ABSTRACT:
The Unified Health System (SUS) in Brazil mandates comprehensive Pharmaceutical Services, within which the guaranteed availability of essential medicines is fundamental to quality and equity of care. Access to medicines is a key outcome of system performance. This study examined medicine availability and institutional responses to shortages in Niterói, Rio de Janeiro, from users’ perspectives. A cross-sectional quantitative study was conducted using validated methodologies for evaluating Pharmaceutical Services, adapted from WHO and Brazil’s National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM). Structured interviews were performed with 290 users from different types of primary care units in Niterói (RJ). Data were analyzed using descriptive statistics, Pearson’s chi-square test, and Cramer’s V to explore associations between unit type and users’ behavior in seeking medicines during shortages. Ethical approval was obtained from the UFF Research Ethics Committee (CAAE 38353120.1.0000.5243). Medicine unavailability was reported by 42.4% of participants (n=290). A statistically significant association was found between the type of primary care unit and users’ strategies to obtain medicines (χ²=23.944; p=0.008; V=0.203). Institutional responses to shortages were heterogeneous: reporting unavailability (53.8%), recommending private purchase (19.3%), or referring users to the Farmácia Popular program (12.1%). This heterogeneity reflects fragmented management practices and weak coordination within Pharmaceutical Services, with potential to shift costs to households and amplify inequalities—an issue of central concern for HTA and policy evaluation in decentralized systems. Medicine unavailability affected 42.4% of participants (n=290). A significant association emerged between primary care unit type and users’ strategies to obtain medicines (χ²=23.944; p=0.008; V=0.203). Institutional responses were heterogeneous—reporting stockouts (53.8%), advising private purchase (19.3%), or referral to Farmácia Popular (12.1%)—revealing fragmented pharmaceutical management that shifts costs to households and deepens inequities relevant to HTA and policy evaluation.