Transcript Module 1 - pdi training materials

Module 1
Why are we here?
Training of PDI Pharmacy Staff
September 2005
TB SITUATION: Global Perspective
WHO Report 2005
22 High-burden countries: 80% of global TB burden
The Philippines ranks 9th among the High Burden Countries
TB SITUATION: Regional Perspective
World Health Organization
Regional Office for the Western Pacific
Mongolia
Republic of Korea
WHO Report 2000
Japan
Tuberculosis Situation in the
Western Pacific Region
(All Types) 2000
People's Republic of China
Macao
Hong Kong
Lao People's
Democratic Republic
Cambodia
Viet Nam
Brunei
Malaysia
Northern Mariana Is.
Philippines
Guam
Republic of
Marshall Is.
Palau
Federated States of Micronesia
Singapore
Papua New Guinea
Nauru
Solomon Islands
Cases / 100,000
> 100
25 - 100
< 25
Kiribati
Tuvalu
Tokelau
Vanuatu
New Caledonia
Fiji
Samoa
Wallis and Futuna
Australia
Tonga
American Samoa
Niue
Cook Is.
French Polynesia
New Zealand
The designations on this map do not imply the expression of
any opinion on the part of the Regional Director concerning the
legal status of any country or territory or the delimitation
of its frontiers.
PIC group of islands not to scale
NOTE: Shaded areas are outside the WHO Region
for the Western Pacific
TB SITUATION: Philippines – A National Burden
WHO Report 2005
Alarming incidence
We rank:
9th among 22 countries
with the highest number of
TB cases
2nd in the Western Pacific
region
TB SITUATION: Philippines
DOH 1998
Top 10 Causes of Mortality 1998
Male
Female
Total
Number
Rate
% of
Total
Deaths
1. Diseases of the heart
32,260
23,570
55,830
76.3
15.8
2. Dis. vascular system
23,712
17,668
41,380
56.6
11.7
3. Pneumonia
17,632
16,077
33,709
46.1
9.5
4. Malignant Neoplasm
17,457
14,633
32,090
43.9
9.1
5. Accidents
24,160
5,714
29,874
40.8
8.5
6.Tuberculosis, all forms
18,874
9,167
28,041
38.3
7.9
7. COPD & allied conditions
9,459
4,769
14,228
19.5
4.0
8. Diabetes Mellitus
9. Other Resp. diseases
10. Nephritis, nephritic
syndrome and nephrosis
4,262
3,780
4,557
3,736
8,819
7,516
12.1
10.3
2.5
2.1
4,417
3,036
7,453
10.2
2.1
More Filipinos are dying today than ever before.
Local TB SITUATION: [Site Name, Year]
Local Mortality and Morbidity Rates
[data]
[data]
TB SITUATION: Philippines – A National Burden
1997 NPS, FHSIS
Alarming morbidity & mortality
RP among 22 high burden countries
63% population infected (22-M
Filipinos)
200,000 to 500,000 new cases infect
2 to 10 million Filipinos annually
TB kills 75 Filipinos a day (28,000
deaths per year)
TB SITUATION: Philippines – The Economic and Productivity Costs
2003 BOD,TIPS Study
Economic and Productivity Costs
Increased absenteeism among the workforce
TB costs an average female worker
P 216/day and the average male worker
P 451/day
Estimated annual lost wages: P8 billion
All untreated persons can be treated for P500
million
Annual spending (budget) for TB drugs: P200
million
Health Seeking Behavior of TB Symptomatics
1997 NPS
70% of TB
symptomatics
do not seek
professional care
Hospital, 5.3
Private MD, 9.6
Govt health center,
6.5
Family members,
2.5
No action , 49.1
Traditional healer,
2.7
Self-medication,
24.3
n:1,805
Contextual Realities
Contextual Realities
Numerous, widely dispersed,
and strategically located
Commonly the first point of
contact for health concerns
and information on drugs
Convenient and trusted for
medication advice and other
services
Contextual Realities
Contextual Realities
Dispensing of drugs largely unregulated
TB drugs readily dispensed without a prescription
24% of TB symptomatics resort to self-medication
Problem of Multiple Drug Resistance
Drug Resistance
Factors that contribute to Drug Resistance
Interrupted Treatment
Monotherapy
Pre-existing Drug Resistance
Drug Resistance
When do we suspect resistance?
Those with treatment failure
Previous intermittent treatment
Interrupted treatment
Exposure to MDR-TB case
Why are we afraid of MDR-TB?
1st line drugs no longer effective
More side effects
Very difficult to treat
Poor outcomes
Central Roles Pharmacies can play in TB Control
Change dispensing behavior of
pharmacists to truly serve the
health of the general public
Change behaviors on selfmedication, especially since 1 in
every 4 Filipinos self-medicate
TB is CURABLE
And the best way to do it is
through
DOTS
The Comprehensive and Unified Policy on TB Control in the Philippines
CUP 2004
Executive Order No. 187 – March 21, 2003
“Instituting a Comprehensive and Unified Policy on TB Control
in the Philippines”
Signed by Her Excellency President Gloria Macapagal Arroyo
Joint effort of the Government (DOH) and the Private Sector
(PhilCAT)
Adoption of the DOTS strategy of the NTP – basis of
implementation of their TB control
CUP 2004: Coverage Status of the NTP
CUP 2004
BEYOND Health Sector and BEYOND Public Sector
N
T
P
GOVERNMENT
HEALTH SECTOR
OTHER GOVERNMENT
HEALTH- RELATED
SECTORS
PRIVATE
HEALTH SECTOR
CUP 2004
CUP Agencies
Government
DOH
DEPED
DILG
DND
DOJ
DSWD
DA
DAR
DOST
PHIC
DOLE
OWWA
NEDA
NCIP
GSIS
SSS
ECC
Private
PhilCAT
PMA
TUCP
ECP
AHMOPI
Major Project Accomplishments
PhilTIPS Report 2005
Improved policy environment & financing for DOTS service provision
Technical assistance to Dept. of Labor & Employment DOTS in
the Workplace Guidelines (D.O. 73-05)
15 covenants signed with major partner institutions
TB policy & financing framework (with LEAD)
Major policy studies: Private Drug Facility, TB Policy Assessment,
Burden of Disease
27 private DOTS clinics in project sites with access to anti-TB
medicine
Major Project Accomplishments
PhilTIPS Report 2005
Operations research, capacity-building, communications, support to partners
3,000 doctors given Basic DOTS Training
10 medical schools in Master TB Educator program & using TB-DOTS
syllabus developed by project
47 private DOTS clinics in project sites certified
10 DOTS service models studied & enhanced
KAP study of 1,500 doctors completed
Operations research: TB in the Labor Force, Single-Practice Network,
Center of Excellence
Evidence-based integrated communications strategy developed
Capacity-building support to PhilCAT
Major Project Accomplishments
Increased number & improved quality of DOTS providers
4,377 – Total TB patient referrals since July 2004 in 20 private
clinics assisted by project
• 86% – Overall TB treatment success rate
• 17.52% – Case Detection Rate
704 – Number of certified DOTS-engaged doctors in project
sites
25%– Percentage of TB-treating doctors practicing DOTS in
project sites
170 – Number of drugstores in 7 project sites participating in
Pharmacy DOTS Initiative
14 – Number of Workplace DOTS Clinics assisted by project
(with PBSP)
DOTS Fund Grantees
Dr. Yu, PhilTIPS 2005
LUZON – Laoag City, Dagupan
City, City of Manila, Quezon
City, Angeles City, Cabanatuan
City, Municipality of Bacoor
(Cavite), Batangas City, Naga
City, Puerto Princesa City
VISAYAS – Roxas City, Iloilo
City, Tacloban City, Cebu City
MINDANAO – Davao City,
Cotabato City, Zamboanga City
Pharmacy DOTS Initiative Partner Sites
PDI, PhilTIPS 2005
LUZON –Dagupan City,
Quezon City, Municipality of
Bacoor (Cavite)
VISAYAS –Iloilo City, Cebu City
MINDANAO – Cagayan de Oro
City, Davao City
170 drugstore partners contributed
ave. of 8% to public sector’s CDR
in the 7 sites
Master TB Educator Award Grantees
Dr. Yu, PhilTIPS 2005
• De la Salle University (Cavite)
• University of the PhilippinesManila
• University of Sto. Tomas (Manila)
• Xavier University (Cagayan de
Oro)
• Saint Louis University (Baguio)
• West Visayas State University
(Iloilo)
• Cebu Institute of Medicine
• Davao Medical School Foundation
• University of the East (Quezon
City)
• Angeles University Foundation
(Pampanga)
Total: 10 medical schools
TB in the Workplace
Dr. Yu, PhilTIPS 2005
Luzon:
•American Standard Inc. (Manila)
•Toyota Motor Phil. (Manila)
•Central Azucarera Don Pedro
(Batangas)
•Aboitiz Transport System (Manila)
•Medicard (Manila)
•GST Philippines (Manila)
Visayas:
•Central Azucarera de la Carlota
(Negros)
•Cebu Power (Cebu)
•Lexmark Phil. (Cebu)
•Fairchild Semiconductor (Cebu)
•Pacific Traders & Mfg. Corp. (Cebu)
•DMC Busa Printers (Cebu)
•East Asia Utilities (Cebu)
Mindanao:
•Dole Stanfilco
What has been done?
What has been done?
Pharmacy DOTS Initiative (PDI)
•A model developed by Philippine TIPS
•Piloted in 7 Sites: Dagupan, Cavite,
Quezon City, Iloilo, Cebu, Davao,
Cagayan de Oro
•Participated in by 170 pharmacies
•Key collaborators are PPhA, DSAP,
DOH, LGU, BFAD, PhilCAT, local
coalitions, PPMD advocates
Pharmacy DOTS Initiative
Project Goal
To harness the potentials of pharmacies to
contribute to national efforts to control TB
in the Philippines
Specific Objectives
• To improve dispensing patterns among
pharmacy staff
• Promote the standardized form of TB
management (DOTS)
• To improve TB health-seeking behavior of
TB symptomatics/patients
• To promote TB DOTS services (public and
PPM)
• To strengthen and promote collaboration
among TB stakeholders
The 7 PDI Pilot Sites
PDI Interventions
At the Pharmacy level
Empower pharmacists and their assistants to:
1. Discourage self-medication, and
encourage adherence to NTP guidelines
2.
Provide correct information about TB
3.
Support DOTS through prescreening and
referrals to proper DOTS clinics
Achievements
1. Declarations of Support
(National and Local)
DOH, CHD
LGU
PhilCAT
DSAP
PPhA
PhilTIPS
USAID
Achievements
2. Signing of MOUs
PhilTIPS and all participating
pharmacies
PhilTIPS and CHOs
PhilTIPS and participating PPM
DOTS centers
Achievements
3. Pharmacy staff trained: 1,260
4. Training sessions: 45
Performance Summary (July ’04 to June ’05)
Source: PM and DOTS Clinic Data, Jul’04 - Jun’05
7,454 SERVED
2,487 REFERRED
856 ACCESSED
87 % (or 742) of
those who
accessed were
confirmed TB
symptomatics
263 TB CASES
129 SMEAR +
88 % enrolled in
DOTS
The 3 PDI Saturation Sites
All you need to say is
Yes!
You can be part of us….
We need you.
The people need you.
The country needs you.
Workshop 1
Green Cards
What do you know about TB?
Yellow Cards
How is TB transmitted?
Pink Cards
How is TB treated?