JUBERT P. BENEDICTO,MDPhilippine Coalition Against Tuberculosis

(PhilCAT)IUATLD-APR ConferenceKuala Lumpur, Malaysia

August 3, 2007

ENGAGING THE PRIVATE SECTOR

IN TB CONTROL IN THE CONTEXT OF AN INVIGORATED

NATIONAL TB PROGRAM (NTP)

DISCLOSURE STATEMENTSI am a private practitioner (pulmonary

critical care specialist by profession).

I’ve never been an employee or consultant of the Department of Health or the National TB Program.

I am the immediate past chair of the Philippine Coalition Against Tuberculosis or PhilCAT.

PhilCAT: fighting TB through unified action

25 to 49

50 to 99

100 to 299

< 10

10 to 24

300 or more

No Estimate

per 100 000 population

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

© WHO 2002

THE PHILIPPINESSoutheast Asia3 main regions

(Luzon, Visayas, Mindanao)

> 7,100 islands

Population: 87 million (as of mid-2007)

TB as the 6th cause of morbidity and mortality

NATIONAL TB PROGRAM (NTP)DEPARTMENT OF HEALTH

Adopted DOTS strategy by 1996; 100% DOTS population coverage by the public sector since 2002

2004 data: CDR exceeded 70% target and treatment success rate maintained over 85% for the past 5 years

Public-Private Mix DOTS (PPMD) StrategyDOTS certification and accreditationComprehensive and Unified Policies (C.U.P.) on TB

ControlEQA on direct sputum smear microscopyRevision of the Manual of Procedures (MOP)Collaboration with pertinent groups (social

mobilization, DOTS plus, childhood TB)

THE PRIVATE PRACTITIONERS IN THE PHILIPPINES44,200 physicians (majority engaged in private

practice)Around 6-8,000 family medicine practitionersAround 6ooo internists – 600 infectious disease

practice, 847 pulmonologists

2001and 2002 private practitioners survey on TB management- great variations in treatment regimen- overreliance on CXR as the sole diagnostic tool

Around 33% of TB patients seek consult in the private sector

67%

33%

Public Private

Medical Consultation

35%

28%

37%

None

Non- medical actionsMedical consultation

Profile of Health- Seeking Behaviour of Persons with TB Bacillary Disease

Action Taken PercentNone 34.5

Non- medical actions 27.5· Self- medication 22.4· Traditional healer 3.4· Family member 1.7

Medical consultation 38Public 25Health center 15.5Hospital 9.8Private 12.7

o       Clinic 10.4o       Hospital 2.3

Profile of Health-Seeking Behavior of Persons

with TB Bacillary Disease

PHILIPPINE COALITION AGAINST TUBERCULOSIS (PhilCAT)

Founded in 1994 by seven members

Now, more than 60 members (multisectoral)

Partner with the DOH NTP

Principal activities: advocacy, training, DOTS certification, PPMD installation and monitoring, policy, research

SYNCHRONIZATION OF VARIOUS INITIATIVES

Philippine Health Insurance TB DOTS Package (2003)(203 certified and 113 accredited)

2003- Philippine Tuberculosis Initiatives for the Private Sector (PhilTIPS) and the GFATM(end of 2005: 64 operational PPMD units)

Training of non-program practitioners on DOTS

Participation of private MDs in the TB Diagnostic Committees(TBDCs) for smear negative TB (74 TBDCs operational)

Integration of DOTS to various curriculaInvolvement of professional medical societies

PhilCAT: fighting TB through unified action

Tuguegarao CHO, Cagayan Valley

Cavite Medical Society, Imus Cavite

St. Paul’s Hospital, Iloilo City

CDO Polymedic Hospital, Misamis OrientalOroquieta CHO, Misamis Occidental

Davao Chest Center, Davao CityDavao Doctors Hospital, Davao City

Bambang RHU, Nueva Vizcaya

RENMAR Clinic, Santiago City, Isabela

Felix Takano Center for Health, Cainta, Rizal

Sta. Rosa RHU, LagunaLucena United Doctors Hospital, Quezon

Maddela Quirino RHU, Quirino

Gingoog CHO, Misamis OrientalOzamis CHO, Misamis Occidental

Tagum CHO, Davao Del NorteMati MHO, Davao Oriental

Digos CHO, Davao Del Sur

San Jose MHO, AntiqueMedi-Link, Bacolod City, Negros Occidental

Kabankalan CHO, Negros Occidental

Legaspi CHO, AlbayTabaco CHO, Albay

Butuan Medical Center, Agusan Del NorteSan Francisco RHU, Agusan Del Sur

Balamban RHU, CebuMabolo Health Center, Cebu City

Global Fund PPMD UnitsYear 3 PPMD Sites (August 2005 – July 2006)

PUBLIC-initiated (60 PPMD Units)

PRIVATE-initiated (11 PPMD Units)

Cauayan City, IsabelaAparri RHU, Cagayan

San Jose City, Nueva EcijaTarlac City, Tarlac

Balanga City, Bataan

SMMGHHSC, Sorsogon CityNaga CHO, Albay

Panabo City, Davao

Bislig, Surigao del SurSurigao City, Surigao del Norte

Ormoc City, LeyteCalbayog City, Samar

SUMC, Dumaguete City, Negros Oriental

Danao City, Cebu

Malaybalay City, BukidnonValencia City, Bukidnon

Kalibo City, AklanSilay City, Negros, OccidentalBago City, Negros, Occidental

Cabuyao RHU, LagunaTanauan City, BatangasSan Pablo City, Laguna

Bangued, AbraTabuk, Kalinga

Alaminos City, PangasinanUrdaneta City, Pangasinan

San Fernando City, La Union

Calapan City, Oriental MindoroSan Jose, Occidental Mindoro

Dipolog City, Zamboanga del NortePagadian City, Zamboanga del Sur

Ipil, Sibugay

Tacurong, Sultan KudaratKidapawan City, Cotabato

San Juan de Dios Foundation, Pasay CityLongos Health Center, Malabon, Metro Manila

San Isidro Health Center, ParañaqueTunasan Health Center, Muntinlupa

Sto. Niño Health Center, Marikina CityMalinta Health Center, Valenzuela

Malamig Health Center, Mandaluyong CityDr. Jose N. Rodriguez Meml Hospl, Caloocan

NCRNCR

Mindanao Sanitarium & Hospital-ISI, Iligan City

Tagbilaran City Health Office, Bohol

Region IVARegion IVA

Region IVBRegion IVB

RELEVANT DOCUMENTS PRODUCEDOperational Guidelines for PPM DOTS

Manual on Building Local Coalitions

Philippine Clinical Practice Guidelines on the Diagnosis, Management, and Control and Prevention of Tuberculosis in Adults: Updates 2006

TB in the Workplace

LESSONS LEARNEDFormation of a coalition was crucial and might have

been the “tipping point” in engaging the private practitioners in the Philippines

Multiple activities where we can integrate were critical

Strong partnership with the DOH NTP

Continuous feedback , dialogue, and consultations sustain our participation

Selection of advocates, role models, and “DOTS champions”

ACKNOWLEDGEMENTS

Department of HealthWHOPhilippine Coalition Against Tuberculosis

(PhilCAT)

Ma. Teresa U. Benedicto, MD (Radiologist)

Rontgene M. Solante, MD (Infectious Disease)