BETWEEN NORM AND NEGLECT: STRUCTURAL, INSTITUTIONAL, AND PROFESSIONAL BARRIERS TO THE INTEGRATION OF NATIVE CAATINGA PHYTOTHERAPEUTICS INTO THE BRAZILIAN UNIFIED HEALTH SYSTEM

Abstract

The National Policy of Integrative and Complementary Practices has formally existed since 2006, yet nearly two decades later the gap between regulation and clinical practice remains disconcerting. This integrative review investigated the barriers obstructing the incorporation of native Caatinga phytotherapeutics into the Brazilian Unified Health System, employing an Implementation Science framework in a multilevel perspective: macro, meso, micro, and contextual. A systematic search across five databases (VHL, SciELO, PubMed, LILACS, and Web of Science), conducted between October 2025 and March 2026, identified 1,336 records, of which 27 references were selected for qualitative synthesis following PRISMA-ScR guidelines. Findings reveal that the implementation failure is not accidental: RENAME systematically privileges exotic species, Living Pharmacies operate fragmented and disconnected from medical prescription, health professionals receive insufficient training and sustain skepticism that appears more corporativist than scientific, and the semiarid region faces climate and social vulnerabilities that render any generic implementation unfeasible. More critically, this failure reproduces territorial and socioeconomic inequities that disproportionately affect poor rural populations in the Northeast, precisely those who most know and demand native medicinal plants. The study concludes that genuine PNPIC implementation requires simultaneous reconfiguration at multiple levels, with emphasis on participatory revision of RENAME, mandatory curriculum reform in health courses, permanent federal funding, and epistemic valorization of traditional sertanejo knowledge.