1. ENGAGING THE PRIVATE SECTOR IN TB CONTROL IN THE CONTEXT OF AN INVIGORATED NATIONAL TB PROGRAM (NTP)
JUBERT P. BENEDICTO,MD
Philippine Coalition Against Tuberculosis (PhilCAT)
IUATLD-APR Conference
Kuala Lumpur, Malaysia
August 3, 2007

2. DISCLOSURE STATEMENTS
I 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.

3. 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 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
PhilCAT: fighting TB through unified action

4. THE PHILIPPINES Southeast Asia
3 main regions (Luzon, Visayas, Mindanao)
> 7,100 islands
Population: 87 million (as of mid-2007)
TB as the 6th cause of morbidity and mortality

5. 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) Strategy
DOTS certification and accreditation
Comprehensive and Unified Policies (C.U.P.) on TB Control
EQA on direct sputum smear microscopy
Revision of the Manual of Procedures (MOP)
Collaboration with pertinent groups (social mobilization, DOTS plus, childhood TB)

7. THE PRIVATE PRACTITIONERS IN THE PHILIPPINES
44,200 physicians (majority engaged in private practice)
Around 6-8,000 family medicine practitioners
Around 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

8. Profile of Health-Seeking Behavior of Persons with TB Bacillary Disease

9. 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

10. 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 curricula
Involvement of professional medical societies

11. Global Fund PPMD Units Year 3 PPMD Sites (August 2005 – July 2006)
Tuguegarao CHO, Cagayan Valley
Bangued, Abra
Bambang RHU, Nueva Vizcaya
Tabuk, Kalinga
Maddela Quirino RHU, Quirino
Alaminos City, Pangasinan
RENMAR Clinic, Santiago City, Isabela
Urdaneta City, Pangasinan
Cauayan City, Isabela
San Fernando City, La Union
Aparri RHU, Cagayan
San Jose City, Nueva Ecija
San Juan de Dios Foundation, Pasay City
Tarlac City, Tarlac
Longos Health Center, Malabon, Metro Manila
Balanga City, Bataan
San Isidro Health Center, Parañaque
Tunasan Health Center, Muntinlupa
Cavite Medical Society, Imus Cavite
NCR
Sto. Niño Health Center, Marikina City
Sta. Rosa RHU, Laguna
Region IVA
Malinta Health Center, Valenzuela
Lucena United Doctors Hospital, Quezon
Malamig Health Center, Mandaluyong City
Felix Takano Center for Health, Cainta, Rizal
Region IVB
Dr. Jose N. Rodriguez Meml Hospl, Caloocan
Cabuyao RHU, Laguna
Tanauan City, Batangas
Legaspi CHO, Albay
San Pablo City, Laguna
Tabaco CHO, Albay
SMMGHHSC, Sorsogon City
Calapan City, Oriental Mindoro
Naga CHO, Albay
San Jose, Occidental Mindoro
Ormoc City, Leyte
St. Paul’s Hospital, Iloilo City
Calbayog City, Samar
San Jose MHO, Antique
Medi-Link, Bacolod City, Negros Occidental
Balamban RHU, Cebu
Kabankalan CHO, Negros Occidental
Mabolo Health Center, Cebu City
Kalibo City, Aklan
Danao City, Cebu
Silay City, Negros, Occidental
Tagbilaran City Health Office, Bohol
Bago City, Negros, Occidental
SUMC, Dumaguete City, Negros Oriental
CDO Polymedic Hospital, Misamis Oriental
Butuan Medical Center, Agusan Del Norte
Oroquieta CHO, Misamis Occidental
San Francisco RHU, Agusan Del Sur
Mindanao Sanitarium & Hospital-ISI, Iligan City
Bislig, Surigao del Sur
Gingoog CHO, Misamis Oriental
Surigao City, Surigao del Norte
Ozamis CHO, Misamis Occidental
Tacurong, Sultan Kudarat
Davao Doctors Hospital, Davao City
Malaybalay City, Bukidnon
Kidapawan City, Cotabato
Davao Chest Center, Davao City
Valencia City, Bukidnon
Digos CHO, Davao Del Sur
PUBLIC-initiated (60 PPMD Units)
PRIVATE-initiated (11 PPMD Units)
Dipolog City, Zamboanga del Norte
PhilCAT: fighting TB through unified action
Tagum CHO, Davao Del Norte
Pagadian City, Zamboanga del Sur
Mati MHO, Davao Oriental
Ipil, Sibugay
Panabo City, Davao

15. RELEVANT DOCUMENTS PRODUCED
Operational 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

16. LESSONS LEARNED
Formation 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”

17. ACKNOWLEDGEMENTS Ma. Teresa U. Benedicto, MD (Radiologist)
Department of Health
WHO
Philippine Coalition Against Tuberculosis (PhilCAT)
Ma. Teresa U. Benedicto, MD (Radiologist)
Rontgene M. Solante, MD (Infectious Disease)