10 Jul Philippines: USAID/TB Innovations engages hospital networks to notify privately managed TB cases
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_separator type=”normal” thickness=”2″ up=”20″ down=”20″][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_gallery type=”nivo” interval=”3″ images=”2795,2794″ img_size=”full”][vc_column_text]While private and public hospitals are the preferred providers of TB services in the Philippines according to various health-seeking behavior surveys, the current notification rates remain as low as 30% in these facilities. This is mainly due to poor reporting of TB cases and the lack of efficient patient tracking. Previous initiatives have involved hospitals as members of the Service Delivery Network (SDN), but some are still unengaged. Implementation across the majority of these hospitals is limited as hospital managements are not involved in the process.
The chief executive of the local government unit is responsible for managing the health sector, and it is only recently that the country’s government units are beginning to recognize the importance of inviting private hospitals to be part of the local health system. Unfortunately, hospitals – which are not regulated by the government – are perceived as tertiary care providers that are not usually involved in public health initiatives. Hence, engaging private hospitals to join the government service delivery network demands the government a lot of time and resources.
Although most level 3 hospitals* are sensitized and trained on TB case finding, additional technical assistance is necessary to enhance engagement, strengthen their existing networks and support the human resources to systematically screen, diagnose, treat, and notify TB cases.
*Level 3 hospitals are large tertiary care providers with residency training programs for internal medicine, pediatrics, family medicine, surgery or obstetrics-gynecology.
The Public-Private Mix (PPM) National Action Plan (NAP) 2018-2022 responds to the critical need to strengthen hospital engagement initiatives and support the recent commitment of the Philippines to find and treat 2.5 million TB cases by 2022; make GeneXpert the primary diagnostic tool; and introduce systematic TB screening in health care facilities across the country.
The Enhancing Hospital Networks and Communities to End TB (ENHANCE) is one of the core PPM initiatives of USAID/TB Innovations and Health Systems Strengthening (TB Innovations). ENHANCE is a multi-disciplinary model that aims to strengthen tertiary hospital systems in delivering quality and patient-centered TB services. ENHANCE optimizes existing hospital organizational structures to systematically screen, diagnose, treat, and notify TB cases. This approach is adopted from the Enhanced Hospital Engagement Model described in the PPM NAP 2018-2022 in close coordination with the National TB Control Program (NTP) of the Department of Health (DOH).
The approach was implemented in 72 Level 3 PhilHealth-accredited hospitals – both public and private – across 3 high-burden regions: National Capital Region (NCR) (54 facilities), Region 3 (10 facilities), and Region 4A (8 facilities). The target population is everyone seeking care in tertiary hospitals with a specific focus on high‑risk groups such as TB contacts, elderly people, smokers, patients with diabetes or HIV and slum dwellers. In these hospitals, all TB cases must be notified either through the Integrated TB Information System (ITIS) or through the mandatory TB notification portal for private physicians.
Among the 72 partner hospitals, USAID/TB Innovations deployed hospital active case finding (ACF) officers in ten large public hospitals, who help improve the implementation of DOTS, ensure proper internal referral among all wards and units, and external referral between peripheral DOTS facilities. They also ensure that all patients with presumptive and confirmed TB are tended to by the hospital TB DOTS clinic and properly recorded using the tools and registry developed and provided by the DOH NTP.
From January to May 2019, 209 registered doctors notified 4,242 cases across the 3 target regions. Based on non-all-inclusive, initial data, there has been an 18% increase of patients initiated on treatment from 1,498 in Q4 2018 to 1,770 in Q1 2019.
A significant increase of TB case notification is expected for the next quarter (July to September 2019) after the successful orientation and registration of doctors in most ENHANCE hospitals this second quarter.
The training of hospital TB committees across partner hospitals is also expected to increase case notification. Each hospital is supported to create or update their hospital policies, revise their clinical pathway based on recent updates in the TB program, and form their own hospital TB committee. This committee serves as the technical oversight of ENHANCE implementation to ensure greater scale, sustainability and impact.
Full deployment of the 6 hospital ACF officers to the 10 large public hospitals is expected to conclude in the next quarter. They will ensure that all patients undergo systematic screening in both inpatient and outpatient departments and conduct regular visits to all wards and hospital units to guarantee all presumptive and confirmed TB cases are referred and recorded.
In addition, the current Integrated TB Information Systems (ITIS) is being improved to facilitate tracking, notification and feedback of privately managed TB cases to notifying physicians and facilities in level 3 hospitals.
Engaging key partners
It is imperative to systematically involve and get the buy-in and endorsement of the hospital management for the successful roll-out of the ENHANCE activities.
Through ENHANCE, USAID/TB Innovations ensures that the heads of the facilities and the respective city health offices take part in providing their commitment to support all TB advocacy and notification activities. With this, at least 5 hospitals have recently released a hospital order or memo that mandates to notify all TB cases, either online or using the official NTP forms, while most of the other project’s hospitals are currently working on this document for sustainability.[/vc_column_text][/vc_column][/vc_row]