Dots CERTIFICATION AND ACCREDITATION
Dots CERTIFICATION AND ACCREDITATION
Dots CERTIFICATION AND ACCREDITATION
Introduction
Population: 90 million Prevalence of NSP ( 2007) 200/100,000 CDR: 72% and treatment success rate: 89% Decentralized health delivery system
Context of development
Late 1990s: DOTS being expanded, PPM started with help of the Philippine Coalition Against TB (PhilCAT) Health sector reform: increase benefits provided by the Philippine Health Insurance Corporation (PhilHealth) USAID-funded project provided TA Aim: To provide funding support to DOTS facilities to sustain PPM and to improve quality of TB services
Phases of development
Phases
1. Planning (2000 2003)
Activities
Stakeholder discussions Announced TB-DOTS outpatient benefit package; (*change of President and Health Secretary)
2. Developmental (2003 Developed certification and accreditation system; 2005) Issuance of policies by PhilHealth and DOH; Pilot testing; Trained regional assessors and TA provders 3. Implementation and Implemented initiative, identified initial operational enhancements (2004 problems and implemented solutions present) 4. Evaluation (2007 2009) Assessments done by external consultants Comprehensive review by PhilHealth in 2009
Coordinating mechanism
National: National Coordinating Committee for PPMD ( DOH, PhilHealth, PhilCAT, WHO) Regional: Regional Coordinating Committee for PPMD ( regional DOH and Philhealth, private rep, local coalition)
Certification standards
Standard 1. The TB DOTS center is easily located Standard 2. The TB DOTS center provides facilities for privacy and comfort Standard 3. The TB DOTS center provides for the safety of its patients and staff Standard 4. All patients undergo a comprehensive assessment to facilitate the planning and delivery of treatment Standard 5. All patients have continuous access to TB diagnostic tests Standard 6. A care plan is developed and followed for all patients Standard 7. Patients have continuous access to safe and effective anti-TB medications through-out the duration of treatment Standard 8. Policies and procedures for providing care to patients are developed, disseminated, implemented and monitored for effectiveness. Standard 9. Policies and procedures for managing patient information are developed, disseminated, implemented and monitored for effectiveness Standard 10. The DOTS center has an adequate number of qualified personnel skilled in providing DOTS services.
Duration: 1 year Benefit: Could avail of the TB-DOTS outpatient benefit package
Results
Problems
Low number of certified and accredited DOTS facilities ( long processes, public health workers do not get a share of reimbursements, lack of knowledge) Low utilization rate ( non-disclosure of patients on PhilHealth membership)
Plan
Improve implementation Extend coverage re-treatment cases and develop package for MDR-TB
Lessons learned
Critical factors: enabling policy environment ; clear policies, guidelines and tools and trained certifiers and TA providers Financial incentives encourage health staff participation including the private practitioners There are indications that linking quality and financial incentive is effective
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