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The below graph represents the trend on six (6) rounds of procurement of the Consortium members since Quarter 1 of 2020. During the first few procurement cycles, there were some unsteady changes that occurred which can be attributed to low membership as well as projection of testing capacity and procurement capability of the members. For the latest round of procurement, however, members have placed 2,400 ultra cartridges and one 4-module GeneXpert machine.

To date, the Consortium is already able to pool orders for 8,800 cartridges (7,950 ultra and 850 regular cartridges) and 13 GeneXpert systems. The yellow line indicates that the testing is steadily picking up. This can be attributed to both membership uptake as well as increase in the demands of testing per facility.

For the last quarter alone (January to March 2021), a total of 1,410 tests were conducted in stark contrast to 909 tests in October to December 2020. This is 55% increase in testing.

Graph 1. Quarterly Procurement and Test Conducted

The below graph indicates the increase in utilization of the members’ surplus stocks, resulting to 150% utilization rate in Q1 of 2021 alone.

Graph 2. Utilization rate

The below graphs (Graph 3 and 4) indicate 15-20% positive/MTB detected results. MTB detection was lower during the last quarter as compared to the previous quarters even with increased testing.

Graph 3. No. of GeneXpert Tests Done and Results Breakdown (May 2020 – March 2021)

Graph 4. Positivity Rate (18%)

Key Takeaways:

1. The Philippine National Tuberculosis program partnered with several private organizations to establish the first Philippine Private Sector Diagnostics Consortium ("The Consortium")

2.The Consortium’s membership has grown to seventeen member private hospitals and laboratories in the country’s four highest populated regions

3. In less than a year, the consortium has brought down the cost of GeneXpert TB to clients by more than 70% – from being the second most expensive to becoming the third cheapest globally

One in three Filipinos prefer private providers for TB care despite the free services offered by the government. Patients incur catastrophic costs of nearly 70% under private care. However, the availability of rapid TB diagnostic tests like GeneXpert/MTB/Rif are either limited or not affordable in the private sector. As of 2018, only 20 (4%) out of the total 488 GeneXpert machines in the country were in private sector, thereby limiting the bacteriologic confirmation of nearly 93% privately notified TB patients. Improved access to rapid diagnostic testing in the private sector has been one of the identified strategies in the 2018 PPM National Action Plan, a sub-plan of the Philippine Strategic TB Elimination Plan (PhilSTEP1).

In collaboration with the National Tuberculosis Program (NTP) and National TB Reference Lab (NTRL), the TB Innovations and Health Systems Strengthening (TBIHSS) project funded by USAID and managed by Family Health International (FHI360) in partnership with Interactive Research and Development (IRD), provided technical assistance to establish the first Philippine Private Sector Diagnostics Consortium (“The Consortium”). It is a market-driven national platform for pooled procurement and concessional pricing to private hospitals and laboratories, linking testing to notification, and for offering much reduced and uniform prices to patients.

Cost drivers were identified through market research and analysis which informed the framework for a series of consultations with influential players in private diagnostics. This was in order to appraise the willingness to leverage resources to invest in TB diagnostics, support public health, and set parameters for partnership. This led to the formation of a critical base of private providers sensitized to jointly support in finding 2.5M Filipinos with active TB through patient-centred care. With an eye on increasing accessibility and recovery to quality and affordable TB diagnostics among private sector, a series of negotiations and consultations have been conducted with suppliers, distributors and for-profit hospitals and laboratories. These consultations aimed to find a balance between the proposed concessional pricing via pooled procurement (high volume – low price strategy) and the acceptable profit margins across players to ensure sustainability and recovery.

To solicit government support, well-paced mindset change events were facilitated, with the Philippine Coalition Against Tuberculosis (PhilCAT) as the convening agency and secretariat. The Consortium has ratified its own charter, has signed MOUs with members, suppliers and distributors, and has elected a Governing Council voted by the general assembly which meets quarterly to ensure its mandate and vision. The Consortium also partnered with the Philippine Pharmaceutical Procurement Inc. (PPPI), a government owned and controlled (GOCC) as default procurement partner.

To date, The Consortium’s membership has grown to seventeen (17) member private hospitals and laboratories in the country’s four (4) highest populated regions, with the supplier Cepheid and the local distributor Macare for GeneXpert MTB/Rif as the first rapid TB diagnostic test in its portfolio.

In less than a year, the consortium has brought down the cost of GeneXpert TB to clients by more than 70% (from US$152 average in 2018 to US$42 per test in 2020) – from being the second most expensive to becoming the third cheapest globally.

Since its launch in February 2020, The Consortium procured a total of 11 GeneXpert machines and 5,500 cartridges worth PHP25 million, trained 120 laboratory staff on the use of GeneXpert, and oriented consortium members on the notification framework for recording and reporting.

USAID’s TBIHSS will continue to support the expansion of The Consortium nationwide through targeted marketing to physician groups, professional societies and hospital/laboratory networks. It will also expand its diagnostics portfolio to other globally recommended rapid TB tests this year and tests for other communicable diseases in the future. It launched its website TheConsortium.ph for web-based procurement, membership support and monitoring, and patient e-resources for TB which include self-assessment tools and geo-map for private laboratories and hospitals under The Consortium. Private providers have more options to refer their patients for TB testing based on their preferences, facilitating one-stop-shop services for consultation and testing, improved turnaround times to treatment initiation, and overall, concretely contributing to PhilSTEP1 targets.

About the organization:

TB Innovations and Health Systems Strengthening (TBIHSS) is the lead technical assistance 5-year TB project (2018-2023) to the Philippine Government and relevant key organizations from different sectors to introduce innovative approaches and technologies in diagnostics, treatment, private sector engagement and demand generation for TB to support the country in achieving its national TB elimination goals identified in PhilSTEP1 . It is funded by the United States Agency for International Development (USAID) and managed by Family Health International (FHI360) and its partners including Interactive Research and Development (IRD), Meridian, Philippine Business for Social Progress (PBSP) and mClinica

Corresponding Author for TBPPM Learning Network:

Dr. Lalaine Llamido Mortera is a board-certified internist-pulmonologist trained at the University of the Philippines - Philippine General Hospital (UP-PGH), graduated from Saint Louis University College of Medicine Philippines, and worked as a private pulmonologist, clinical trialist and academician for almost 2 decades and past National Chair of the Philippine Coalition Against Tuberculosis (PhilCAT). Currently, she is the Private Sector Advisor of USAID’s TB Innovations and Health Systems Strengthening (TB IHSS) Project leading country efforts for private sector engagement in TB care. She is also the Board Secretary of the American College of Chest Physicians (CHEST) - Philippines; Co-Chair of the Philippine College of Chest Physicians (PCCP) TB Council and TB Assembly Head of the Asia Pacific Society of Respirology (APSR).

After receiving their two 16-module GeneXpert system, the De La Salle Medical and Health Sciences Institute (DLSHSI) - Center for TB Research officially joined The Consortium as its first member in CALABARZON (Region 4A) on October 22, 2020.

In November 2020, three additional private health facilities – FEU-NRMF, Our Lady of Lourdes Hospital, and DLSU Medical Center, joined the Philippine Private Sector Diagnostics Consortium (The Consortium), a network established to provide diagnostic TB tests at a concessional pricing among Filipinos.

In collaboration with the Department of Health National Tuberculosis Control Program (DOH NTP), National Tuberculosis Reference Laboratory (NTRL), Philippine Coalition Against Tuberculosis (PhilCAT), Cepheid, and Family Health International (FHI360), Interactive Research and Development (IRD) through the USAID’s TB Innovations & Health Systems Strengthening Project, The Consortium held its first successful recording and reporting online orientation workshop on July 29, 2020. The activity aimed to introduce the paper-based and online NTP recording and reporting platforms, explore C360 software in assessing utilization and positivity rates at facility level, and to strengthen public-private collaborations in this component.

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