Industrial policy and medicines in Brazil: State, Markets and sectoral arrangement
Post: Postdoctoral fellow (principal investigator)
Few developing countries understand the production of medicines as an industrial strategy as Brazil. These countries are usually discouraged to adopt industrial policies for this sector given the associated costs; on the other hand, they are encouraged to promote access to medicines. How can innovations in public policies in Brazil contribute to understanding and overcoming the contradiction between the availability of health inputs and social protection policies? Previous studies have analysed the implications of health industrial policy for economic development. 
Sponsor: Sao Paulo Research Foundation (Fapesp)


Federalism and pharmaceutical assistance: an analysis of the program for high cost medicines
Post: Postdoctoral fellow (principal investigator)
Description: Brazil has a relevant, although little known, free and universal program for high cost medicines to treat illnesses such as cancer and kidney failure. This program is partly financed by the Ministry of Health (MoH) (approx. R$ 2 billons in 2010) and the responsibility for its management and the purchase of medicines is with the State Health Secretariats (SHS). However, until 2009 there were no formal rules defining the responsibilities of each of these two levels of government in managing and financing this initiative. Furthermore, SHS have faced important challenges in the provision of medicines, with an increasing demand of individual lawsuits (particularly for high cost medicines). Why have state governments decided to keep the responsibility of the program of high cost medicines, despite the increase in judicial demands? It is argued that although subnational governments have the autonomy to define their agenda, they opt for assuming the responsibility of federal policies based on a calculation of the cost/benefits of this decision (considering the historical legacy of the policy, capacity to operationalize it, and political action) (cf. Arretche). This comparative study of three regions of Brazil s federation where this dilemma is more evident (SP, RJ, MG) will use documentary research and semi-structured interviews to trace the historical process of federative bargains in pharmaceutical assistance. 
Sponsor: Sao Paulo Research Foundation (Fapesp)


Reforming pharmaceutical regulation: a case study of generic drugs in Brazil (2007-2011)
Post: Principal investigator
Description: Brazil is renowned worldwide for its remarkable reforms in pharmaceutical regulation, as the Generic Drug Act that have enhanced access to essential medicines while lowering drug costs. In contrast with analysis of pharmaceutical regulation that invokes international guidelines as inspiration for countries to reformulate their norms or argues that regulations emerge in order to serve the interests of powerful interest groups; this paper focuses on actors' preferences and demands to explain how Brazil promoted this large-scale regulatory policy. Paradoxically, the generic drug regulation introduced in the name of patients and opposed by local firms given the high cost to adapt its plants and processes, is today opposed by important patient advocacy groups but solidified by the strong support of local and multinational pharmaceutical firms. 

Sponsor: The University of Edinburgh Development Trust, UK


Authority and Responsibility in European Health Policy: The Diffusion of Power in European Health Policy (2006-2008)
Post: Visiting research fellow
Description: The efficiency and effectiveness of health policy depends in large part on the level of government carrying out the policy. There is persistent confusion about decentralization in health care and what it is supposed to do. We approach the question by explaining authority in health care systems. There are many theories of why a given policy should be at a given level- but what explains what happens? We test two broad theories of authority allocation. The economic theory suggests that rational governments will concentrate information-intensive operations such as primary care planning at lower levels, and redistributive and regulatory functions such as health financing and pharmaceuticals at higher levels. The political theory, by contrast suggest that all governments will concentrate in areas where they can reap public credit, and will all avoid areas that have a high concentration of blame (such as service reconfiguration).
Coordinator: Dr Scott Greer
Sponsor: Nuffield Trust, UK

Mobilizing bias in Europe: Lobbies, democracy, and EU health policymaking (2007)

Post: Visiting research fellow
Description: Do interest groups help democratize or legitimize the EU? We test four hypotheses about the nature of lobbying resources, developed in aggregate quantitative studies or qualitative case studies, in the health sector. We use a newly constructed database, from four official and public sources, that allows us to compare c. 70 health groups against c. 700 general EU interest groups, and supplemented by literature review, a survey, and 51 interviews. Are the big organizations in Brussels the same as the ones in member states? Are some countries’ lobbies more engaged than others? And does the structure of EU lobbying itself create insiders and outsiders? Our answers to the questions suggest that EU interest intermediation does little to redress imbalances of power.
Coordinator: Dr Scott Greer
Sponsor: Nuffield Trust, UK


Health economy among São Paulo Municipalities, Brazil (2006)

Post: Visiting research fellow
Description: The project has studied the new roles in the financing and provision of primary health care of the local government in Brazil. It evidences that decentralization process has favored strong decisional space for the local government (municipalities). In the Stated of Sao Paulo, local autonomy has been significantly associated with more governmental spending in health care functions and with better primary health care performance.
Coordinator: Dr Nilson do Rosario Costa
Sponsor: São Paulo Research Foundation (Fapesp)


Devolution, AIDS and Harm Reduction in Brazil (2005-2008)

Post: Principal Investigator
Description: Brazil's AIDS program is world-renown for providing free and universal access to AIDS treatment, successful civil society partnerships, prevention programs, and its nationwide needle exchange programs (NEPs) for injecting drug users (IDUs). In 2002, Brazil's highly centralized National AIDS Program began decentralizing federal AIDS programs to all of Brazil's 27 states and 422 municipalities to better integrate AIDS programs with primary health care. Decentralization also aimed to promote cost-sharing with states and municipalities. It is still unclear what effects decentralization will have on AIDS programs, particularly controversial programs such as those that serve IDUs and commercial sex workers. This research proposal will examine how financial and organizational decentralization have impacted fiscal transfers to states and municipalities for needle exchange programs between 1998 and 2006.
Sponsor: Ministry of Education (CAPES), Brazil
Media quotes: Agencia de noticias Fiocruz, Canal Futura.

Expanding access to antiretroviral drugs in Brazil: a policy analysis (2005-2007)

Post: Associate Researcher
Description: Joint project with Harvard School of Public Health. This research aims to better understand how and why the Brazilian AIDS Program simultaneously implemented several complex, highly controversial policies to promote large-scale AIDS treatment programs at the national and international level. This case study employs a political economy theoretical construct to analyze Brazil's recent AIDS-related health reforms. Qualitative interviews with key policy makers, diplomats and AIDS experts will explore the factors that influenced former President Fernando Henrique Cardoso and Brazilian Ministry of Health (MOH) leaders' controversial decisions to 1) to reverse-engineer and produce generic copies of off-patent ARVs for public use in 1994; 2) reverse-engineer patented ARVs in 1998 in order to threaten to issue compulsory licenses for generic production of patented ARV medicines in 2001. This later step induced multinational pharmaceutical companies to engage in ARV price negotiations with the Brazilian MOH between 2001 and 2004, reducing ARV costs significantly. .
Coordinator: Dr Amy Nunn
Sponsor: United States Departament of Defense and Harvard Center for Population and Development Studies
Media quotes: BBC, Agencia de Noticias AIDS, Harvard School of Public Health News and others.

International Network on HIV/AIDS Management & Care and Women’s Reproductive Choices: Focus on Brazil (2005-2006)

Post: Associate Researcher
Description: The proposed study and intervention will follow 500 HIV-positive women aged 18-50 years in Rio de Janeiro, Brazil and will examine the impact of HAART on women’s sexual and contraceptive behavior, desire and intention to have more children, fertility, and survival of their children. Brazilian findings will be full integrated into a comprehensive network of similar initiatives carried out in South Africa and Uganda, in cooperation with colleagues from Canada and the US.
Coordinator: Dr Francisco Inacio Bastos
Sponsor: Ford Foundation

Assessing the Effectiveness and Potential Unintended Consequences of Oral HIV Testing Among Drug Users in Brazil (2004-2006)

Post: Associate Researcher
Description: Joint project with Yale University and Iowa University. Main goal: To increase the use of HIV/AIDS diagnostic and counseling services among drug users Specific aims: 1. To make oral HIV testing available to a sample of street drug users in three distinct locations in the Rio De Janeiro area. 2. To determine the impact of oral testing on their likelihood of returning for their post test counseling session. 3. To compare those individuals who have never received an HIV test prior to the current project with those individuals who have previously been tested for HIV. 4. To compare the effectiveness of limiting mismessaging of an enhanced counseling and testing protocol based on verbal and experiential messages against a standard oral testing and counseling protocol based only on verbal messages. Study design: The study is will employ both qualitative and quantitative data collection methods.
Coordinator: Dr Merril Singer (Yale University), Dr Scott Clair (Iowa University) and Dr Francisco I. Bastos (FIOCRUZ)
Sponsor: Hispanic Health Council.

Opportunities to support adherence and safe sex among people living with HIV/AIDS receiving HAART in Public Health Clinics in Rio de Janeiro, Brazil (2005).

Post: Associate Researcher
Description: Joint project with Johns Hopkins University.
Coordinator: Dr Deanna Kerrigan (Johns Hopkins) and Dr Francisco I. Bastos (FIOCRUZ)
Sponsor: Johns Hopkins University

Pilot Study: Assessing HIV-infected Drug Users Access and Adherence in Rio de Janeiro, Brazil. (2004-2005).

Post: Associate Researcher
Description: Main goal: To assess HIV-infected drug users barriers and facilitators to access and adhere to HIV treatment and anti-retroviral therapy in Rio de Janeiro, Brazil. Study design: The proposed study will employ both qualitative and quantitative data collection methods. Study population: The research will involve HIV+ drug users, both currently engaged and not engaged in ARV therapy.
Coordinator: Monica Malta
Sponsor: Centre for Addiction and Mental Health (CAMH), Canada.

The Impact of Highly Active Anti-retroviral Therapy (HAART) for the Treatment of HIV/AIDS on HIV-related Protective Behavior in Rio de Janeiro, Brazil (2002-2003)

Post: Associate Researcher
Description: Research Questions/Specific Aims 1. To investigate local beliefs and attitudes regarding anti-retroviral therapy for the treatment of HIV/AIDS among heterosexuals and infection drug users in Rio de Janeiro, Brazil. 2. To develop a culturally appropriate and reliable measure of "optimism-skepticism" related to HIV/AIDS as a result of access to anti-retroviral therapy in Brazil. 3. To test the statistical association between "optimism-skepticism" regarding HIV/AIDS due to anti-retroviral therapy and HIV-related behavior. 4. To explore possible intervention models that could be employed to address "optimism" regarding HIV/AIDS due to anti-retroviral therapy in future prevention-care programming. Methods Study design: The proposed study is formative and cross-sectional in nature and will employ both qualitative and quantitative data collection methods. Study population: The research will involve two sub-populations: (a) heterosexual men and women and (b) injection drug users.
Coordinator: Dr Deanna Kerrigan (Johns Hopkins) and Dr Francisco I. Bastos (FIOCRUZ)
Sponsor: Johns Hopkins University