Elize Massard da Fonseca




Recent research grants

 

Policies to increase the competitiveness of the pharmaceutical sector: Brazil's experience (2016-2020)

Fapesp Young Investigator Award: 2015/18604-5

 

The Brazilian government has invested in its pharmaceutical sector as part of an innovative strategy for economic and technological development. In parallel, it increased access to high-cost medicines such as drugs to treat cancer or AIDS through the National Health System. Social science scholars have paid relatively little attention to these initiatives, focusing instead on the impact of the health-industry complex (CIS) on economic development. As such, little is known about the political processes underlying this public policy innovation. The present research will analyze (i) why and how Brazil selected to implement policies to stimulate the competitiveness of its pharmaceutical sector; (ii) the contribution of civil society and the private sector to the development of policies for CIS and pharmaceutical regulation are also explored. This qualitative study combines formal and informal documentary sources with in-depth interviews to assess the political actions of key stakeholders in the health sector. This analysis contributes to the understanding of the process of development of these policies and of the dynamics of interest groups in influencing regulation, which is understudied in the literature. Hopefully, this research will stimulate scholars to further investigate the pharmaceutical sector in Brazil, yet little explored in comparison to other segments of the economy.

 

 

Industrial policy and medicines in Brazil: state, markets and sectoral arrangement (2014-2016)

Fapesp postdoctoral research: 2014/07725-3

 

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 this dilemma be balanced? 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. This project takes a different approach and looks at the political action of relevant actors in the health sector as the main explanatory mechanism, arguing that the capacity of the Ministry of Health to coordinate policies, the influence of a community of specialists, and the gain in innovative capacity of the private local pharmaceutical industry have all been crucial to the formulation and development of this agenda. This qualitative research will conduct a documentary investigation and in depth interviews. It will trace the process of negotiation for the different public policies promoted under the Health Industry Complex strategy; the agendas of regional governments regarding the public laboratories and their relationships with the national policy; and the mechanisms to finance and monitor the industrial health policy between 2003 and 2013. Therefore, this study contributes to understanding of the political process of health industry policy as well as the dynamic of interest groups in Brazil, whose literature still focuses on the structure of corporate representation. 

 

 

Federalism and pharmaceutical assistance: an analysis of the program high cost medicines (2012)

Fapesp postdoctoral research: 2012/01195-7

 

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. This research can contribute to a better understanding of the political process of this program, which is still little known. It also informs us of the institutional context in which the industrial policy for the pharmaceutical sector - a core agenda of the MoH in this decade - has been implemented.

 

For other research projects that I have participated, please, see my CV lattes.