PhilCAT-CDC/USAID: 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, Philippines

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.