1. 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.

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

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

5. Is there a Need for PPM?

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

7. 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.)

8. 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.)

9. 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.)

10. 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.)

11. 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.)

12. 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.)

13. 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.)

14. 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)

15. 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 ?

16. 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

17. 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

18. 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)

19. 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

20. 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

21. Evolution of a National PPM Framework
Philippine Health Insurance Corporation
Outpatient TB package ~ US$ 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)

22. 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)

23. 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

24. 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

25. Maraming salamat po.
Thank you.