Public-Private Mix DOTS in the Philippines Rodrigo L. C. Romulo, M.D. Philippine Tuberculosis Initiatives for the Private Sector Philippine Coalition Against Tuberculosis Philippine Tuberculosis Society, Inc.

Outline of Presentation Overview The Need for PPM Evolution of a National PPM Framework PPM DOTS Expansion

Philippines Population: Political infrastructure 2000 – est. 77 M 2004 – projected 82 M Population density – 251.6 people / square kilometer 56% live on Luzon island Political infrastructure 16 Regions 78 provinces 82 cities 1,525 municipalities 41,939 barangays

Is there a Need for PPM?

Action Taking Among TB Symptomatics, National Prevalence Survey 1997 Asympt. = 10,643 Asympt., Sp + = 98 N= 2,358 N = 76

Private MDs: Dearth of Data Total no. of physicians No. of gov’t. MD’s No. of GMD’s with PP No. of private physicians No. of practicing PMD’s probably treating TB No. new TB “cases” / month / PMD No. new TB “cases” seen by PMD’s / year (if 1 /mo.)

Private MDs: Dearth of Data Total no. of physicians 42,535 IMS 2000 No. of gov’t. MD’s No. of GMD’s with PP No. of private physicians No. of practicing PMD’s probably treating TB No. new TB “cases” / month / PMD No. new TB “cases” seen by PMD’s / year (if 1 /mo.)

Private MDs: Dearth of Data Total no. of physicians 42,535 IMS 2000 No. of gov’t. MD’s ~7,000 – 8,000 Dept. of Health + Local Gov’t. Units No. of GMD’s with PP No. of private physicians No. of practicing PMD’s probably treating TB No. new TB “cases” / month / PMD No. new TB “cases” seen by PMD’s / year (if 1 /mo.)

Private MDs: Dearth of Data Total no. of physicians 42,535 IMS 2000 No. of gov’t. MD’s ~7,000 – 8,000 Dept. of Health + Local Gov’t. Units No. of GMD’s with PP ? After office hours No. of private physicians No. of practicing PMD’s probably treating TB No. new TB “cases” / month / PMD No. new TB “cases” seen by PMD’s / year (if 1 /mo.)

Private MDs: Dearth of Data Total no. of physicians 42,535 IMS 2000 No. of gov’t. MD’s ~7,000 – 8,000 Dept. of Health + Local Gov’t. Units No. of GMD’s with PP ? After office hours No. of private physicians 35,304 (~83%) No. of practicing PMD’s probably treating TB No. new TB “cases” / month / PMD No. new TB “cases” seen by PMD’s / year (if 1 /mo.)

Private MDs: Dearth of Data Total no. of physicians 42,535 IMS 2000 No. of gov’t. MD’s ~7,000 – 8,000 Dept. of Health + Local Gov’t. Units No. of GMD’s with PP ? After office hours No. of private physicians 35,500 (~83%) No. of practicing PMD’s probably treating TB ?19,224 / 24, 531 GP, G IM, IM Spec./ Ped No. new TB “cases” / month / PMD No. new TB “cases” seen by PMD’s / year (if 1 /mo.)

Private MDs: Dearth of Data Total no. of physicians 42,535 IMS 2000 No. of gov’t. MD’s ~7,000 – 8,000 Dept. of Health + Local Gov’t. Units No. of GMD’s with PP ? After office hours No. of private physicians 35,304 (~83%) No. of practicing PMD’s probably treating TB ?19,224 / 24, 531 GP, G IM, IM Spec./ Ped No. new TB “cases” / month / PMD 5 – 10 Medicos del Mundo, PhilCAT Surveys No. new TB “cases” seen by PMD’s / year (if 1 /mo.)

Private MDs: Dearth of Data Total no. of physicians 42,535 IMS 2000 No. of gov’t. MD’s ~7,000 – 8,000 Dept. of Health + Local Gov’t. Units No. of GMD’s with PP ? After office hours No. of private physicians ~35,000 (~83%) No. of practicing PMD’s probably treating TB ?19,224 / 24, 531 GP, G IM, IM Spec./ Ped No. new TB “cases” / month / PMD 5 - 10 Medicos del Mundo, PhilCAT Surveys No. new TB “cases” seen by PMD’s / year (if 1 /mo.) 230,688 / 294,372 WHO est. incidence = 229,000 (all cases)

Private MDs: Dearth of Data No. new TB “cases” seen by PMD’s / year (if 1 / mo.) 294,372 / 230,6888 WHO est. incidence = 229,000 (all cases) All TB cases (Dept. Of Health) 89,194 (2001) Cases shifting to public after initial private consult ?

Evolution of a National PPM Framework Philippine Coalition Against Tuberculosis (1994) Philippine Health Insurance Corporation TB package Medical School Curriculum Reform Philippine PPM DOTS Coordinating Committee

Evolution of a National PPM Framework Philippine Coalition Against Tuberculosis (1994) 53 organizations plus individual members Department of Health, Philippine TB Society, Phil. College of Chest Physicians, Society for Micro. & Infectious Dis., Academy of Family Physicians, etc. Gov’t TB Control Head automatically vice-chairman Monthly Board meetings forum for PP dialogue Annual Meeting (August), World TB Day PPM pilots by members

Initial PPM Projects in the Philippines Private University TB Clinic (U. Santo Tomas) Private Tertiary Med Ctr. DOTS Clinic (Makati Medical Center) Corporate Social Responsibility DOTS Clinic (Unilab) Private University TB Clinic – Public health center Network (De La Salle University)

Recent PPM Projects Manila Doctors Hospital Friendly Care DOTS PhilAmCare (HMO) DOTS Program Public-Initiated PPM Pasig, Capiz, Oroquieta, Las Pinas, Cagayan Valley Local PhilCAT chapter-initiated Iloilo, Davao, Cagayan de Oro More next year

Philippine TB Initiatives for the Private Sector (PhilTIPS) 3-year project funded by USAID 6 Tasks Policy Operations Research (Private Health Provider Study, Pharmacy Initiative) Model Development Model Replication Training & Certification / Communications Financing

Evolution of a National PPM Framework Philippine Health Insurance Corporation Outpatient TB package ~ US$ 74.00 for 6 month treatment of new smear (+) To be given to “accredited DOTS Centers” (not to patients or physicians) PhilCAT deputized to certify Centers Certified centers can apply for accreditation by PHIC “accredited DOTS Centers” may give portion of PHIC TB package to referring MDs “certified” by PhilCAT (basic DOTS training session)

Evolution of a National PPM Framework Medical School Curriculum Reform Work began by PhilCAT, accelerated by TIPS Modules for teaching of TB and DOTS in medical schools developed Proposed to Association of Philippine Medical Colleges; adopted in May 2003 Master TB Educator Award (TIPS)

Evolution of a National PPM Framework National PPM Coordinating Committee DOH PhilCAT Representatives of PPM projects: TIPS, GFATM Technical Advisers: WHO-WPRO, JICA Develop guidelines for operations of PPM in the Philippines including monitoring and evaluation

PPM DOTS Expansion PhilTIPS “Replication” Global Fund to fight ATM 20 programs in different cities by 2005 Global Fund to fight ATM ~70 PPM “units” by 2008

Maraming salamat po. Thank you.