| Private
practitioners in Malabon: establishing their practices and
collaboration with the public health centers : A survey among 45 private doctors of Malabon, a municipality of Metro Manila, Philippines,was performed. The interviewees estimated that in total they saw approximately 3,500 adult TB patients in one year, corresponding to an amazingly high rate of 900 TB cases per 100,000 inhabitants.
Forty-three respondents routinely use X-ray and 6 (13%) routinely use sputum examinations.
As to treatment of patients with far-advanced tuberculosis, only 44% stated to prescribe the recommended four-drug regimen for six months (though most prescribe Ethambutol for longer than 2 months).
None of the respondents prescribed the proper re-treatment regimen for patients previously treated with anti-TB drugs.
Lack of money to buy drugs was the most frequently mentioned believed reason for patient non-compliance (n = 41). Consequently, most respondents saw advantages in making referral by the private doctors of poor TB patients to the health centres compulsory though problems with this were also identified.
The second idea presented to the private practitioners was to make anti-TB drugs of the health centres available for their poor patients if the private practitioner has a case holding mechanism and sends reports to the municipal health office. Seventy-three percent felt this was a good idea. But only 33% felt this could be easily put into practice.
Identified obstacles to collaboration between the private and public health sector:
Lack of availability of anti-TB drugs in the health centre.
Lack of trust in the efficacy of the anti-TB drugs of the health centres.
Poor/non-existing case holding mechanisms of the private doctors.
Keeping records is non-existing among the private doctors Loss of income and respect feared if referral to health centres is frequent
Based on the findings of the survey a strategy to facilitate private public health sector collaboration was considered. The following activities were performed:
All respondents were re-visited and the WHO-recommended treatment guidelines were given and discussed.
A seminar was organised where issues of diagnosis and treatment of TB as well as private public collaboration were discussed.
After the seminar, the private practitioners were again visited and materials for strengthening case holding and facilitating referral to the public health centres were given.
Author
Dr.Christian Auer (Phillipines)
email :
christian.auer@unibas.ch
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