TB Innovations & Health Systems Strengthening Project

TB Screening in Healthcare Settings

Mandatory TB Notification for Doctors

LALAINE L. MORTERA, MD, FPCP, FPCCP, FCCP

TECHNICAL ADIVSOR FOR PRIVATE SECTOR
FAQs on TB Notification
Processes for Doctors
Not ALL Providers
are the Same Manage DR-

Rx TB and/or
complicated
TB cases
Diagnose and Diagnose,
treat, don’t treat and
notify notify DS-TB

Diagnose and
Notification Rate from private sector only 17% in 2017
refer

Refer for
diagnosis
Primary care
Secondary care
Tertiary care
 Where are the Providers?

31.8% consulted Private* 66.5% consulted the Public*

• 475 government hospitals
• 632 birthing homes
• 323 infirmaries
• 960 private hospitals • 16,043 doctors
• 798 birthing homes • 2,599 RHUs & HCs
• 312 infirmaries • 20,333 BHS
• 35,422 private MDs
• 3,000+ clinical labs
• thousands of private clinics *National TB Prevalence Survey 2016
National TB Prevalence Findings: Initial Providers Consulted

1997* 2007** 2016***

Private MD 36.2 Private MD 21.7 Private provider 31.8
Hospital/clinic 19.9 Private hospital 16.0 Public provider 66.5
Public Health 24.5 Public Health 26.7 Others 0.6
Center Center
Traditional 10.0 Public hospital 26.4 No data 1.0
healer
Family member 9.4 Others 9.2
* providers consulted by patients surveyed with TB symptoms
**providers consulted by patients surveyed with cough of 2 weeks in the past 3 months
***providers consulted by patients with 2-week cough and/or hemoptysis in the past month at the time of survey (n=2,665)
What is mandatory TB notification?
• Mandatory TB notification is a process of requiring all
health care providers and facilities, both public and private,
to report to the DOH every case of TB they had seen using
the format and processes that had been designed for the
purpose. It is a mandatory act for all providers as required
by Republic Act (RA) 10767.
What is the legal basis for the mandatory TB
notification?
SEC. 12. Notification on TB Cases
–All public & private health
centers, hospitals and facilities
shall observe the national
protocol on TB management and
shall notify DOH of all TB cases as
prescribed under the Manual of
Procedures of the National TB
Program and the Philippine Plan
of Action on TB Control.
Implementing Rules & Regulations
Section 8.1 Notification of TB cases. The Secretary
of Health shall ensure that:
▪ Current TB notification system shall be revised to cover all
service providers, not only those that are considered part of
an established TB service delivery network, to ensure that
all cases diagnosed and treated are reported, including its
outcome, and according to the requirements of the MOP;
▪ All public and private providers shall be guided accordingly
by the NTP MOP and current clinical practice guidelines;
▪ Review and consult all stakeholders regarding the current
implementation of TB notification system as specified in
the MOP in terms of coverage, acceptability to providers,
and other operational barriers;
Why do we need to notify TB cases?
• TB is a notifiable disease and a major public health problem
• TB burden remains unabated in the last 10 years.
• Despite PPM, many are still unengaged, hence, many
unreported TB cases to the NTP.
• Will bolster case finding, help ensure high quality TB
management in both the public and private sectors and
assess progress towards TB disease elimination goals.
• Requires an improved surveillance system
Who are required to notify TB cases?
• All healthcare providers providing TB care services from
both public and private facilities providing part or all TB
services such as diagnosis, treatment and prevention
What are the steps to notify TB cases?
1. Registration of Health Care Providers and Facilities
2. Identification of a TB case
3. Notification and reporting of TB cases
4. Data analysis and interpretation
5. Feedback and response

Explain to the TB patient the need to notify him/her to DOH as mandated

in RA 10767 in accordance with the Data Privacy Act of 2012.
How does one register to notify?
All health care providers and facilities need to register electronically
or manually
• TB Service Provider Information Sheet
• Once validated, entered into Integrated TB Info System (ITIS):
• Doctors - TB Care Providers Database
• Hospitals, clinics, facilities – TB Care Facilities Database
Online Registration

URL

Official: itis.doh.gov.ph/register
Alternative: itisdoh.pbsp.org.ph/register

The online registration started

last November 26, 2018
Who should be notified?
ALL TB cases should be notified
• Initiated treatment or not
• Referred to another provider for treatment
• Refused treatment

CXR/lab results to be interpreted by attending MD and provide diagnosis

Case definitions based on NTP Manual of Procedures CPGs will be used
Duplication of reports will be filtered by ITIS
How does one report or notify TB cases?
• Explain to patient the need to notify him/her to the DOH as
mandated by RA 10767 and the Data Privacy Act of 2012
• Fill-out the TB Case Notification Form electronically or
manually (for doctors) or encoded in the TB Register (for TB
DOTS facilities)
• Filling-out forms and encoding may be delegated to a trained
personnel
When should TB cases be notified?
• Upon diagnosis
• Upon initiation of treatment
• When treatment outcome is known

Reporting is done at the end of each month

Zero case reporting is required if no TB cases seen for the month
Online TB Notification

URL

itis.doh.gov.ph/mandatorynotification

itisdoh.pbsp.org.ph/mandatorynotification
SCENARIOS IN TB Notification
SCENARIO 1: Physician to report

Clinic
SCENARIOS IN TB Notification
SCENARIO 2: Hospital point person to report
Hospital
SCENARIOS IN TB Notification
SCENARIO 3: DOTS Clinic to report
DOTS Clinic Nurse

DOTS ITIS user

Providing Hospital encodes TBN
Data thru the
System

Collects and submits TBN

Data (hard copy)
SCENARIOS IN TBMN
SCENARIO 3: TB Notification Officer to encode
TB Notification Officer

Hospital Based DOTS ITIS user

Clinic encodes TBN
Data thru the
RHU
System

Collects and
submits TBN
Data (hard
copy)
Points to Remember:

▪ ITIS Hotline - for immediate technical assistance

6
Mandatory TB Notification
for Private Physicians and Facilities Platforms

Web-
Paper Android
based

File
iOS
sharing
How are patient data utilized?
The designated TB Notification Officer and designated NTP
Coordinator will review and analyze ITIS-generated reports.

Findings shared only with the head of facility, other key staff
for the sole purpose of data analysis and interpretation
What is the role of the TB Notification
Officer?
The designated TB Notification Officer shall:
• CONTACT MD/unit to verify report and whether initiated/referred for treatment
• If referred for treatment, determine if referral feedback received (for manual reporting).
• Check ITIS whether patient has been encoded (for manual reporting).
• Ensure that patients started treatment within 2 weeks from notification; all treatment
delays or refusals are traced, addressed and documented
• Provide feedback to referring health care provider regarding status of referral
• Submit collated information to the TB Program for planning and policy development.
Who are responsible for the collection,
consolidation, and analysis of TB Notification
reports for submission to the higher level?
• All Rural Health Units and Health Centers and their designated TB
Notification Officers at the municipality, city, provincial and regional
levels in collaboration with NTP coordinators / point persons, shall be
responsible for the collection, consolidation and analysis of TB
notification reports and submission to the higher level.
What other government agencies are involved to
ensure compliance to mandatory TB
notification?
• The Philippine Health Insurance Corporation (PHIC), Government
Security Insurance System (GSIS), Social Security System (SSS), and
Employees’ Compensation Commission (ECC) shall require TB
notification as part of claims processing requirements.
I am a medical practitioner but I neither
diagnose nor treat TB cases. Do I still have to
submit the TB Notification report?
• Medical practitioners not routinely diagnosing or
treating TB patients may give an undertaking
regarding the same and agree to submit the
information in the future, in case they diagnose or
treat any TB case
 Sample Declaration
To: TB Notification Officer, Name of Facility, District, Province/City

Dear Sir/Madam:
This is to declare that I, (name), with (PRC License),
practicing in (clinic address), do not routinely
diagnose and/or manage TB patients. My practice is
limited to (reason). I take full responsibility that I will
report any TB case should I diagnose or treat any TB
case in the future.
Is mandatory TB notification not against
data privacy?
• While TB is a communicable and notifiable disease, patient details
shared are submitted only to public health authorities designated for
this purpose. TB Notification Officers should uphold data privacy in
accordance to the Data Privacy Act of 2012.

• Patient should be informed of the need and purpose of notification

 Moving Towards a Hospital-Wide Notification System
➔ patients move ➔ patients move
Old Model ➔ information moves New Model

Treating Treating
Hospital
MD in
MD in Pharmacy
MAB
MAB
X-ray Wards
X-ray Wards

Referring Hospital TB DOTS

Hospital Referring
MD TB DOTS Clinic or Hospital
Lab MD TB Notifying Lab
Clinic
Unit

MAB – medical arts building

Enhanced Hospital Engagement Model
• Screen all high
risk groups for TB

• Simplify & modify

procedures
(innovative DOT, ICT
tools, etc.)
• Improve Xpert
access, efficient
specimen
transport from
point of care, using
ICT platforms for
feedback
Enhanced Hospital Engagement Model
• SOPs and tools to
engage physicians
in medical arts building
(MAB) clinics
• Engage all L2, L3
hospitals as treatment
providing facilities in a
phased approach
• Enhance the TB
PhilHealth package
and certification
process
Future Directions for Hospital Engagement

Bundled TB DOTS Web- or app-based

A more responsive
PhilHealth notification by
PhilHealth TB
accreditation for hospital notification
Package
L2 L3 hospitals officers

TB notification Integrate TB DOTS

required for Link current
Rotation in Clerkship,
PHIC/SSS/ECC/GSIS hospital data Internship, Residency,
claims processing system to ITIS Fellowship Programs
Need to engage a full range of providers to
reach ALL people with TB with quality care

A Service Delivery Network for Quality TB Care

• transmission as a result of early dx & treatment

• mortality & morbidity due to appropriate tx
• drug resistance due to complete treatment
• catastrophic costs to patients and families