1. Mobilizing Single Practice Providers for DOTS Network Service Delivery Marilou P. Costello, PhD Elmer S. Soriano, MD Philippine Tuberculosis Initiative for the Private Sector (PhilTIPS)

2. The Need to Mobilize the Private Sector “If the Philippines is to make any headway in the management and control of TB…the private sector needs to be encouraged to play a bigger role in the campaign.” -PhilTIPS 2002 Policy Assessment

3. The Philippine Tuberculosis Initiative for the Private Sector A USAID-funded project organized in 2002, managed by a consortium led by Chemonics International Aims to enhance private sector involvement in TB Control Developed models for bringing private sector to TB management aligned with the NTP- DOTS guidelines

4. Single Practice Physicians Who are they? Physicians with individual, stand-alone private practices Constitute the largest percentage of private practitioners Numbering 12,000-15,000 in the country General practitioners or family physicians Slow to adopt DOTS; Slow to adopt DOTS; longtime GPs relatively set in their ways --treat suspected TB patients more traditionally, with visual examination and chest x-ray, and limited use of sputum testing. Linked with organized groups: HMOs, workplace, schools, pharmaceuticals, etc

5. Single Practice Physicians Why are SPPs slow to adopt DOTS? SPPS are not in a position to provide the full DOTS regimen for their TB patients Have no sputum testing capacity No access to free or low-cost drugs nor assured of uninterrupted supply No experience organizing treatment partners Have neither time nor inclination to do essential record keeping and case reporting But : There is willingness to participate if some mechanisms could be established to meet the requirements of DOTS in their situation.

6. Unbundling the DOTS Elements: Single Practice Network (SPN) Model STAND ALONE Microscopy Laboratory STAND ALONE Pharmacy STAND ALONE CASE MANAGER STAND ALONE SPP DOTS elements contained in four walls of clinic DOTS Clinic Microscopy Laboratory Treatment Partner SPP Drugs PPM DOTS Clinic Model Distributed functions of DOTS In a network Vs. The SPN Model

7. Features of the SPN Approach Physicians linked with other providers (pharmacy, lab services, health workers) Physicians linked with other providers (pharmacy, lab services, health workers) Networks certified and accredited (DOH-NTP and PHIC) Networks certified and accredited (DOH-NTP and PHIC) Each network provides quality DOTS---ensured through effective monitoring Manual of procedures (suited to different contexts) Tested in different settings and evaluated

8. Conclusions SPPs occupy an important role in TB control Stand alone SPPs cannot implement a full DOTS regimen Stand alone SPPs are willing to become DOTS providers if necessary support systems were available