Logística reversa de medicamentos e suas embalagens: estudo crítico sobre a viabilidade da sua implementação no Brasil
Data
2024-07-26
Autores
Paludetti, Diego Xavier 
Orientadores
Kummrow, Fábio
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A prática de manter estoques domiciliares de medicamentos é comum em muitos países, resultando no acúmulo desses produtos que, quando expirados ou desnecessários, geram resíduos farmacêuticos (RF). Programas de logística reversa de medicamentos (LRM) são globalmente reconhecidos como a melhor prática para o descarte desses resíduos pela população. No Brasil o sistema de LRM foi estabelecido em 2020 pelo Decreto nº10.388/2020, envolvendo toda a cadeia farmacêutica. O decreto prevê a implantação gradual de pontos de recebimento de RF em todo o território nacional. O programa teve início em 2021 e deve abranger todos os municípios com população ≥ 100 mil habitantes até 2026. Devido à diversidade no desenvolvimento dos estados brasileiros, é essencial analisar o desempenho e a efetividade do modelo de LRM, propondo ajustes e refinamentos conforme necessário. O objetivo deste estudo foi avaliar a implantação e o desempenho do sistema de LRM no Brasil durante seu primeiro estágio (2021-2023), identificando oportunidades de melhoria nas políticas e práticas de gestão de RF. As principais fontes de dados foram a estimativa populacional de 2021, o Censo Brasileiro de 2022, e os relatórios do LogMed, entidade gestora do sistema de LRM, disponibilizados pelo Sistema Nacional de Informações sobre a Gestão dos Resíduos Sólidos (SINIR+). Inicialmente, o estudo focou no estado de São Paulo, onde um Termo de Compromisso para a LRM (TCLR) que antecipou o início da operação do sistema de LRM, com a meta de implantar pontos de recebimento em municípios com população ≥ 200 mil habitantes já em 2021. Em São Paulo, o sistema de LRM representou um avanço na gestão de RF domiciliares, pois o sistema de LRM em 2021 atendeu cerca de 64% da população do estado, coletando 35 mil kg de resíduos em 40 dos 41 municípios previstos para iniciarem a sua operação. Com a divisão dos 40 munícipios que operaram a LRM pelas estruturas administrativas do sistema de saúde pública, os Departamentos Regionais de Saúde (DRS), foi verificado, por exemplo, que a maior coleta de resíduos ocorreu no DRS I – Grande São Paulo (15 municípios). Quando avaliado os dados nacionais referentes ao período de 2021-2023, foram incluídos todos os estados brasileiros, abrangendo aproximadamente 75 milhões de habitantes. De acordo com estimativas do IBGE, 85 municípios deveriam iniciar a LRM em 2021, mas apenas 69 o fizeram neste ano, impactando o desempenho do sistema, especialmente na região Norte. Em 2022, a atualização do Censo Brasileiro, incluiu Araçatuba (SP) no critério de meta geográfica, elevando para 86 o número de municípios que deveriam implementar a LRM nesta fase. É inegável que o sistema brasileiro de LRM representou um importante avanço na gestão dos RF domiciliares. Contudo, a análise contínua do desempenho do sistema de LRM é essencial para ajustes futuros e melhoria na gestão de RF, garantindo que as políticas e práticas sejam eficazes e adaptadas às necessidades regionais.
The practice of maintaining household stocks of medications is common in many countries, resulting in the accumulation of these products, which, when expired or unnecessary, generate pharmaceutical waste (RF). Reverse logistics programs for medications (LRM) are globally recognized as the best practice for the disposal of this waste by the population. In Brazil, the LRM system was established in 2020 by Decree No. 10.388/2020, involving the entire pharmaceutical chain. The decree provides for the gradual implementation of RF collection points throughout the country. The program began in 2021 and aims to cover all municipalities with a population of ≥100,000 inhabitants by 2026. Due to the diversity in the development of Brazilian states, it is essential to analyze the performance and effectiveness of the LRM model, proposing adjustments and refinements as necessary. The objective of this study was to evaluate the implementation and performance of the LRM system in Brazil during its first stage (2021-2023), identifying opportunities for improvement in policies and practices for RF management. The primary data sources were the 2021 population estimate, the 2022 Brazilian Census, and the reports from LogMed, the managing entity of the LRM system, available through the National Solid Waste Management Information System (SINIR+). Initially, the study focused on the state of São Paulo, where a Term of Commitment for LRM (TCLR) anticipated the start of the LRM system operation, with the goal of implementing collection points in municipalities with a population of ≥200,000 inhabitants as early as 2021. In São Paulo, the LRM system represented an advancement in household RF management, as it served in 2021 about 64% of the state's population, collecting 35,000 kg of waste in 40 of the 41 municipalities scheduled to start their operation. With the division of the 40 municipalities operating the LRM by the administrative structures of the public health system, the Regional Health Department (DRS), it was found, for example, that the largest waste collection occurred in DRS I – Greater São Paulo (15 municipalities). When evaluating national data for the period 2021-2023, all Brazilian states were included, covering approximately 75 million inhabitants. According to IBGE estimates, 85 municipalities were expected to start LRM in 2021, but only 69 did so that year, impacting the system's performance, especially in the North region. In 2022, the update of the Brazilian Census included Araçatuba (SP) in the geographic target criterion, raising to 86 the number of municipalities that should implement LRM at this stage. It is undeniable that the Brazilian LRM system represented a significant advancement in the management of household RF. However, continuous analysis of the LRM system´s performance is essential for future adjustments and improvement in RF management, ensuring that policies and practices are effective and adapted to regional needs.
The practice of maintaining household stocks of medications is common in many countries, resulting in the accumulation of these products, which, when expired or unnecessary, generate pharmaceutical waste (RF). Reverse logistics programs for medications (LRM) are globally recognized as the best practice for the disposal of this waste by the population. In Brazil, the LRM system was established in 2020 by Decree No. 10.388/2020, involving the entire pharmaceutical chain. The decree provides for the gradual implementation of RF collection points throughout the country. The program began in 2021 and aims to cover all municipalities with a population of ≥100,000 inhabitants by 2026. Due to the diversity in the development of Brazilian states, it is essential to analyze the performance and effectiveness of the LRM model, proposing adjustments and refinements as necessary. The objective of this study was to evaluate the implementation and performance of the LRM system in Brazil during its first stage (2021-2023), identifying opportunities for improvement in policies and practices for RF management. The primary data sources were the 2021 population estimate, the 2022 Brazilian Census, and the reports from LogMed, the managing entity of the LRM system, available through the National Solid Waste Management Information System (SINIR+). Initially, the study focused on the state of São Paulo, where a Term of Commitment for LRM (TCLR) anticipated the start of the LRM system operation, with the goal of implementing collection points in municipalities with a population of ≥200,000 inhabitants as early as 2021. In São Paulo, the LRM system represented an advancement in household RF management, as it served in 2021 about 64% of the state's population, collecting 35,000 kg of waste in 40 of the 41 municipalities scheduled to start their operation. With the division of the 40 municipalities operating the LRM by the administrative structures of the public health system, the Regional Health Department (DRS), it was found, for example, that the largest waste collection occurred in DRS I – Greater São Paulo (15 municipalities). When evaluating national data for the period 2021-2023, all Brazilian states were included, covering approximately 75 million inhabitants. According to IBGE estimates, 85 municipalities were expected to start LRM in 2021, but only 69 did so that year, impacting the system's performance, especially in the North region. In 2022, the update of the Brazilian Census included Araçatuba (SP) in the geographic target criterion, raising to 86 the number of municipalities that should implement LRM at this stage. It is undeniable that the Brazilian LRM system represented a significant advancement in the management of household RF. However, continuous analysis of the LRM system´s performance is essential for future adjustments and improvement in RF management, ensuring that policies and practices are effective and adapted to regional needs.