Private Hospital Partnership in the Philippines: TB experience

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Private Hospital Partnership in the
Philippines TB experience
Private Sector Partnerships in the Fight Against
HIV/AIDS, TB and Malaria 13-14 Dec 07 ?
New Delhi

• Ma. Imelda D. Quelapio, MD
• Tropical Disease Foundation Manila, Philippines

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Green Light Committee-approved MDRTB projects
Abkhazia Bolivia Costa Rica Dominican
Republic Egypt El Salvador Estonia
Georgia Haiti Honduras India Jordan Kenya
Kyrgyzstan Latvia Lebanon Malawi Mexico Moldova
Nepal Nicaragua Peru Philippines Romania Russia
Syria Tunisia Uzbekistan
GLC-approved DOTS-Plus projects (44) from 58
countries, 2007
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Outline

• Magnitude of TB in the Philippines
• History of private sector involvement in TB
  control
• In DOTS as a PPMD unit
• In Programmatic Management of MDR TB
• Roles of the private and public sector in
  addressing the (MDR) TB burden in the Philippines

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Philippines Magnitude of the TB problem

• 86M population 17 regions
• 9th of 22 high-burden countries 133/100,000
• 3rd in WPRO
• 16th of 25 priority countries for MDRTB
• 4.4 MDR in new and 21 in previously treated
  (2004, DRS) vs global ave 1.2 and 7.7
• 4,469 estimated MDR cases every year (Global
  MDR/XDR Response, 2007-2008)

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Other Urban Areas
Rural Areas
1997 Nationwide TB Prevalence Survey
Baggao, Cagayan
Luna, La Union
Itogon, Benguet
Diffun, Quirino
Guimba, Nueva Ecija
Capas, Tarlac
San Miguel, Bulacan
Lubao, Pampanga
Rosario, Cavite
Kawit, Cavite
Undertaken by the private sector Tropical
Disease Foundation commissioned by the
Department of Health

Lucena, Quezon
Cabusao, Camarines Sur
. Mauban, Quezon
Bagsok, Mindoro
Balogo, Sorsogon
Sta. Magdalena, Sorsogon
Catarman, Samar
Biliran, Biliran
Tacloban, Leyte
Pototan, Iloilo
Binalbagan, Negros
La Castellana, Negros Occidental
Aloguinsan, Cebu
Bayugan, Agusan Sur
Poblacion Bayugan, Agusan del Sur
Laguindingan, Mis Or
Gingoog, Misamis Oriental
Linamon, Lanao

Diplahan, Zamboanga
Mati, Davao
Tarragona, Davao
History of private sector involvement in TB
control
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Action-taking among TB symptomatics (n2,358)
Tupasi, et al
1997 Nationwide TB Prevalence Survey
Choice of health care provider among those who
consulted (n601)
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Public-privatecollaboration

• The private sector should also assume
  responsibility in TB control as does the public
  sector.

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The Makati Medical Center (MMC) DOTS CLINICa
private-public Mix DOTS (PPMD) unit
On World TB Day March 24, 1999

• PRIVATE
• Makati Medical Center (private tertiary hospital)
  
• Tropical Disease Foundation (science research NGO
  with a laboratory)
• PUBLIC
• Department of Health (NTP)
• Barangay San Lorenzo (local government unit)

MOU
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Five elements of DOTS roles?
PRIVATE TDF Tropical Disease Foundation MMC
Makati Medical Center
PUBLIC NTP National TB Control Program LGU
Local Government Unit
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Five elements of DOTS roles
PRIVATE TDF Tropical Disease Foundation MMC
Makati Medical Center
PUBLIC NTP National TB Control Program LGU
Local Government Unit
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Role of the private sector

• Hospital (Makati Medl Center)
• Space for out-patient DOTS implementation
• Staff support Doctor, nurses
• Pharmacy for drug storage
• Hospital beds for serious patients
• Ambulance for default tracing
• X-ray facilities (subsidized)
• Specialists to manage adverse reactions and
  comorbidites, e.g,. psychiatrist,
  endocrinologist, radiologist, etc.

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Role of the private sector

• NGO (Tropical Dse Foundation)
• Setting up/running the MDR clinics
• Laboratory quality assured smear, culture and
  DST
• Training/Capacity building
• Development of training modules
• Initiating consultative meetings

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Role of the public sector

• Political commitment Setting the policy
  environment Implementing guidelines

• Laboratory National TB Reference Lab being
  developed as lead in the laboratory network

• DOT
• Public hospital as Tx Center and health
  centers as DOT sites

• Drug management
• Government warehouse for storage and
  distribution

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Political Commitment setting the policy
environment Memorandum of Understanding

• Department of Health
• Lung Center of the Philippines
• Tropical Disease Foundation

• Department of Health
• Regional Health Office
• National TB Reference Lab
• Lung Center Philippines
• Local government Units - MM
• Tropical Disease Foundation

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17 Regions in the Philippines
Metro Manila Region
Nationwide coverage ALL regions by 2011
36 (6)
Region II
Region I
10 (2)
CAR
13 (2)
6 (1)
19 (3)
122 (22)
Region III
6 (1)
Region IVA
Metro Manila
162 (29)
11 (2)
20 (4)
Region IVB
Region V
69 (12)
30 (5)
25 (4)
Region VI
Region VII
15 (3)
Region VIII
6 (1)
Region X
Region XIII
8 (1)
Region IX
Treatment Center
Places of residence 99- July 07
Region XI
Treatment Site
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Metro Manila Region 2 DST Centers 6 Culture
Centers
Nationwide coverage ALL regions by 2011
Culture Center
DST Center
Laboratory Network
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Possible entry points for the private sector in
TB control

• As DOT clinics/MDR TB centers
• As treatment partners in the workplace or in the
  community
• As laboratory support
• As a hospital provide bed(s) for serious TB
  patients
• As a partner in training/capacity building
• As counselors

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Conclusion

• Private sector participation and partnership in
  TB control can be a significant contribution.
• Certain roles can be assumed by the private
  sector in TB control.
• Private sector is additionality to government and
  external funding for national programs.
• Consultation with the NTP is crucial in private
  sector involvement in TB control.

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Thank you