Pharmaceutical Care involves all activities related to medicines;
being a fundamental part of health care services to the citizens.
It involves the supply of medicines in all and each of its
constituent steps, conservation and quality control, safety and
therapeutic efficacy of drugs, monitoring and evaluation of the
use, the gathering and distribution of information on medicines
and continuing education for health professionals, patients, and
the community to ensure the rational use of drugs.(BRAZIL-
2001)
To ensure people's access to medicines, CEMEPAR (Drug
Center of Paraná) implemented the programs offered by the
Ministry of Health-MS and the Ministry of Health of Paraná-
SESA/PR. One of the programs is Exceptional Medicines.
(HEALTH - 2008)
The Exceptional Drug Program was established by the Ministry
of Health officially in 1982. It is responsible for providing
drugs to treat specific diseases, which usually has a high unit
value or requires chronic treatment; making it extremely
expensive, precluding the population regardless of social class,
to dispose of these drugs due to their high cost. (HEALTH -
2008)
Exceptional Drugs
The Exceptional Drug Program, which is managed by the
Department of Health Care, covers drugs with high unit value or
that the treatment of chronic diseases has become too expensive
to be supported by the population. This policy has enormous
reach in all social classes, since, if they were not distributed
free of charge, such drugs would be accessible to many people
due to the high cost of treatment. In operational terms, the
funds for the acquisition of Exceptional Drugs are transferred
by the Ministry of Health to the States every month and in
advance; so then States can plan to purchase the drugs, and
control the distribution and inventories according to the needs

5. of the population.
The program has existed since 1993 and from that time until the
current management of the Ministry, many inclusions and
exclusions were made. In early 1999, Secretary of Health
Service implemented new management which has been very
effective and has generated good results grounded in expansion
funding in nominal control of patients, and strict monitoring of
the behavior of the pharmaceutical market that sets the value
table for each medication and the proper management of the
prescription and supply of medicines. Clinical Protocols and
Therapeutic Guidelines were developed for each of the drugs,
which rationalize their prescribing and dispensing.
The adopted management firm allowed the rationalization of
expenditures, and expansion on the number of drugs available
and patients covered by the program. Although medications
were part of the table in practice until 1996, few drugs were
actually dispensed to the population.
In 1997, the program had an increase in the supply of medicines
and number of patients benefited.The growing trend of the
program started in 1998, which registered a significant increase
in the quantity of drugs dispensed.
From 1997 to 2001, many drugs were included in the program,
as well as many diseases are being cured and an increase in the
number of patients observed. In 2002, the program was
significantly increased representing more than double of
medications available in 2001.
The financial resources of the Ministry of Health are transferred
monthly to the states, which are responsible for the planning,
procurement, distribution, and dispensing of these drugs to
patients registered in accordance with the Therapeutic
Guidelines and Clinical Protocols-PCDT. They aims to establish
criteria diagnosis of each disease, inclusion and exclusion of
patients to treatment, the correct doses of prescription drugs,
and control mechanisms, monitoring, and evaluation. (HEALTH

6. - 2008)
The patient may only have access to these drugs if they are
prescribed by a doctor during a consultation, thus avoiding self-
medication as a drug administered improperly can not only
decrease the effectiveness of treatment but can also cause
serious injuries to the health of the patient. (HEALTH - 2008)
The State Pharmacy is located next to the building of 2nd
Regional da Saude. At the entrance, there is a counter for the
withdrawal password which will be the first evaluation of
prescription and roles required for drug withdrawal. There are
waiting chairs available so users can sit while for awaiting their
password to be called. Just ahead is a panel showing the number
of the password to be received. This panel will appear for
normal and special passwords (for seniors, pregnant women,
disabled, or people with a lap child), and a bathroom for male
and female users is available. There are seven desks with
computers, and there are chairs for the attendant who handles
distribution of the medicine to the patients. In a separated part,
there are twelve shelves and refrigerators to stock the
medicines. In a locked shelf, there are all the controlled drugs
which are supervised by the pharmacist. There is also, another
room for the realization of pharmaceutical care.
2.2 ACTIVITIES
During the training period, I got trained to be able to develop
all the activities of all sectors of the pharmacy, as indicated
below.
2.2.1 Participation in Activities Developed in Sector Screening
and Social Services

7. Screening and social service work is from 8:00 am to 5:00 pm.
As their main functions, these two sectors guide and assist
patients in the process of application of medicines, problems
that prevent patients to withdraw from a drug, and function
check and correct the documentation needed to start the process.
The documentation required to give input to the application of
medicine are the Request for Exceptional Medicine(EMS),
medical prescriptions, medical report, tests that prove the
disease, copies of personal documents, RG, CPF, CNS(National
Health Card), proof of address, and Informed Consent form
signed by the doctor and patient. The whole process is evaluated
by a physician auditor, and if it fits the clinical criteria
established by the Ministry of Health then the patient is
registered in the Program of Special Medication. Social service
after learning of drug release connects the patient to attend the
same sector of social welfare where you will receive guidance
on how to proceed and the necessary documents in the days to
withdraw the drug, expiration dates, and terms of revenues.
Registration renewals are necessary to carry out each quarter.
2.2.2 Participation in the Passwords Distribution
When a patient arrives at the pharmacy, the user needs to wait
their turn to be attended to. There are two rows arranged; the
preferential queue (for the elderly, pregnant women, and
disabled) or normal line. To be attended to the patient needs to
show their photo ID, the prescription if it is a controlled drug,
and the SME (Exceptional Drug Request) containing the internal
number of the user.
The clerk sees the system if the documentation is up to date,
and thus generates a password. With the automated system, the
receipt with the number of the user's password is sent straight to
the pre-dispensation.

8. 2.2.3 Participation in the Activities of Pre-Dispensation
In this sector, the intern prints receipts and engages them with
the revenues. If the drug is controlled he/she fills these receipts
according to the amount of drug released for each patient, and if
the drug is controlled then revenue goes through a new
evaluation performed by the intern. Soon, the drug is separated
according to what is on the receipt, then leading to the booths to
be excused.
In the area of pre-dispensation, is where the trainee acquires
many experiences and learns different types of medications
which are not commonly seen at a retail pharmacy.
2.2.4 Participation in the activities developed in the
Dispensation
In this section, the user is called to service after the appearance
of its passphrase panel. He goes to the window, showing the
clerk a photo ID and your EMS. If you are a family member or
friend of the patient, then the patient should take a compulsory
document described by the patient authorizing the person to
withdraw the drug without his presence. Soon after the intern
checks that the user documentation is up to date, there will be
the realization of the dispensation of medicines.
Controlled drug after being separated is taken to the
dispensation. The dispensation will be retained until the intern
gets a signature from the pharmacist to check if the drug and the
quantity are correct. If it is, then the drug can be dispensed.
The dispensation gives us the opportunity to have direct contact

9. with users, offering them information and resolving their
questions about the drugs. Therefore, only the day-to-day
pharmacy can verify the reality of the NHS, its bureaucracy,
large queues for the withdrawal of the drug.
2.2.5 Participation in the Activities Performed in
Pharmaceutical Care
The first time that a patient is in the pharmacy to withdraw a
drug, after dispensation, it must pass through the pharmacist
where there will be pharmaceutical care. In a separate room
with booths, the pharmacist or pharmacy intern (under the
supervision of the technical manager) will talk with the patient
by performing questions related to other medications used by
the patient beyond those dispensed, establishing schedules for
each drug, explaining how the patient should administer them
and how they should handle storage and transportation of the
drug in case the drug needs to be in refrigeration.
2.2.6 Participation in the Activities of the Internal Pharmacy
after the Service
The Special Pharmacy is open to the public for distributing
passwords until 5:00 pm, after this time the doors are closed
leaving only the internal activities to be performed. After 5:00,
some trainees who are still in attendance at the booth will fill
out receipts for dispensation of the day. Another intern is
responsible for counting the cabinet controlled; noting in
spreadsheets the amount of medication dispensed on the day and
conferring with the amount present in the inventory. All
retained earnings are separated and numbered by the active.
Dosage should then be recorded in the book of prescription

10. drugs.
At the end of the day, the shelves are filled with more
medicines, temperatures are checked for all the refrigerators,
and the controlled drugs are counted to check if there are any
mistakes that need to be fixed.
Bibliography
1) BRASIL. Secretaria Nacional dos Direitos da Cidadania e
Justiça. Assistência Farmacêutica na Atenção Básica. Instruções
técnicas para a sua organização. Brasília: Ministério da Saúde
2001.
2) SAÚDE. Secretaria de Saúde do Estado do Paraná.
Assistência Farmacêutica. Disponível em: www.saude.pr.gov.br,
acesso em 08/11/2008.
Brasil. Conselho Nacional de Secretários de Saúde.). Colecao
para Entender a Gestao do SUS. Date accessed February 04,
2013. Pp17-
18<http://bvsms.saude.gov.br/bvs/publicacoes/para_entender_ge
stao_sus_v.1.pdf>
BRASIL. Ministério da Saúde. Portaria 648, de 28 março de
2006. Date Accessed March 2, 2013.
<http://www.ministerio.saude.bvs.br/html/pt/colecoes.html>
CAMPOS, G.W.; BARROS, R.B.; CASTRO, A. M. Avaliação de
política nacional de promoção da saúde. In: Ciência & Saúde
Coletiva. 2004. v. 9, n. 3, pp 745-749
NOGUEIRA, V. M. R.; PIRES, D. E. P. Direito à saúde -
convite à reflexão. Cadernos de Saude Pública. Rio de
Janeiro: 2004. v. 20, n. 3, p. 753-760