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
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.
per 100 000 population
< 10
10 to 24
25 to 49
50 to 99
100 to 299
300 or more
No Estimate
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
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
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)
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
Profile of Health-Seeking Behavior of Persons
with TB Bacillary Disease
None
Action Taken
Profile of Health-Seeking Behaviour of Persons with TB
Bacillary Disease
Percent
34.5
Non-medical actions
· Self-medication
· Traditional healer
· Family member
27.5
22.4
3.4
1.7
Medical consultation
Public
Health center
Hospital
Private
o
Clinic
o
Hospital
38
25
15.5
9.8
12.7
10.4
2.3
35%
37%
28%
Medical Consultation
33%
67%
Public
Private
None
Non-medical actions
Medical consultation
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)



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(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
Global Fund PPMD Units
Year 3 PPMD Sites (August 2005 – July 2006)
Tuguegarao CHO, Cagayan Valley
Bambang RHU, Nueva Vizcaya
Maddela Quirino RHU, Quirino
RENMAR Clinic, Santiago City, Isabela
Cauayan City, Isabela
Aparri RHU, Cagayan
Bangued, Abra
Tabuk, Kalinga
Alaminos City, Pangasinan
Urdaneta City, Pangasinan
San Fernando City, La Union
San Jose City, Nueva Ecija
Tarlac City, Tarlac
Balanga City, Bataan
Cavite Medical Society, Imus Cavite
Sta. Rosa RHU, Laguna
Lucena United Doctors Hospital, Quezon
Felix Takano Center for Health, Cainta, Rizal
Cabuyao RHU, Laguna
Tanauan City, Batangas
San Pablo City, Laguna
NCR
Region IVA
Region IVB
Legaspi CHO, Albay
Tabaco CHO, Albay
SMMGHHSC, Sorsogon City
Naga CHO, Albay
Calapan City, Oriental Mindoro
San Jose, Occidental Mindoro
Ormoc City, Leyte
Calbayog City, Samar
St. Paul’s Hospital, Iloilo City
San Jose MHO, Antique
Medi-Link, Bacolod City, Negros Occidental
Kabankalan CHO, Negros Occidental
Kalibo City, Aklan
Silay City, Negros, Occidental
Bago City, Negros, Occidental
CDO Polymedic Hospital, Misamis Oriental
Oroquieta CHO, Misamis Occidental
Mindanao Sanitarium & Hospital-ISI, Iligan City
Gingoog CHO, Misamis Oriental
Ozamis CHO, Misamis Occidental
Malaybalay City, Bukidnon
Valencia City, Bukidnon
Dipolog City, Zamboanga del Norte
Pagadian City, Zamboanga del Sur
Ipil, Sibugay
San Juan de Dios Foundation, Pasay City
Longos Health Center, Malabon, Metro Manila
San Isidro Health Center, Parañaque
Tunasan Health Center, Muntinlupa
Sto. Niño Health Center, Marikina City
Malinta Health Center, Valenzuela
Malamig Health Center, Mandaluyong City
Dr. Jose N. Rodriguez Meml Hospl, Caloocan
Balamban RHU, Cebu
Mabolo Health Center, Cebu City
Danao City, Cebu
Tagbilaran City Health Office, Bohol
SUMC, Dumaguete City, Negros Oriental
Butuan Medical Center, Agusan Del Norte
San Francisco RHU, Agusan Del Sur
Bislig, Surigao del Sur
Surigao City, Surigao del Norte
Tacurong, Sultan Kudarat
Kidapawan City, Cotabato
PUBLIC-initiated
(60 PPMD Units)
PRIVATE-initiated
(11 PPMD Units)
Davao Doctors Hospital, Davao City
Davao Chest Center, Davao City
Digos CHO, Davao Del Sur
PhilCAT:
fighting
TB Del
through
Tagum CHO,
Davao
Norte
Mati MHO, Davao
Oriental
unified action
Panabo City, Davao
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
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”
ACKNOWLEDGEMENTS
 Department of Health
 WHO
 Philippine Coalition Against Tuberculosis (PhilCAT)
 Ma. Teresa U. Benedicto, MD (Radiologist)
 Rontgene M. Solante, MD (Infectious Disease)