Resumo Este artigo baseado em uma pesquisa bibliográfica e documental, tem por objeto de estudo a análise crítica da reestruturação modernizante do Instituto Nacional de Seguro Social (INSS), autarquia federal que operacionaliza a política previdenciária e cuja modernização, a partir de 2017, impactou o acesso aos direitos previdenciários da população atendida. A análise, numa perspectiva de totalidade, tem como categorias: o conceito de tecnologia na sociedade, a constituição estrutural do Estado brasileiro e sua modernização, o INSS-Digital e o impacto das mudanças tecnológicas para a população atendida. Contextualizado a partir da década de 1990, quando se iniciam as contrarreformas neoliberais, é particularizado no período de 2016 a 2019, no acirramento das contrarreformas e ajustes de austeridades, orientados pelo ultraneoliberalismo. Deduz-se que o INSS-Digital, em substituição ao atendimento presencial, tem restringido o acesso aos direitos previdenciários e assistenciais da população, que com baixo nível de renda e escolaridade não dispõe de recursos para aquisição dos equipamentos tecnológicos e compreensão da linguagem informatizada, constatado pelos altos índices de indeferimentos dos pedidos de benefícios e a judicialização dos processos. Conclui-se que o INSS-Digital, ao concretizar-se no estreitamento ao acesso dos direitos previdenciários e assistenciais, configura-se como estratégia “competente” na redução da política previdenciária, materializada em suas contrarreformas. Espera-se contribuir para reflexão crítica dos direitos sociais brasileiros e instrumentalizar os movimentos sociais e sindicais na luta e resistência em prol de uma previdência pública, igualitária e universal.

Abstract This article, based on bibliographical and documentary research, has as its object of study the critical analysis of the modernizing restructuring of the National Social Security Institute (INSS, for its Spanish acronym), a federal agency that operates social security policy and whose modernization, as of 2017, impacted the access to social security rights of the population it serves. The analysis, from a totality perspective, has the following categories: the concept of technology in society, the structural constitution of the Brazilian State and its modernization, the INSS-Digital, and the impact of technological changes on the population served. The analysis is contextualized from the 1990s, when neoliberal counter-reforms began, and is particularized to the period between 2016 and 2019, during which time there was an intensification of counter-reforms and austerity adjustments, guided by ultra-neoliberalism. It is deduced that the INSS-Digital, replacing face-to-face service, has restricted access to social security rights for the population, which, with a low level of income and education, does not have the resources to acquire technological equipment and understand computerized language, as confirmed by senior rates of rejection of benefit requests and the judicialization of processes. It can be concluded that the INSS-Digital, when implemented in the narrowing of access to social security rights, is configured as a "competent" strategy in the reduction of social security policy, as evidenced by its counter-reforms. It is expected to contribute to critical reflection on Brazilian social security rights and to equip social and trade union movements in the struggle and resistance in favor of a public, egalitarian, and universal pension.

Resumen: Este artículo, basado en una investigación bibliográfica y documental, tiene como objeto de estudio el análisis crítico de la reestructuración modernizadora del Instituto Nacional de Seguridad Social (INSS), agencia federal que opera la política de seguridad social y cuya modernización, a partir de 2017, impactó el acceso a los derechos de seguridad social de la población atendida. El análisis, desde una perspectiva de totalidad, tiene las siguientes categorías: el concepto de tecnología en la sociedad, la constitución estructural del Estado brasileño y su modernización, el INSS-Digital y el impacto de los cambios tecnológicos en la población atendida. Contextualizado a partir de los años 1990, cuando comenzaron las contrarreformas neoliberales, se particulariza en el período desde 2016 hasta 2019, en la intensificación de las contrarreformas y de los ajustes de austeridad, guiados por el ultraneoliberalismo. Se deduce que el INSS-Digital, en sustitución del servicio presencial, ha restringido el acceso a los derechos de seguridad social de la población, que, con un bajo nivel de ingresos y educación, no cuenta con recursos para adquirir equipos tecnológicos y comprender lenguaje informatizado, como lo confirman los altos índices de rechazo de solicitudes de beneficios y de judicialización de procesos. Se concluye que el INSS-Digital, cuando se implementa en la reducción del acceso a los derechos de seguridad social, se configura como una estrategia “competente” en la reducción de la política de seguridad social, materializada en sus contrarreformas. Se espera que contribuya a la reflexión crítica sobre los derechos de seguridad social brasileños y prepare a los movimientos sociales y sindicales en la lucha y la resistencia a favor de una pensión pública, igualitaria y universal.

ABSTRACT: This article seeks to clarify to what extent the universal aspiration of the Chilean social assistance system -embodied in the Intersectoral System of Social Protection- is compatible with the imposition of conditions that limit access, and enjoyment of benefits aimed at providing a social minimum below which no one should fall. The hypothesis put forward is that the universality offered by the Chilean system is compatible with conditions relating to the status of social assistance beneficiaries and with those that support their autonomy, as opposed to those that are punitive in nature. Therefore, many of the behavioral conditions of the system, as well as their associated sanctions for non-compliance, need to be carefully assessed.

RESUMEN: Este artículo busca precisar en qué medida la vocación universal del sistema de asistencia social chileno -encarnado en el Sistema Intersectorial de Protección Social- es compatible con la imposición de condiciones que limiten el acceso y el goce de prestaciones dirigidas a proveer un mínimo social bajo el cual nadie debería caer. La hipótesis que se plantea es que la universalidad que ofrece el sistema chileno es compatible con condiciones relativas al estatus de los beneficiarios de asistencia social y con aquellas que apoyan la autonomía de estos, por oposición a aquellas que tienen un carácter punitivo. Por ende, muchas de las condiciones conductuales que prevé el Sistema, así como las sanciones que trae aparejada la inobservancia de las ellas, deben ser cuidadosamente evaluadas.

Emergency medical services (EMS) are a vital component of the health system and provide pre-hospital emergency care and specialised transport for patients requiring access to health facilities, thereby contributing to universal health coverage and improving health outcomes. Evidence regarding the current state of EMS within South Africa to fulfil this role is lacking and was the motivation for this review. Our objective was to describe the current state of EMS in South Africa. A literature search was conducted using keywords, BOOLEAN operating terms, and eligibility criteria on Sabinet, EBSCOhost, Google Scholar, ProQuest, Medline, PubMed, and ScienceDirect databases to find articles related to the components of the EMS system in South Africa. The articles were critically assessed, and six themes emerged: leadership and governance; resources; preparedness (knowledge, attitude, and practices) of the emergency care provider; health and safety; training; and communications. Challenges were found in all themes at a provincial EMS level despite improvements in legislation, leadership, and governance from the National Department of Health. These themes demonstrate that all components in the EMS system are not functioning optimally and may be affecting its contribution to improving universal health coverage and health outcomes. The current state of EMS appears to be constrained and requires greater leadership and governance from the Provincial Departments of Health to improve poorly functioning components of the EMS system. SIGNIFICANCE: The current state of EMS in South Africa lacks efficiency in its role to provide emergency care and transportation for patients wanting to access health facilities. Poorly functioning components of the EMS system have been identified and provide an opportunity for health authorities to make improvements so that the goal of universal health coverage and improved health outcomes can be realised.

ABSTRACT The desperate attempt to improve mortality, morbidity, quality of life and patient-reported outcomes in patients on hemodialysis has led to multiple attempts to improve the different modes, frequencies, and durations of dialysis sessions in the last few decades. Nothing has been more appealing than the combination of diffusion and convection in the form of hemodiafiltration. Despite the concrete evidence of better clearance of middle weight molecules and better hemodynamic stability, tangible evidence to support the universal adoption is still at a distance. Survival benefits seen in selected groups who are likely to tolerate hemodiafiltration with better vascular access and with lower comorbid burden, need to be extended to real life dialysis patients who are older than the population studied and have significantly higher comorbid burden. Technical demands of initiation hemodiafiltration, the associated costs, and the incremental benefits targeted, along with patient-reported outcomes, need to be explored further before recommending hemodiafiltration as the mode of choice. mortality morbidity patientreported patient reported modes frequencies decades stability distance burden costs targeted choice

RESUMO A tentativa desesperada de melhorar a mortalidade, morbidade, qualidade de vida e desfechos relatados pelos pacientes em indivíduos em hemodiálise levou a diversas tentativas de aprimorar os diferentes modos, frequências e durações das sessões de diálise nas últimas décadas. Nada foi mais atrativo do que a combinação de difusão e convecção na forma de hemodiafiltração. Apesar das evidências concretas de melhor depuração de moléculas de peso médio e melhor estabilidade hemodinâmica, evidências tangíveis para apoiar a adoção universal ainda estão distantes. Os benefícios de sobrevida observados em grupos selecionados que provavelmente toleram a hemodiafiltração com melhor acesso vascular e com menor carga de comorbidades precisam ser estendidos aos pacientes reais em diálise, que são mais velhos do que a população estudada e apresentam uma carga de comorbidades significativamente maior. As exigências técnicas do início da hemodiafiltração, os custos associados e os benefícios incrementais almejados, juntamente com os desfechos relatados pelos pacientes, precisam ser melhor explorados antes de se recomendar a hemodiafiltração como o modo de escolha. mortalidade morbidade modos décadas hemodinâmica distantes maior almejados escolha

Abstract Objective: To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. Methods: This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saude (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. Results: In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. Conclusions: The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity. Objective Brazil 201 2019 characteristics Methods crosssectional cross sectional 523 PNS, PNS , (PNS) 663 test residence selfreported self reported colorrace color race color/race models 9 CI95% CI95 CI (CI95% year Results 965 96 5 96. 95%CI 95CI 95,897,0, 958970 95,8 97,0 8 97 0 95,8;97,0) 658 65 65. 63,967,7, 639677 63,9 67,7 63 67 7 63,9;67,7) 604 60 4 60. 58,562,3 585623 58,5 62,3 58 62 3 58,5;62,3 respectively 978 97. 97,398,2 973982 97,3 98,2 98 2 97,3;98,2 816 81 6 81. 80,382,9 803829 80,3 82,9 80 82 80,3;82,9 786 78 78. 77,179,9 771799 77,1 79,9 77 1 79 77,1;79,9 white strata Conclusions out importance puerperium equity 20 52 (PNS 66 CI9 (CI95 897 95,897,0 95897 958 95, 970 97, 95,8;97,0 967 63,967,7 63967 639 63, 677 67, 63,9;67,7 562 58,562, 58562 585 58, 623 62, 58,5;62, 398 97,398, 97398 973 982 98, 97,3;98, 382 80,382, 80382 803 80, 829 82, 80,3;82, 179 77,179, 77179 771 77, 799 79, 77,1;79, (CI9 89 95,897, 9589 95,8;97, 63,967, 6396 63,9;67, 56 58,562 5856 58,5;62 39 97,398 9739 97,3;98 38 80,382 8038 80,3;82 17 77,179 7717 77,1;79 (CI 95,897 95,8;97 63,967 63,9;67 58,56 58,5;6 97,39 97,3;9 80,38 80,3;8 77,17 77,1;7 95,89 95,8;9 63,96 63,9;6 58,5; 97,3; 80,3; 77,1; 95,8; 63,9;

Abstract: The present text focuses on poverty as a problem in the Mexican economy. The article demonstrates that at least since the time of the earliest comparable data from Coneval, poverty in Mexico has been stagnant, with only marginal variations. It explains that one of the main causes of poverty in Mexico is the distortion of the labor market: more than half of the occupied population earn wages below the poverty line, and lack access to health services and the other protections provided by social security. Finally, it concludes by showing the limitations of social policy in Mexico based on “social programs” that are not universal and lack a focus on human rights.

Resumen: El texto presente aborda el problema de la pobreza en la economía mexicana. Sustenta que la incidencia de la pobreza está estancada desde que tenemos datos oficiales comparables de Coneval, pese a cambios marginales. La pobreza en México tiene entre sus principales causas la distorsión del sistema laboral, pues más de la mitad de la población ocupada no gana un salario suficiente para superar el umbral de la pobreza y carece de acceso a servicios de salud y demás protecciones de la seguridad social. Finalmente, concluye mostrando las limitaciones de la política social mexicana, basada en programas sociales que no son universales y carecen del enfoque de derechos.

ABSTRACT: In this article, a systematic and integrative review is presented, investigating Brazilian studies on the utilization of Universal Design for Learning (UDL) in Elementary Education, with an emphasis on inclusion and mathematical didactic practices, from 2018 to 2022. The findings were analyzed and synthesized, deepening the understanding in this research area. The importance of developing inclusive didactic practices and using accessible resources as essential strategies to ensure access to mathematical knowledge and provide equitable and affective education is highlighted. Considering the scarcity of studies focused on the proposed objective, it underscores the need for comprehensive research on the implementation of UDL in mathematics education to promote the inclusion of each student.

RESUMO: Neste artigo, é apresentada uma revisão sistemática e integrativa que investigou estudos brasileiros sobre o uso do Desenho Universal para Aprendizagem (DUA) no Ensino Fundamental, com ênfase na inclusão e práticas didáticas de Matemática, no período de 2018 a 2022. Foram analisados e sintetizados os resultados encontrados, aprofundando o entendimento nessa área de pesquisa. É destacada a importância do desenvolvimento de práticas didáticas inclusivas e do uso de recursos acessíveis como estratégias essenciais para garantir o acesso ao conhecimento matemático e proporcionar uma educação equitativa e afetiva. Observada a escassez de estudos voltados para o objetivo proposto, evidencia-se a necessidade de pesquisas abrangentes sobre a implementação do DUA no ensino de Matemática para promover a inclusão de cada um dos estudantes.

Abstract This article outlines the public architecture of social services in Spain from the perspective of the constitutional guarantee of the provision of local social services. For this, the Spanish Constitution is analyzed, as well as the 17 laws of social services corresponding to the different Autonomous Communities. It is therefore a comparative regional study in which the local authority is the essential unit to deploy social services, responding to the principles of universality, proximity, and decentralization; mandated by Spanish legislation. These and other complementary laws establish universal access to social services for all citizens, determine the territorial structure, the competences of the different administrations, rights holders, typologies of services and benefits and their articulation to ensure the quality of life and social welfare of all citizens. this analyzed 1 Communities universality proximity decentralization legislation citizens structure administrations holders

Resumo Este artigo desenha a arquitetura pública dos serviços sociais em Espanha, na perspectiva da garantia constitucional da prestação de serviços sociais locais. Para tal, analisa a Constituição espanhola, bem como as 17 leis sobre serviços sociais correspondentes às diferentes Comunidades Autónomas. Trata-se, portanto, de um estudo autonómico comparativo em que a entidade autônoma local é a unidade essencial para a prestação de serviços sociais, respondendo aos princípios de universalidade, proximidade e descentralização, consagrados na legislação espanhola. Estas leis e outras de caráter complementar estabelecem o acesso universal de todos os cidadãos aos serviços sociais, determinam a estrutura territorial, as competências das diferentes administrações, os titulares de direitos, os tipos de serviços e prestações e sua articulação para garantir a qualidade de vida e o bem-estar social de toda a cidadania. Espanha locais tal espanhola 1 Autónomas Tratase, Tratase Trata se, se Trata-se portanto universalidade descentralização territorial administrações direitos bemestar estar cidadania

BACKGROUND: Community health worker (CHW) programmes contribute towards strengthening adherence support, improving maternal and child health outcomes and providing support for social services. They play a valuable role in health behaviour change in vulnerable communities. Large-scale, comprehensive CHW programmes at health district level are part of a South African (SA) strategy to re-engineer primary healthcare and take health directly into communities and households, contributing to universal health coverage OBJECTIVE: These CHW programmes across health districts were introduced in SA in 2010 - 11. Their overall purpose is to improve access to healthcare and encourage healthy behaviour in vulnerable communities, through community and family engagements, leading to less disease and better population health. Communities therefore need to accept and support these initiatives. There is, however, inadequate local evidence on community perceptions of the effectiveness of such programmes METHODS: A cross-sectional descriptive study to determine community perceptions of the role and contributions of the CHW programme was conducted in the Ekurhuleni health district, an urban metropolis in SA. Members from 417 households supported by CHWs were interviewed in May 2019 by retired nurses used as fieldworkers. Frequencies and descriptive analyses were used to report on the main study outcomes of community acceptance and satisfaction RESULTS: Nearly all the study households were poor and had at least one vulnerable member, either a child under 5, an elderly person, a pregnant woman or someone with a chronic condition. CHWs had supported these households for 2 years or longer. More than 90% of households were extremely satisfied with their CHW; they found it easy to talk to them within the privacy of their homes and to follow the health education and advice given by the CHWs. The community members highly rated care for chronic conditions (82%), indicated that children were healthier (41%) and had safer pregnancies (6% CONCLUSION: As important stakeholders in CHW programmes, exploring community acceptance, appreciation and support is critical in understanding the drivers of programme performance. Community acceptance of the CHWs in the Ekurhuleni health district was high. The perspective of the community was that the CHWs were quite effective. This was demonstrated when they reported changes in household behaviour with regard to improved access to care through early screening, referrals and improved management of chronic and other conditions

Abstract This paper traces the emergence of a new orientation in the reformist agenda of the Judiciary in Argentina aimed at the democratization of the justice system. Originated at a time of expansion of the political arena and growth of the judicial arena (2003-2013), democratizing justice is an aspiration in which diverse proposals and actors converge in the face of the growing judicialization of conflicts. We analyze three policies of reform of the judicial system, emanating from the three branches of the national State, between 2003 and 2019: the incorporation, by the Supreme Court of Justice of the Nation, of mechanisms for citizen participation in the judicial process; the service of Access to Justice Centers, created within the Ministry of Justice and Human Rights of the Nation; and Law 26855 (repealed), which incorporates universal suffrage in the election of councilors of the Council of the Magistratura, popularly known as the law of democratization of justice.

Resumen El presente trabajo rastrea la aparición de una nueva orientación en la agenda reformista del Poder Judicial en Argentina dirigida a la democratización del sistema de justicia. Originada en un momento de expansión de la arena política y crecimiento de la arena judicial (2003-2013), democratizar la justicia es una aspiración en la que convergen propuestas y actores diversos ante la judicialización creciente de los conflictos. Se analizan tres políticas de reforma del sistema judicial emanadas de los tres poderes del Estado nacional entre 2003 y 2019: la incorporación, por parte de la Corte Suprema de Justicia de la Nación, de mecanismos de participación ciudadana al proceso judicial; el servicio de Centros de Acceso a Justicia, creado en el ámbito del Ministerio de Justicia y Derechos Humanos de la Nación; y la Ley 26855 (derogada), que incorpora el sufragio universal a la elección de consejeros del Consejo de la Magistratura, popularmente conocida como ley de democratización de la justicia.

Abstract This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems. PMAQ CEO, , CEO) 201 Brazil (CEO approach independently Mann U. U . U) h0 h (h0 h1. h1 (h1) variables chisquare chi square test. test test) 5 5% 13 resources degrees servants administration tender network records goals 2018) 2014. 2014) preventive interceptive systems 20 (h (h1 1 2

Abstract Childhood overweight and obesity rates are growing at an alarming rate in Spain, affecting poor families more strongly as they consume high-calorie, low-nutritional items. The Covid-19 pandemic has exacerbated this scenario. Ensuring universal and free access to school meals has been suggested as a strategy for tackling this issue, as well as fighting hunger and social inequality. The research that led to the elaboration of this article was carried out in Spain between 2019-2020. It explores the paradoxes and challenges that surround school feeding in this European country and the impasses related to the creation of “home-grown school feeding” type programs. The research on screen is located within the scope of the sociology of food. Among the conclusions, it shows that poverty, hunger and food insecurity are not conjunctural aspects, but problems of a structural nature, the confrontation of which requires a consistent political and institutional framework. highcalorie, highcalorie high calorie, calorie high-calorie lownutritional low nutritional items Covid19 Covid 19 Covid-1 scenario issue inequality 20192020. 20192020 2019 2020. 2020 2019-2020 homegrown home grown programs conclusions poverty aspects nature framework Covid1 1 Covid- 2019202 201 202 2019-202 201920 20 2019-20 20192 2 2019-2 2019-

Resumo Os índices de sobrepeso e de obesidade infantil crescem de forma alarmante na Espanha, afetando mais fortemente as famílias pobres face a ingestão de artigos de alto valor calórico e baixo valor nutricional. A pandemia do Covid-19 agravou este cenário. Assegurar o acesso universal e gratuito à alimentação escolar vem sendo apontado como estratégia para o enfrentamento desta questão, bem como para combater a fome e a desigualdade social. A pesquisa que ensejou a elaboração deste artigo desenvolveu-se em Espanha entre 2019-2020. Explora os paradoxos e desafios que envolvem a alimentação escolar neste país europeu e os impasses relativos à criação de programas de tipo “home-grown school feeding”. A pesquisa em tela se situa no âmbito da sociologia da alimentação. Dentre as conclusões, mostra que a pobreza, fome e insegurança alimentar não são aspectos conjunturais, mas problemas de natureza estrutural, cujo enfrentamento requer um marco político e institucional consistente. nutricional Covid19 Covid 19 Covid-1 cenário questão social desenvolveuse desenvolveu 20192020. 20192020 2019 2020. 2020 2019-2020 homegrown home grown feeding. feeding . feeding” conclusões pobreza conjunturais estrutural consistente Covid1 1 Covid- 2019202 201 202 2019-202 201920 20 2019-20 20192 2 2019-2 2019-

Resumo Este artigo procurou contribuir para a literatura e para o debate nacional e global sobre a superação de uma polarização relacionada ao aspecto jurídico e administrativo do processo de inovação, procurando se concentrar nas patentes como um fator condicionante das trajetórias tecnológicas que viabilizam o aprendizado em âmbito produtivo. Baseou-se em um arcabouço teórico e político relacionado à inovação e ao acesso a medicamentos, especialmente quanto aos direitos de Propriedade Intelectual, e na análise crítico-reflexiva de instrumentos de Propriedade Intelectual utilizados em Parcerias para o Desenvolvimento Produtivo (PDP), desenvolvidas por um instituto de tecnologia em fármacos sintéticos, público e nacional. Os resultados demonstram a relevância da compatibilização dos direitos de patentes com a construção de uma capacidade tecnológica e de inovação no país, vinculada ao acesso universal, especialmente quando envolverem produtos que se destinam ao tratamento de doenças graves, de alta complexidade tecnológica e de alto custo. Conclui-se que, para superação da dependência tecnológica e ampliação do acesso a medicamentos no Brasil, o Estado deve buscar o equilíbrio entre os interesses públicos e privados na área da saúde, a articulação entre os instrumentos jurídicos legais existentes e o alinhamento entre suas políticas de saúde, industriais, de CT&I e Propriedade intelectual.

Abstract This article aims to contribute to the literature and to the national and global debate on overcoming the polarization related to the legal and administrative aspect of the innovation process, seeking to focus on patents as a conditioning factor of the technological trajectories that enable learning in the productive scope. It was based on a theoretical and political framework related to innovation and access to medicines, especially regarding Intellectual Property rights, and on a critical-reflexive analysis of Intellectual Property instruments used in Productive Development Partnerships (PDP), developed by a public national institute for synthetic drug technology. The results demonstrate the importance of making patent rights compatible with the construction of technological and innovation capacities in the country, which are linked to universal access, especially when they involve products that are intended to treat serious, technologically complex and high-cost diseases. In conclusion, to overcome technological dependence and expand access to medicines in Brazil, the State must seek a balance between public and private interests in the healthcare area, articulate the existing legal instruments and align its health, industry, ST&I and intellectual property policies.

ABSTRACT BACKGROUND: Viral hepatitis is a major public health concern worldwide. OBJECTIVES: This study aimed to analyze the factors that facilitate access to care for viral hepatitis. DESIGN AND SETTING: Using a sequential mixed method, this evaluation research was conducted in the state of Mato Grosso, Brazil. METHODS: Mapping of references and selection of regions were made based on the quantity and heterogeneity of services. The stakeholders, including the managers of the State Department of Health and professionals from reference services, were identified. Nine semi-structured interviews were conducted using content analysis and discussions guided by the dimensions of the analysis model of universal access to health services. RESULTS: In the political dimension, decentralizing services and adhering to the Intermunicipal Health Consortium are highly encouraged. In the economic-social dimension, a commitment exists to allocate public funds for the expansion of referral services and subsidies to support users in their travel for appointments, medications, and examinations. In the organizational dimension, the availability of inputs for testing, definition of user flow, ease of scheduling appointments, coordination by primary care in testing, collaboration following the guidelines and protocols, and engagement in extramural activities are guaranteed. In the technical dimension, professionals actively commit to the service and offer different opening hours, guarantee the presence of an infectious physician, expand training opportunities, and establish intersectoral partnerships. In the symbolic dimension, professionals actively listen to the experiences of users throughout their care trajectory and demonstrate empathy. CONCLUSIONS: The results are crucial for improving comprehensiveness, but necessitate managerial efforts to enhance regional governance. BACKGROUND worldwide OBJECTIVES SETTING method Grosso Brazil METHODS stakeholders identified semistructured semi structured RESULTS dimension encouraged economicsocial economic social appointments medications examinations testing flow protocols guaranteed hours physician opportunities partnerships empathy CONCLUSIONS comprehensiveness governance

Abstract This article aims to contribute to the literature and to the national and global debate on overcoming the polarization related to the legal and administrative aspect of the innovation process, seeking to focus on patents as a conditioning factor of the technological trajectories that enable learning in the productive scope. It was based on a theoretical and political framework related to innovation and access to medicines, especially regarding Intellectual Property rights, and on a critical-reflexive analysis of Intellectual Property instruments used in Productive Development Partnerships (PDP), developed by a public national institute for synthetic drug technology. The results demonstrate the importance of making patent rights compatible with the construction of technological and innovation capacities in the country, which are linked to universal access, especially when they involve products that are intended to treat serious, technologically complex and high-cost diseases. In conclusion, to overcome technological dependence and expand access to medicines in Brazil, the State must seek a balance between public and private interests in the healthcare area, articulate the existing legal instruments and align its health, industry, ST&I and intellectual property policies. process scope criticalreflexive critical reflexive PDP, PDP , (PDP) technology country serious highcost high cost diseases conclusion Brazil area health industry STI ST I policies (PDP

Resumo Este artigo procurou contribuir para a literatura e para o debate nacional e global sobre a superação de uma polarização relacionada ao aspecto jurídico e administrativo do processo de inovação, procurando se concentrar nas patentes como um fator condicionante das trajetórias tecnológicas que viabilizam o aprendizado em âmbito produtivo. Baseou-se em um arcabouço teórico e político relacionado à inovação e ao acesso a medicamentos, especialmente quanto aos direitos de Propriedade Intelectual, e na análise crítico-reflexiva de instrumentos de Propriedade Intelectual utilizados em Parcerias para o Desenvolvimento Produtivo (PDP), desenvolvidas por um instituto de tecnologia em fármacos sintéticos, público e nacional. Os resultados demonstram a relevância da compatibilização dos direitos de patentes com a construção de uma capacidade tecnológica e de inovação no país, vinculada ao acesso universal, especialmente quando envolverem produtos que se destinam ao tratamento de doenças graves, de alta complexidade tecnológica e de alto custo. Conclui-se que, para superação da dependência tecnológica e ampliação do acesso a medicamentos no Brasil, o Estado deve buscar o equilíbrio entre os interesses públicos e privados na área da saúde, a articulação entre os instrumentos jurídicos legais existentes e o alinhamento entre suas políticas de saúde, industriais, de CT&I e Propriedade intelectual. produtivo Baseouse Baseou críticoreflexiva crítico reflexiva PDP, PDP , (PDP) sintéticos país universal graves custo Concluise Conclui Brasil saúde industriais CTI CT I intelectual (PDP