Access to Essential Drugs in 11 Brazilian Cities: A Community-based Evaluation and Action Method MARGÔ GOMES DE OLIVEIRA KARNIKOWSKI, OTÁVIO DE TOLEDO NÓBREGA, JANETH DE OLIVEIRA SILVA NAVES, and LYNN DEE SILVER introduction ROM the mid-20th century, the world has awaited a health revolution delivered by the miracles of modern drugs. Nevertheless, in most developing countries the population continues to be marginalized from the benefits of these “miracles”  both because of poverty and poor living conditions, and limited access to health services and medicines. Seventeen million people die yearly from infectious diseases, with 8,000 dying from AIDS every day. The AIDS crisis, in particular, has called attention to the discrepancies in access to essential drugs (1). We undertook a joint effort to monitor the availability of essential drugs for primary care in the Brazilian public health service and then to engage in political action whenever deficiencies were detected. For health systems to be effective, in addition to prevention and pro- motion activities, they need to guarantee access to quality services and goods, especially essential drugs. Yet in most poor countries, insufficient resources and limited public spending on health make access a difficult challenge. Households spend money needed for food, cloth- ing, or shelter to pay for drugs. At the same time, thousands of drugs are offered on the private market  often unsafe, ineffective, with inac- curate labeling or prices out of reach of the population (2,3). In Brazil, the demand for access to essential drugs has long been a leading theme for popular movements as well as for health profession- F 288 204-079_02_health_int2_pf 12/10/04 2:10 PM Page 288