Facilitators and barriers to implementation of the Pharmacy DOTS Initiative in selected project sites in the Philippines

@#<p style="text-align: justify;"><strong>Objectives:</strong> The Pharmacy DOTS Initiative (PDI) was relaunched on a larger scale in 2014 through the Innovations and Multi-Sectoral Partnerships to Achieve Control of Tuberculosis (IMPACT) project. This paper aimed to assess the PDI program through IMPACT by identifying the facilitating and hindering factors in its implementation. The identified factors are classified as to the affected stakeholders or processes.</p><p style="text-align: justify;"><strong>Methods:</strong> Semi-structured interviews were conducted with the PDI Program Manager and four NTP coordinators from selected project sites. Thematic analysis was done to determine the recurring facilitating and hindering factors as identified by the key informants.</p><p style="text-align: justify;"><strong>Results:</strong> Facilitating factors identified include cooperation of the stakeholders, capability-building and a good referral system. The barriers to the implementation were grouped into patient-related, pharmacy-related, health center-related, program-related as well as external factors.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The referral system created through PDI facilitated the flow of referrals starting from the pharmacy. This enabled presumptive patients to have access to health facilities for TB. Hindering factors contributed to the inability of the engaged pharmacies to sustain their consistency and commitment in conducting the PDI interventions.</p><p style="text-align: justify;"><strong>Key Words:</strong> barriers, facilitators, tuberculosis, directly observed therapy, program evaluation, pharmacy</p>

Pharmacy DOTS Initiative (PDI): A case study on integrating pharmacies in the tuberculosis directly observed treatment-short course (TB DOTS) network in the Philippines

Background@#Tuberculosis (TB) is a disease that has continuously burdened Filipinos. Various programs have been launched by public and private sectors to decrease the incidence of TB and to scale up TB prevention and control in the country. In line with this, pharmacists have been contributing in the campaign against TB since 2004 through the implementation of the Pharmacy DOTS Initiative (PDI). Through the project Innovations and Multi-Sectorial Partnerships to Achieve Control of TB (IMPACT), PDI was relaunched in the country in 2014. @*Objectives@#This case study aims to evaluate the impact of PDI on TB prevention and control by assessing the effectiveness of the technical assistance package rolled out during program implementation. @*Methods@#A review of documents was done to evaluate the achievement of the specific targets of PDI. @*Results@#Among the targets, the percentage of actively referring pharmacies and the number of referrals made throughout the program failed to meet the target. The remaining program targets such as the establishment of a referral system, training of pharmacy personnel, adoption of a TB DOTS curriculum in pharmacy schools, and presence of national legislation, policies, and guidelines relevant to PDI were satisfactorily met. @*Conclusion@#PDI had a good response at the start of its implementation, but several issues resulted in the inability to sustain the interventions and achieve set targets.

Perception of program administrators and student representatives on the implementation of return service agreement in selected institutions in the Philippines

Objectives@#The study aimed to determine the perception of program administrators and students on the implementation of return service agreement (RSA) in the Philippines. It examined the different components of, and opportunities, and challenges in the implementation of RSA of selected institutions.@*Methods@#Key informant interviews using a topic guide were conducted with ten program administrators and student representatives from selected institutions implementing a return service policy. Interviews were transcribed and responses in Filipino were translated to English. Open coding and focused coding were performed to identify categories and themes from the interview transcripts.@*Results@#Addressing human resource for health (HRH) needs of the country is a common rationale behind RSA implementation among the institutions sampled for the study. A notable difference in implementation arrangements is the manner of rendering service. Majority of RSA programs require promisors to be employed in any part of the Philippines in need of health workers, while other RSA programs recruit students from rural areas in order to deploy them later on in their hometowns. There is also an apparent lack of institutionalized mechanisms for job placement for students to fulfill their return service obligations. One challenge in most institutions is the need for a formal monitoring and evaluation scheme for the policy.@*Conclusion@#Integration of the voice of stakeholders is critical in the conceptualization, development, and implementation of RSA policies. This will ensure that issues attendant to operationalization are mitigated if not outrightly avoided.

Outputs and Outcome of the Pharmacy Directly-Observed Treatment Short-Course (DOTS) Initiative in the Philippines

@#<p><strong>OBJECTIVE:</strong> This was an evaluation of the effectiveness of the technical assistance package for the Pharmacy DOTS Initiative (PDI) in the Philippines.</p><p><strong>METHODOLOGY:</strong> Five pre-identified implementation sites were included in the evaluation. A survey was conducted to ascertain pharmacies currently implementing PDI and the number of TB presumptive cases referred by these pharmacies. Data abstraction was performed to determine the change in the number of TB cases seen by local TB programs after its implementation.</p><p><strong>RESULTS:</strong> Findings revealed that the proportion of pharmacies actively referring presumptive TB patients is not significantly lower than 60% (p=0.1892). Furthermore, results showed that the average monthly referrals were not statistically lower than 20 clients per month (p=0.9159). Nevertheless, interrupted time series analysis found no statistically significant immediate effects (p=0.516) and long-term effects (p=0.3673) on the total number of new TB cases identified after the PDI was implemented in the year 2014.</p><p><strong>CONCLUSION:</strong> The PDI was able to achieve outputs related to pharmacy engagement and referral of TB presumptive clients. However, the PDI was unsuccessful in increasing the actual number of TB presumptive cases seen by local TB programs in its implementation sites.</p>

A historical perspective of the mandatory service policy in the Philippines: A document analysis

@#<p><strong>BACKGROUND</strong>: The Philippines has, mandatory service policies to address the insufficiency and maldistribution of human resources particularly for health services. Despite being perceived as an appropriate intervention to bridge the aforementioned HRH gaps, the past and present implementations of such programs in the country have never been formally studied.</p><p><strong>OBJECTIVE</strong>: This paper aimed to present the history of mandatory service programs in the Philippines, look at their natures, and see how their different implementations relate to each other.</p><p><strong>METHODOLOGY</strong>: Using a qualitative document analysis method, administrative issuances and reports relevant to past and current implementations of mandatory service policies in the Philippines were obtained and reviewed.</p><p><strong>RESULTS</strong>: Mandatory service programs have been implemented in the country by institutions from both the private and public sectors as early as 1968. The focus of such has been mostly for government positions and specialized professions including physicians and scientists. While extensive efforts have been made through the years, the policies demonstrated fragmentation and recurring gaps in implementation. Such gaps include the lack of enabling policy mechanisms, formal monitoring and evaluation, and program institutionalization.</p><p><strong>CONCLUSION</strong>: The historical narrative of return service programs in the country is a potential source for the development of an overarching mandatory service policy framework for human resources in the Philippines, one that is specific to the context and setting of the country. By articulating policy issues identified, this paper provided a stepping-off point for future mandatory service program policy planning, implementation, evaluation, and institutionalization in the Philippines.</p>