Development & Implementation of DOTS by the Private
Sector in the Philippines
In September 2001 PhilCAT with support from the United
States Agency for International Development (USAID) through
the Centers for Disease Control took the lead in developing
several models of Directly Observed Treatment, Short Course
(DOTS) in the private sector. Five models were developed
in Year 1 of project implementation, started enrollment
of TB cases in Year 2 and maintained its operation in
Year 3. These models provided DOTS services to walk-in
patients coming from their respective catchment area and
to patients referred by private medical practitioners.
Five DOTS models were developed during the first year
of project implementation focusing on the need to address
the concerns of both the private doctor and the patient
to ensure utilization of available services for TB case
finding and treatment. In developing the DOTS models the
relative strengths of the public and the private sectors
and their capacities to undertake the five essential elements
of DOTS were also given extensive and considerable attention.
Support from the public health system was also sought
for training and regular supply of anti-TB drugs.
Dialogues with important stakeholders and project partners
were made to establish mechanisms of coordination and
to agree on the terms for collaborations. These partnerships
were made official through the signing of a Memorandum
of Agreement (MOA). The guidelines for DOTS implementation
by the various models were all based on the existing NTP
polices and procedures.
2. Model Description
2.1. Model 1: Hospital Based DOTS. Manila Doctors Hospital
(MDH) DOTS Center
This Private Hospital DOTS Models is located at the Manila
Doctors Hospital (MDH), a 400-bed private tertiary hospital
at United Nations Avenue, Ermita, Manila. It has 500 active
and courtesy physician staff members of varied field of
Hospitalization. The Hospital offers multi-specialty services
both in the outpatient and in-patient departments. The
MDH TB DOTS Clinic was envisioned to serve patients referred
not only by the physician staff of the hospital, but also
by nearby hospitals and clinics. To facilitate follow-up
and defaulter tracing, patients who live or work within
the 2-km radius of MDH is the catchment population, which
covers about half of the area of District V city of Manila.
2.2. Model 2: De La Salle University (DLSU) Public-Private
Mix (PPM) DOTS Center.
The pilot site of Model 2 is located at De La Salle Health
Sciences Campus (DLSHSC) Private Public Mix (PPM) DOTS
Center, Room 6105, Angelo King Medical Research Center,
DLSHSC, Congressional Avenue, Dasmariñas, Cavite,
DLSUHSC PPM DOTS Center is the first ever private DOTS
Center in Cavite created through the collaboration of
the private physicians and government sector with the
goal of implementing DOTS Strategy based on National TB
Program (NTP) for tuberculosis (TB) patients from Dasmariñas,
Cavite and neighboring towns using the Cavite Public-Private
Referral System. It is one of the major sections of the
Tuberculosis Research Unit (TRU) of DLSHSC. Envisioned
to be the private counterpart of the Rural Health Units
implementing DOTS strategy, it accepts referral from both
the private and public sectors. Most of the referrals
came from private physicians of DLSHSC which includes
consultants and fellows and residents-in-training. Some
of the patients were referrals from other private physicians
(outside DLSHSC) practicing in Dasmariñas and neighboring
towns. Some of the referrals came from Municipal Health
Officers (MHOs) of Dasmariñas and Silang.
The main catchment area is Dasmariñas, Cavite
with an estimated adult population of 416, 790 (Municipal
Health Office Data for 2003). But since DLSHSC is considered
as a tertiary referral center in Cavite minor catchment
areas include Silang, General Trias, Imus and Alfonso
(were DLS-Poblete Hospital is located). Referrals from
other neighboring towns including Gen. Mariano Alvarez,
Bacoor, Tanza, Trece Martirez, Amadeo, Indang, Rosario,
Kawit, Tagaytay, Naic, Carmona, and Maragondon are being
considered on a case to case basis. The estimated population
of Cavite is 2.1 million as of 2000 Censal Data.
2.3. Model 3: UNILAB DOTS Center for Wellness and Good
Health: A Corporate Social Responsibility Model.
United Laboratories Inc. is the largest pharmaceutical
company in the Philippines. It carries a long tradition
of the “bayanihan spirit” and strongly supports
initiatives of community service. The DOTS Center is located
at the 2nd floor of the Green Field Development Corporation
Building, 750 Shaw Boulevard corner EDSA Central Avenue,
Mandaluyong City. The DOTS Center caters to all patients
who walk-in or are referred by physicians around area
of Pasig and Mandaluyong and the First Health Clinic.
2.4. Model 4: DOTS in the Workplace Model.
2.4.1. EDS Manufacturing Inc. (EMI) PPM Model
EMI is a large multinational semi-conductor company located
along E. Aguinaldo Highway, Anabu, Imus, Cavite. This
model caters to both regular and non-regular employees
and their dependents. EMI has a total population of 6,757
employees of which 4,871 are regular.
2.4.2. Industrial DOTS Center (IDC) Model.
This Model operates in partnership with Our Savior Hospital,
which is 1.5 kms. from the Cavite Export Processing Zone
Authority (CEPZA), an industrial zone. The IDC caters
to the employees working at CEPZA, both regular and contractual.
Services are also extended to walk-in patients of Our
Savior Hospital, which maybe dependents of employees or
residents of the immediate community. The model serves
a total workforce of 75,900 of which 23% or approximately
18,000 employees is covered by this pilot project.
2.5. Model 5: PhilamCare TB DOTS Clinic. A Health Maintenance
Organization (HMO) Model.
PhilamCare Health Systems, Inc., is the biggest health
maintenance organization in the Philippines since 1985,
maintains 16 clinics nationwide, five of which are Manila-based
servicing around 300,000 Filipinos. It has affiliated
more than 2,950 physicians of varied field of specialization,
in 27 of the better-equipped hospitals in Metro Manila
and 184 hospitals in key cities nationwide. Five of these
clinics located in Metro Manila and one in Southern Luzon
are included as part of the HMO Model. The HMO DOTS Model
is first of its own. No other similar DOTS model exists
within the structure of a truly private-run HMO catering
to purely private patients. The establishment of this
model is anchored on research with the following objectives:
(1) to determine the efficacy of a clinic-based versus
family-based DOTS; (2) to generate a model of DOTS suited
to the HMO environment; and (3) to engage PhilamCare,
as a model of HMO, towards effective TB control.