BROKERING PARTNERSHIPS TOWARDS A TB-FREE PHILIPPINES

First breath of life

The Philippine Coalition Against Tuberculosis (PhilCAT) was conceived in 1993, a time when the Philippines had one of the highest levels of tuberculosis (TB) in the world. Many obstacles faced those who would work to control TB in the country. The government’s National Tuberculosis Program (NTP) had standardized policies and was organized on a nationwide basis; but private medical practitioners viewed it with condescension for its perceived  shortcomings. The private physicians on the other hand, needed to improve their TB control practices; and there was no standardized diagnosis and  treatment of TB in the private sector.

It was on this background of mistrust and animosity that the idea of a coalition against TB was born. Filipino delegates from both the public and private sectors to the regional meeting of the International Union Against Tuberculosis and Lung Diseases (IUATLD) in Bangkok, Thailand, had a serendipitous meeting when their bus got stuck in heavy traffic. They agreed on the need to collaborate for TB control, and on their return to Manila, convened an organizational meeting of interested stakeholders. The legal groundwork was then prepared and the Philippine Coalition Against Tuberculosis was formally inaugurated in 1994.

Dr. Camilo C. Roa, Jr. led the coalition as its founding chairman for the first three years. From then on, the dialogue between public and private sectors found a formal forum in PhilCAT activities, particularly the PhilCAT Annual Convention. Since 1996, PhilCAT has also spearheaded the annual World TB Day commemoration activities. Although a purely voluntary organization and despite limited resources, PhilCAT has managed to galvanize the different groups interested in fighting TB in the Philippines. Under PhilCAT leadership,
consensus guidelines for the Management of Childhood Tuberculosis, and Tuberculosis in the Workplace have been developed. For the management of adult TB, PhilCAT led the development of the National Consensus on Tuberculosis for 1998, which served as the national guidelines for diagnosis and
management of TB in the country at that time.

Within the landmark global document, “Tuberculosis: A Comprehensive  International Approach,” Dr.Camilo C. Roa, Jr. and Dr. Rodrigo Romulo co-authored the chapter “Coalition Building for Tuberculosis Control – The Philippine Experience.” Said manuscript provided the blueprint for a TB Coalition and a unified strategy for TB control involving the government and private healthcare providers in the country.

Local Action, Global Impact

At the forefront of promoting Public-Private Mix in TB, PhilCAT’s achievement over the years has earned respect of the international health community. The Philippines has been acknowledged for the Public- Private Mix model that PhilCAT developed and adopted.

Some of the coalition’s trailblazing initiatives over the years include the following:

2001

• PhilCAT has been awarded a grant from the Center for Disease Control (CDC) of the United States. The grant entitled, “Philippines Cooperative Agreement: The Development and Implementation of the Directly-Observed Treatment, Short-Course Strategy by the Private
  Sector in the Philippines,” was aimed at developing models for the implementation of DOTS by private physicians focusing on five specific settings – hospital-based DOTS, private physician-government health center model, private DOTS, DOTS in the workplace, and family-based DOTS among patients of private medical practitioners. The grant of over $250,000.00 went on for two years, with one year extension. The project was led by Project Coordinator Dr. Rodrigo Romulo and Project Administrator Ms. Amelia Sarmiento. In addition, PhilCAT has also been awarded $5,000 Project Development Grant from the World Health Organization (WHO) for the same topic of Private Sector DOTS.
• Together with the Philippine College of Chest Physicians (PCCP), PhilCAT successfully co-hosted the International Union Against Tuberculosis and Lung Disease (IUATLD) Eastern Region Meeting.

2002

• A historic Memorandum of Agreement (MOA) was signed by government and private sectors to work on the Development of a Comprehensive Policy for TB Control in the Philippines. A National TB summit ensued to draft a document that would clarify and clear up oftentimes conflicting policies and come up with a unified policy for all.
• The dissemination of the TB Consensus Guidelines in tandem with DOH NTP and Manual of Procedures was carried out under the leadership of Dr. Jubert Benedicto and Dr. Renato Dantes. A MOA with PCCP and Wyeth Philippines ensured the coverage of 6 provinces for round-table
  discussions and surveys involving both the public and private takeholders. Congruently, CCAT in Cavite, and CICAT in Iloilo (local PhilCAT affiliates) were established.

2003

• PhilCAT signed an agreement with the Philippine Health Insurance Corporation (PhilHealth) to launch an outpatient TB package covering TB diagnosis and treatment. This TB package is unprecedented in the country. PhilCAT was made the certification arm of PhilHealth.
• With PhilCAT and the DOH at the forefront, 22 government agencies and major private sector health partners joined hands to ratify the “Comprehensive and Unified Policy (CUP) for History and Trailblazing Accomplishments Tuberculosis in the Philippines,” the first unified policy of its kind in the world. It demonstrated how the Philippines was leading the world in bringing together all sectors to combat this disease. WHO now points to the Philippines as having achieved the fastest expansion of DOTS in the world and as a champion of the public-private mix approach to TB control. Executive Order 187 was signed by President Gloria Macapagal-Arroyo, mandating both public and private sectors to follow the Comprehensive and Unified Policy for TB.
• Through the initiative of PhilCAT with DOH and WHO-WPRO, the Philippines became a recipient of US$1.5 million grant from the Global Drug Facility of the Stop TB Partnership. Such grant was intended for the complete 6-month courses of TB medications of 130,000 TB patients over the next three years for both the public as well as PPM-DOTS expansion activities.
• PhilCAT became a sub-recipient of the Global Fund for AIDS, TB and Malaria (GFATM) grant to the Philippines amounting US$11.3 million for TB. PhilCAT was selected as the main implementor with DOH of the PPM-DOTS activities. Under this grant, PhilCAT has been tasked to provide technical and administrative support for the installation of 70 PPMD units nationwide over a period of three years. It shall also lay the foundation for the setting-up of an organizational structure from national to regional down to the PPMD units as a strategy for the scaling up of the PPM DOTS initiative.
• PhilCAT with the help from the Philippine TIPS project, and WHO, paved for the adoption of the DOTS syllabus by the Association of Philippine Medical Colleges, integrating it into the 31 medical schools of the country, a historic first in the world. PhilCAT donated scores of books from its Clinical TB Book project to all medical school libraries.
• PhilCAT made the way for 6 major professional societies in the Philippines to give their commitment to collaborate with PhilCAT for the training of trainors for DOTS in close cooperation with the Philippine TIPS project.

2004

• With DOH and WHO, PhilCAT prepared the Operational Guidelines for Public-Private Mix DOTS. This document cemented the PPMD as a national strategy for increasing case detection, and a unified approach to TB management among all health care providers.
• Under the GFATM grant, RCCs and PPMD units were launched in a road show as part of the World TB Day commemoration. The launching was graced by the presence of the Secretary of Health Manuel Dayrit, and Dr. Jean-March Olive and Dr. Michael Voniatis of the WHO.
• As certification arm of PhilHealth, PhilCAT developed the certification standards along the lines
  of the DOH’s Sentrong Sigla and PHIC standards. These standards were maintained even when Secretary of Health Manuel Dayrit signed a Department Order designating DOH Sentrong Sigla and NTP to carry on the DOTS certification with PhilCAT still helping on in the private sector.
• PhilCAT’s 10th Annual Convention became a venue for two monumental events in the history of TB control
  1. Almost 700 physicians went through the basic DOTS, training of trainors (ToT), certification, DOTS and potential DOTS provider courses. Renowned Editor Dr. Lee Reichman publicly acknowledged it as “probably the largest single day in history where so many private physicians went through training for DOTS.”
  
  2. Manila Declaration was signed by 6 organizations together PhilCAT, DOH, PhilHealth and Philippine TIPS. Through an MOA, they committed to advocate for the utilization of the DOTS strategy among their members through the conduct of the  History and Trailblazing Accomplishments NTP Course for DOTS Referring Physicians and promoting activities in DOTS training
  and certification adopting DOTS.

2005

• Guidebook on Local Coalition Building and Strengthening was published as a guide for building local TB coalitions and strengthening existing local coalitions aimed at promoting further cooperation in TB control between the private physicians, TB stakeholders and the local government units.
• Clinical Practice Guidelines (CPG) on TB in Children has been developed by the Committee on TB mostly composed of PhilCAT members – Philippine Pediatric Society (PPS), Pediatric Infectious Disease Society of the Philippines (PIDSP), World Vision, DOH, and WHO, among others.
• Philippine Training Course in Tuberculosis Program Management was devised as a three-week course training for a critical mass of health managers in all aspects of TB control. PhilCAT developed the manual for this course.
• PhilCAT witnessed the formal launching of the DOLE Department Order 73-95: Guidelines for the Implementation of Policy and Program on Tuberculosis Prevention and Control in the Workplace.
• PhilCAT was an active participant in the first Forum of the Philippine Partnership to Fight TB, Malaria and AIDS. It was then that PhilCAT was confirmed as a member in the public-private coalition involvement in the Country Coordinating Mechanism (CCM).

2006

• Round 5 of the GFATM grant started as a result of Round 2 project being able to show that through PPMD, it was possible to engage the private sector in the
  implementation of the DOTS strategy; and that the initiative has likewise
  contributed to increasing case detection at the national, and areas covered; and the achievement of high treatment success rates. Under this grant were activities such as: Launching of key PPMD installations nationwide; barrage of basic DOTS and TB Diagnostic Committee trainings covering key cities and provinces, which ensured constant involvement of the private sector.

2007

• Round 2 GF PPMD units were able to achieve the following:
  – Installation of 70 PPMD units nationwide
  – Installation of a National Coordinating Committee for PPMD and 16 Regional
  Coordinating Committee
  – Training of 1,305 private physicians committed to refer patients to the PPMD units
  – Detection of a total of 4,918 new smear (+) cases since 2004 through referrals from
  private physicians and walk-in TB cases of private PPMD units
  – CDR contribution in 2006 of 11% in the areas covered by the 70 PPMD units and 2%
  nationwide.
  History and Trailblazing Accomplishments
  – Cure rate of 87% and a success rate of 92% for cases detected from January to June 2006.
• PhilCAT has served Agreement for Performance of Work (APW) from the WHO where it
  functioned as conduit for funds donated to the NTP. Guidelines have been put in place to systematize the flow of funds from WHO to the PhilCAT to the NTP, as well as the flow of documents and reports back to WHO. Some of the APW activities included the following:
  – Monitoring and evaluation of non-GF PPMD units
  – Training on correct operation procedure, handling, maintenance and repair of
  microscope
  – Workshop on the development of policy and surveillance of TB/HIV.

2008

• PhilCAT started focusing on MDR-TB as one of the challenges in TB control through partnership.
  PhilCAT offered training on programmatic management of drug-resistant TB for private referring MDs, as well as community treatment partners.
• Round 2 GFATM grant ceased but PhilCAT was awarded an extension of the grant through the Rolling Continuation Channel, which will cover funding from January 2009-December 2014.

2009

• With the approval of the GF consolidated grant in the amount of €9,588,383, PhilCAT provided funding support to the on-going PPMD activities, and the scale-up of the PPM initiative through the creation of a Provincial Coordinating Committee in 44 provinces until December of 2011.
• From 2004 to 2008, efforts to attract support from the private sector in the past years have resulted to at least 36,870 all types of TB cases initiated to treatment, out of which, 15,892 were new smear (+) TB cases. In 2008, the 6,914 new cases of smear (+) TB cases detected through the referrals of 2,912 private physicians contributed 6% to the national case detection rate. Furthermore, additional 3,188 new smear (+) cases were detected from January to June 2009. Excellent treatment outcomes were also seen in the PPMD sites. Treatment success rate was 90% for the 5,593 new smear (+) cases detected in 2007 and 91% for the 3,191 cases detected from January-June 2008.

2010

• Following the assumption of Philippine Business for Social Progress (PBSP) as the new Principal Recipient of the GF-TB project, PhilCAT renewed its commitment to lead the implementation and expansion of PPMD in the country, with the signing of Project Grant Agreement with PBSP. Under this new agreement, PhilCAT continued to provide technical and financial assistance to the existing 100 Round 5 PPMDs; and the 44 PCC expansion sites. Within the first two years of implementation, initial accomplishments of the province-wide PPM initiative has shown that it can contribute in increasing case detection and in synchronization of management of TB among all care providers. Furthermore, the gains of the initiative have been demonstrated beyond numbers. Structures, systems and enabling factors for PPM implementation has been set in place. The multi-sectoral PCC has been instrumental in eliciting commitment and participation  History and Trailblazing Accomplishments from all those with stake in TB care and control – the public health sector, the private sector, other government agencies, LGUs and those which have initially been termed to as “nonNTPproviders.” All of these partners have been enjoined to partake in TB control on a whole
  new level. As of June 2011, PCCs contributed a total of 3,846 referrals from the newly engaged non-NTP care providers. Forty percent (or 1,536) of these cases were new smear positive.
• PhilCAT completed the TB Research Agenda Setting, a project between PhilCAT, PTSI and PCHRD, aimed at identifying the research priorities regarding TB in the Philippines.
• PhilCAT endorsed the technical assistance Agreement for the Performance of Work (APW) for the assistance in the conduct of rapid assessment and advocacy on hospital participation in TB control in Metro Manila by the Infectious Disease Office (IDO) of the DOH.

2011

• PhilCAT paved for the unification of TB in Children Guidelines when it hosted the consultative meeting with different societies and stakeholders to come up with a joint statement on the management of childhood TB in view of the recently released, Rapid Advisory on Treatment of TB in Children by the WHO.
• PhilCAT became an active partner in initiatives to widen the implementation of TB in the workplace. Some of the activities under this initiative include roundtable discussions with private sector partners – ECOP, TUCP, AHMOPI, PMAP; and public sectors – DOH, DOLE, PhilHealth, and SSS. All these led to the MOU signing which sealed their commitment and support to the revised guidelines on TB in the Workplace.
• PhilCAT’s 17th Annual Convention became the venue for the presentation and launching of the Philippine Plan of Action to Control Tuberculosis (PhilPACT 2010-2016), the roadmap for TB control program in the country. In support of the PhilPACT, PhilCAT’s incumbent Board of Trustees with several past presidents agreed to align the coalition’s efforts towards achievement of the objectives of the PhilPACT during theStrategic Planning Workshop July 16-
  17, 2011.

2012

• The National World TB Day Commemoration was held outside Metro Manila for the very first time. This was done to recognize the efforts and achievements of persons and organizations involved in TB control outside the capital region. Due to its impressive track record, Region 6 was unanimously chosen as the host. The Citizens Iloilo Coalition Against Tuberculosis (CICAT) led by Dr. Malbar Ferrer spearheaded the activity with the theme “STOP TB in my Lifetime
• In July 1, 2012, PhilCAT signed an agreement with the Philippine Business for Social Progress (PBSP) for Phase 2 of the Rolling Continuation Channel of the Global Fund Project. PhilCAT was selected as one of the sub-recipients through a competitive bidding. From July-December 2012 the following were achieved: engagement of 124 public hospitals and 110 private hospitals; training of 952 public hospital-based health workers and 908 private hospital-based health
  workers.

2013

• Creation of the Task Force to Update the 2006 Philippine Clinical Practice Guidelines: Diagnosis, Treatment, Prevention and Control of Tuberculosis of TB in Adults in line with new developments and release of international standards and local procedures in diagnosis, History and Trailblazing Accomplishments treatment and reporting of TB (NTP MOP 5th Edition 2013, WHO TB Definitions and Reporting Framework 2013, WHO Treatment Guidelines on TB 2010, ISTC 2009.
• PhilCAT was selected as sub-recipient through competitive bidding to implement Global Fund Phase 2 Project “Sustaining TB Control and Ensuring Universal Access to Comprehensive Quality TB Care” to scale-up the Enhanced Hospital DOTS implementation which started in July 1, 2012.
• The Board of Directors approved coming up with a Coffee Table Book to mark the Coalition’s 20th Year Anniversary not only as a memento of the past 20 years but also to promote the importance of coalition building, national partnerships and meaningful collaborations for a more strengthened coalition.
• PhilCAT represented by Dr. Lalaine Morters, National Chairperson and Ms. Amy Sarmiento participated in the First Forum of National Partnerships to Stop TB in the World Health Organization (WHO) Western Pacific and South-East Asia Regions held in Seoul, Korea, 22-23 November 2012
• PhilCAT represented by Ms. Amy Sarmiento participated in the 2-day workshop for the TB Mapping Dissemination in Nairobi, Kenya organized by the TB Advocacy Consortium (TAC to enhance collaboration between TB patients, civil society, organizations, government agencies, and research institutions.
• PhilCAT represented by Dr. Jennifer Ann Mendoza Wi and Ms. Amy Sarmiento participated in the Philippines Joint Program Review August 26, 2013 to September 6, 2013
• PhilCAT shared Philippine experience on public-private partnership in TB control and care – NTP Vietnam Study Tour October 18, 2013

2014

• PhilCAT launched the Young TB Research Award supported by OTSUKA to stimulate the advancement of innovative approaches in TB control and patient management and care during the 2014 World TB Day Commemoration. Dr. Aileen V. Giannan (First Place) and Dr. Ma. Philina Pablo-Villamor (Second Place) were announced as winners during the 2014 PhilCAT Convention.
• Dr. Lalaine Mortera and Ms. Amy Sarmiento attended the meeting organized by the American Thoracic Society and the World Health Organization: Caring for the “hidden” 1.5 million TB cases in high burden countries in Bali, Indonesia, 8-9 September 2014. The meeting focused on utilizing professional societies to facilitate delivery of high quality tuberculosis care.

2015

• With the theme: END TB IN CHILDREN: The Philippine Clinical Practice Guidelines 2016, the 23rd Annual PhilCAT convention held on August 18-19, 2016 provided the venue for the first public stakeholders’ presentation of the guidelines on TB in children developed by a group of experts based on available evidence.
• In 23 June 2015. Ms. Amy Sarmiento participated in the second of four regional consultations on the Global Plan to Stop TB 2016-2020. Meeting participants reinforced the importance for a paradigm-shift in the way TB is fought in countries, underlying the importance of engaging the private sector, the need for community-led demand and for innovations in care delivery.
• In December 11, 2015, with support from Philippine Business for Social Progress (PBSP). Organized a private sector participated by twenty (20) to harness the potential of the private sector in ending the TB epidemic through the development of an effective collaboration and  History and Trailblazing Accomplishments sharing of resources between the various private sector that will ensure the successful implementation of the interventions and packages for the prevention and cure of tuberculosis.

2016

• Responding to the challenges of the new END TB STRATEGY, PhilCAT embarked on a new initiative. TB Advocacy to Business Communities (TB-ABC) in five (5) regions in partnership with selected local coalitions:: Citizens Iloilo Coalition Against Tuberculosis (CICAT); Coalition of Concerned Caviteños Against Tuberculosis (CCCAT); Davao City Coalition Against Tuberculosis (DACICAT); Northern Mindanao Coalition Against Tuberculosis (NORMINCAT); Pangasinan Koalisyon Alis TB (PangKAT).
• The first search for the MLQ-PhilCAT TOPS Award, Outstanding Private Sector award was launched: Outstanding Private DOTS Facility; Outstanding Private Referring Physician; Outstanding DOTS in the Workplace Program and Outstanding Private Organization. Awarded during the Opening Ceremony of the 23rd Annual Convention.
  
  Outstanding Private DOTS Facilities
  1. Lorma Medical Center – San Fernando, La Union (Luzon)
  2. St. Anthony College Hospital – Iloilo (Visayas)
  3. Xavier University Health Care Center (Mindanao)
  Outstanding Private Referring Physicians
  1. Dr. Rosalyn H. Sebastian (Region IV-B/MIMAROPA)- Luzon
  2. Dr.Cecilia P. Momville (Iloilo)-Visayas
  3. Dr. Irish Ruth Batalla (Davao)-Mindanao
  
  Outstanding Workplace Program:
  Tagum Agricultural Development Co. Inc. (Mindanao)
• PhilCAT participated in the DOH-NTP 2016 Joint Program Review conducted from March 6-18, 2016. The Board served as resource persons for the TB-HIV and PPM components of the JPR while Ms. Amy Sarmiento served as the Geographic Team Leader for Region I and acting Team Leader for the Public-Private Mix (PPM) component.
• PhilCAT shares experience on “Partnering to Implement the National TB Programme” during the the 47th Union Conference on Lung Health, 26-29 October 2016, Liverpool United Kingdom.

2017

• With the theme: SHIFT, SHAKE & SEISMIC CHANGE TOWARDS TB ELIMINATION, the 24th Annual PhilCAT Convention will be held on August 17-18, 2017. This convention was historic and momentous one as PhilCAT had as Keynote Speaker, the very dynamic and active Executive Director of the Stop TB Partnership, Dr. Lucia Ditiu. The convention provided the venue the
  launching of the Philippine Strategic TB Elimination Plan (PhilSTEP) 2017-2022 and the Implementing Rules and Regulations (IRR) of Republic Act. No. 10767 (Comprehensive Tuberculosis Plan Act of 2016). Likewise this was also the first public dissemination of the results of the 2016 National TB Prevalence Survey.
• PhilCAT elected as secretariat of the “Philippine TB Caucus”, a network of political representatives who will work collectively and individually to end the TB epidemic launched March 14, 2017 at the Speaker Feliciano Belmonte Hall, South Wing Annex, House of Representatives, Quezon City.
  
  History and Trailblazing Accomplishments
• PhilCAT organized the Asia Pacific TB Summit in partnership with Global TB Caucus Secretariat The Global TB Caucus is an international network of over 2,300 active members of parliament from over 131 countries. Part of the Summit was an evening plenary on May 2 jointly organized by the Global TB Caucus, the Philippines TB Caucus and the Philippine Coalition Against Tuberculosis (PhilCAT) to discuss the global threat of drug-resistant TB as well as deliberate on needed action to tackle these pressing challenges.

2018

• PhilCAT led the ceremonial signing of the pledge of commitment to support the implementation of the Philippine Strategic Tuberculosis Elimination Plan (PhilSTEP) during the 2017 World TB Commemoration
• PhilCAT completed the Global Fund Project on hospital engagement with outstanding performance exceeding targets across all periods
• PhilCAT participated in a workshop on tuberculosis (TB) community, rights and gender (CRG) tools held in Addis Ababa, Ethiopia organized by the Stop TB Partnership, April 9-11, 2018