Singapore-Philipines Feasibility Assessment_6

Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Twinning Program Proposal St Jude International Outreach Program-Singapore-Philippines Prepared by: Raul C Ribeiro, MD Director, International Outreach Program George Vélez, MBA CAAMA CHE Administrative Director, International Outreach Program St Jude Children’s Research Hospital International Outreach Program 332 North Lauderdale Street International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Memphis, Tennessee (USA) 38105-2794 Table of Contents I Executive Summary II Background a Singapore i ii iii iv v vi Demographics National Cancer Hospitals National University Hospital Pediatric Hematology/Oncology Unit Childhood cancer survival rates Foundation Viva Government and hospital leadership support b Philippines i ii iii iv v vi III Demographics National Cancer Hospitals National University Hospital Pediatric Hematology/Oncology Unit Childhood cancer survival rates Davao Children’s Cancer Fund, Inc Government and hospital leadership support Objectives Defined a Aim #1: Improve the survival of children with cancer and hematological disorders i Singapore ii Philippines b Aim #2: Implement techniques of minimal residual disease c Aim #3: Collaborative research between St Jude and Singaporean investigators IV Financial Analysis a Assumptions b Pro-forma Budget c Cost-benefit Analysis V Risk and Environmental Analysis a Entry and Exit Barriers International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines b Capabilities Assessment c Scales of Economies d Experience Curve Analysis e SWOT Analysis f Value Chain Analysis g Development Lifecycle Analysis h Transformation Strategy i Summary and Risk Assessment VI Recommendations VII Appendices a VIVA Foundation for Children with Cancer Limited b Map of Davao City Location c The Davao Children’s Cancer Fund Inc d Letter of Support: Singaporean Ministry of Health e Letter of Support: Davao Children’s Cancer Fund Inc f Letter or Support: Viva Foundation g Letter of Support: Edison Lui, MD VIII Glossary IX Citations International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines I Executive Summary The SJCRH International Outreach Program (IOP) is constantly looking for new and innovated ways to continue our mission of improving the survival rates of children with catastrophic illness worldwide, through the transfer of knowledge, technology, and organizational skills Our mission is accomplished through international partnerships via a strategy of mentoring and consultation of clinical services, education, and research The IOP is considering to undertake a new twinning modality and initiative with Singapore and the Philippines In this new twinning model, Singapore would take the lead ion assisting in the development of a Pediatric Hematology-Oncology unit in the Philippines This twinning initiative embodies three aims: 1) Improve the survival of children with cancer and hematological disorders; 2) Implement techniques of minimal residual disease; and 3) Collaborative research between St Jude and Singaporean investigators IOP would provide mentoring and scientific collaboration with limited financial support towards this project Our Singapore partners will provide the greater part of oversight and resources for the project in the Philippines The 21st Century promises to provides us with a myriad of scientific advances that will most definitely empower us on our never-ending quest to find cures and save the lives of our children However, we must find ways to accomplish this mission with everdwindling and limited resources This SJCRH-Singapore-Philippines twinning proposal is a thorough and comprehensive study that provides us with a feasibility analysis and strategy that will enable us to accomplish this twinning initiative with the commitment of International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines limited resources, capitalizing on knowledge transfer of the SJCRH expertise via a host of diverse technologies, and create new research opportunities for new research in Asia II Background Singapore Singapore is made up of not just one island but a main island with 63 surrounding islets The main island has a total land area of 682 square km However, its compact size belies its economic growth In just 150 years, Singapore has grown into a thriving center of commerce and industry Located at one of the crossroads of the world, Singapore's strategic location, excellent facilities, fascinating cultural contrasts and tourist attractions contribute to its success as a leading destination for both business and pleasure Its geographical location is 136.8 km north of the equator, between latitudes 103 degrees 38' E and 104 degrees 06' E Singapore boasts one of the most stable societies in Asia Its multi-racial, multireligious and multi-lingual groups are united in the common effort to keep Singapore a prosperous place It is with this knowledge and sensitivity that Singapore is able to blend the various cultures and religions together in harmony Singapore demographics The total population is about 4.2 million, with a resident population of 3.44 million in 2003 Singapore has a relatively young population, with only 7.7% of the International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines population above 65 years of age The age and ethnic composition of the resident population are given on the following page: Age Group - 14 years 15 - 64 years 65 years and above 2003 20.8% 71.5% 7.7% Ethnic Group Chinese Malays Indians Others 2003 76.2% 13.8% 8.3% 1.7% Table 1, Singapore age and ethnic composition Singapore’s population is aging and the birth rates have been declining to below replacement Despite the recent incentives by the Government of Singapore to boost the birth rates in Singapore, the birth rates in Singapore will continue to decline; the crude birth rate in Singapore declined by 10% from 11.4 per 1000 in as recent as 2002 to 10.1 per 1000 in 2004 In addition, as Singapore is now a developed nation, it is crucial that every child is given the best care both medically and in education to achieve their utmost Singapore Healthcare system Singapore possesses a dual system of healthcare delivery The public system is managed by the Government while the private system is provided by the private hospitals and general practitioners For the more costly hospital care, 80% of the hospital care being provided by the public sector and the remaining 20% by the private sector In 1999, the public healthcare delivery system was re-organized into two vertically integrated delivery networks, National Healthcare Group (NHG) and Singapore Health Services (SHS) This is to enable more integrated and better quality healthcare services through greater co-operation and collaboration among public sector International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines healthcare providers This system will minimize duplication of services and ensure optimal development of clinical capabilities Patients are free to choose the providers within the dual healthcare delivery system and can walk in for a consultation at any private clinic or any government polyclinic Philosophy of Singapore Healthcaree TheThe Singapore healthcare philosophy emphasizes the building of a healthy population through preventive healthcare programs and the promotion of healthy living The population is encouraged through the public health education program to adopt a healthy lifestyle and be responsible for his own health Payment of Healthcare The Government ensures that good and affordable basic medical services are made available to all Singaporeans through the provision of heavily subsidized medical services at the public hospitals and government clinics The basic medical package will reflect good, up-to-date medical practice, which is cost-effective and of proven value But it will not provide the latest and best of everything The treatment will be delivered without frills by trained personnel using appropriate facilities It will exclude nonessential or cosmetic services, experimental drugs and procedures of unproven value The Singapore health care delivery system is based on individual responsibility, coupled with Government subsidies to keep basic health care affordable Patients are expected to pay part of the cost of medical services which they use, and pay more when they demand International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines a higher level of services The principle of co-payment applies even to the most heavily subsidized wards to avoid the pitfalls of providing "free" medical services For those who choose to be accommodated in the lower classes or types of wards in the public hospitals, their hospitalization expenses are subsidized up to 80% by the government Individuals are encouraged to take responsibility for their own health by saving for medical expenses Under the Medisave scheme, every working person is required by law to set aside 6-8% of his income into his personal Medisave Account which can be used to pay for the hospitalisation expenses incurred by himself or his immediate family members MediShield, a catastrophic illness insurance scheme, is designed to help individuals meet the medical expenses from major or prolonged illnesses Medifund acts as a safety net of last resort for those who are truly indigent Therefore, no Singaporeans will be denied access into the healthcare system or turned away by the public hospitals because of the inability to pay In 2003, Singapore spent about S$ 6.3 billion or 3.8% of GDP on healthcare Out of which, Government expenditure on health services was S$2,007 million or 1.2% of GDP The standard of medical care in Singapore is lauded to be the 6th best in the world by WHO World Health Report 2000 The infant mortality rates are the lowest in the world at 2.29 per 1000 live births and excellent life expectancy easily exceeding standards in USA (Table on next page) International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Singapore Hong Kong Japan USA World Ranking for Infant mortality rate Life expectancy Infant Mortality 42 Per 1000 live births 2.29 2.96 3.26 6.5 in years 79.30 81.39 81.15 77.71 Table Infant mortality rates and life expectancy in selected countries compared to Singapore (Source: Central Intelligence Agency, USA) Figure 5-year survival rates in USA (SEER data) and Singapore (Song YS, Master’s Thesis, NUS) Data for 1998 onwards is projected International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Childhood cancer care in Singapore The results of treatment of childhood cancer in Singapore are still lagging behind most developed nations like USA (Figure 1) and Japan The relatively poor results in treatment of childhood cancer are not due to the fact that Asians poorer in childhood cancers per se For example data from the US CCG group has shown that survival for childhood acute lymphoblastic leukemia in Asians in USA was the highest, exceeding the Whites, African Americans and Latinos The local, NUH ALL treatment data has also improved to 84% 5-years event-free survival from 1997-2002 (Yeoh AEJ and Quah TC, 2005) MASPORE-Relapse-free survival: By Protocol protoco l H K MASPOR E MASPORE 2003 HK-SG 199702 NUH site only NUH HKcensored MASPORE censore d NUHcensored NUH I/II 198896 198897* 197887* 196877* Cum Surviv al 0 0.0 2.0 4.0 6.0 8.0 Relapse free survival time 10.0 12.0 14.00 Figure Results of ALL therapy in Singapore and in NUH International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez 56 Singapore-Philippines (ii) To fund positions in National University Hospital or other institutions for doctors, nurses, administrators, technologists, therapists, social workers, and other personnel involved in the treatment and care of children with cancer and childhood cancer survivors c To fund, establish and support a regional center in Singapore to carry out regional outreach program(s) to be set up by the foundation and/or other parties and St Jude Children’s Research Hospital (Memphis, U.S.A) that will provide training and continuing medical education programs and research opportunities in Asian countries in partnership with local parties, institutions and corporations, which activities will include but are not limited to the following: (i) To organize childhood cancer workshop(s), conference(s) and/or seminar(s) to promote, inter-alliance , continuing medical education and training of doctors, nurses and caregivers and all those involved in the treatment and care of children with cancer and childhood cancer survivors (ii) To organize clinical treatment and research programs for children with cancer and childhood cancer survivors in Asian countries d To carry out, and execute any other activities in furtherance of and in support of the objectives hereinbefore mentioned International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez 57 Singapore-Philippines Appendix B Figure 85, Strategic location of Davao City as a referral center for Pediatric Oncology Care in the region – circle includes the potential referral zone International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez 58 Singapore-Philippines Appendix C The Davao Children’s Cancer Fund Inc The impact of cancer in countries like the Philippines is significant due to poverty and our large and continuously growing population The concerns of the Philippine government in various fronts has relegated the care of cancer to the background – but it is a concern that will not go away The challenge has to be faced In Mindanao, cure for children with cancer is almost inaccessible to most children, many of whom belong to indigent families Davao Children’s Cancer Fund Inc (DCCFI) was conceptualized and registered to the Securities and Exchange Commission in 2004 as a non-stock, nonprofit organization of advocates for kids with cancer, to answer the call of better care and survival for children Its mission vision is to bring hope, promote better survival rates and achieve excellent, holistic care for children with cancer through advocacy, research and environmental protection The specific objectives are: a Childhood cancer advocacy - To promote public awareness and education through tri-media approach, establish linkage with government and nongovernment organizations b Holistic cancer care for children -Better access to treatment through adequate preventive, diagnostic and therapeutic facilities, promote psychosocial and spiritual support, Environmental protection International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez 59 Singapore-Philippines c Training and Research -To promote training for medical and paramedical staff, create a pediatric cancer registry, establish adequate facilities for childhood cancer research Its Founding president is Dr Mae Concepcion Dolendo, a pediatric oncologist and the following as Charter Officers and Board of Trustees: Dr Pelagio Iriarte (pediatric oncologist) Dr Jennifer Mendiola (pediatrician), Dr Odette Valderrama (ophthalmologist), Dr Jeannie Ong (pediatric hematologist), Dr Grace Pecson (pediatric hematologist), Dr Renie Maguinsay (pediatric hematologist), Dr Lily Yu (pediatric hematologist), Ana Basilio (nurse and local newspaper columnist), Fr Boy Guinit (priest), Dr Michael Manalaysay (pediatric nephrologist) Over the past two years, DCCFI has projected a strong advocacy stance for childhood cancer through Information-Education Campaign by giving basic information on childhood cancer through television, radio and print media It has produced information board exhibits and flyers in major Cancer Consciousness activities as well as supported initiatives such as Survivor’s Day and the Cancer Support Group Summit It was chosen as a major information exhibitor and beneficiary in the “Just for Kids” program of the recently concluded ASEAN Tourism Forum held in Davao City Aside from the annual Christmas and Mother’s Day celebration, it has worked closely and supported the psychosocial activities of Kythe Foundation that included Celebrate Life parties for children, short field trips by the kids and their families to the Fire station, Christmas concert with the kids as special guests and the trip to the Philippine Eagle sanctuary which is in keeping the organization’s pitch for environmental protection International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez 60 Singapore-Philippines It supports a special unit for children with cancer at Davao Medical Center (DMC) – the Pediatric Oncology and Blood Diseases Unit by creating linkages with the National Children’s Cancer Society in Missouri, USA which regularly donates some chemotherapy drugs and antibiotics to the Unit Despite being a new organization with meager resources, it has supported the treatment of some children with cancer undergoing chemotherapy at DMC Capacity building is an important thrust of the organization which aims to train not only physicians but also nurses and others involved in the holistic care of children with cancer Its major undertaking was the first region wide Pediatric Oncology Conference in November 2004 that brought together 130 participants from all over Mindanao It was a 2-day lecture and workshop conducted by AProf Quah Thuan Chong (National University Hospital), Dr Ayda Nambayan (St Jude Children’s Research Hospital, USA) and local specialists which included adult oncologists, cancer surgeon, radiation oncologist, oncology nurse, and child life specialist It has also facilitated the attendance of a pediatric residents who conduct research on pediatric cancer to the ASEAN Childhood Workshop in Singapore Among its mid- and long term goals is the establishment of a half-way house for families of children with cancer coming from far-flung provinces in Mindanao and the realization of a Cancer Institute and Research Center at Davao Medical Center As a preliminary step towards this goal, a location has already been earmarked and included in the DMC master plan for this facility and a proposal has also been submitted to the DMC Chief of Hospital International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez 61 Singapore-Philippines Currently, its fund-raising activities are mainly through donations made by private individuals and groups but there are plans to undertake regular major fundraising activities after it has expanded its membership and volunteer base Three of its officers and current members have undertaken a formal volunteer recruitment training through the Volunteer Services Organization and Asia Foundation International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Appendix D Letter of Support: Singaporean Ministry of Health International Outreach Program St Jude Children's Research Hospital 62 Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines International Outreach Program St Jude Children's Research Hospital 63 Twinning Feasibility Assessment: Dr Ribeiro & Vélez 64 Singapore-Philippines Appendix E Letter of Support: Davao Children’s Cancer Fund Inc MEMORANDUM TO: From: Date: Subject: International Outreach Program, St Jude Children's Research Hospital Mae Concepcion J Dolendo, MD 05 March 2006 Letter of Support This letter serves to confirm my support in principle in behalf of the Davao Children’s Cancer Fund Inc (DCCFI) for the proposed partnership between St Jude Children’s Research Hospital (Memphis, Tennessee, USA)(“St Jude”) and National University Hospital (Singapore)(“NUH”) I understand that the parties are contemplating the signing of a Memorandum of Understanding to outline the areas of cooperation among the parties centering around the establishment of NUH as an international center of excellence for the treatment and cure of childhood cancers, especially Leukemia, stem cell transplantation, clinical research and the training and continuing education of doctors, nurses and healthcare workers from Singapore and the region DCCFI further supports the twinning partnership between Singapore and the Philippines specifically NUH and the Davao Medical Center Pediatric Oncology and Blood Diseases Unit, Davao City Philippines This will be a major step in the battle against childhood cancer especially in developing countries where almost half of the population are children Indeed, it will be a dream come true for DCCFI whose mission vision is to bring hope, promote better survival rates and achieve excellent, holistic care for children with cancer It is hoped that through this initiative, the lives of many children with cancer can be saved not only in Singapore but in the region, and that the clinical research done under the program can benefit all children with cancer in the world //Signed// MAE CONCEPCION J DOLENDO, MD, DPPS, FPSPO President Tel: (6382) 221-4950 loc 184 Cel: 09209522587 International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Email: mae_dolendo2003@yahoo.com Appendix F Letter of Support: Viva Foundation International Outreach Program St Jude Children's Research Hospital 65 Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Appendix G Letter of Support: Edison Lui, M.D International Outreach Program St Jude Children's Research Hospital 66 Twinning Feasibility Assessment: Dr Ribeiro & Vélez 67 Singapore-Philippines M E M O RAN D U M TO: International Outreach Program, St Jude Children's Research Hospital FROM: Edison Liu, M.D Executive Director, Genome Institute of Singapore DATE: March 3, 2006 SUBJECT: Letter of Support It is my pleasure to give in principle support to the proposed partnership between St Jude Children’s Research Hospital (Memphis, Tennesse, USA)(“St Jude”) and National University Hospital(Singapore)(“NUH”) I understand that the parties are contemplating the signing of a Memorandum of Understanding to outline the areas of cooperation among the parties centering around the establishment of NUH as an international center of excellence for the treatment and cure of childhood cancers especially Leukemia , stem cell transplantation including haploidentical transplants and graft manipulation , clinical research and the training and continuing education of doctors ,nurses and healthcare workers from Singapore and the region I certainly believe that this effort will make a difference The lives of many children with cancer especially leukemia can be saved not only in Singapore but in the region and that the clinical research done under the program can also benefit all children with cancer in the whole world Let me know how I can help in this effort //Signed// Edison T Liu, M.D Genome Institute of Singapore +65-6478-8007 lieu@gis.a-star.edu.sg International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines VIII Glossary ACRA-Accounting and Corporate Regulatory Authority ALL: Acute Lymphoblastic Leukemia ASEAN: Association of Southeastern Asian Nations A*STAR: Agency for Science and Technology CBCC: Children’s Blood and Cancer Centre CMI: Children’s Medical Institute CQI: Continuous Quality Improvement Cure4Kids: www.cure4kids.org DCCFI: Children’s Cancer Fund Inc DMC: Davao Medical Center Dx: Diagnosis GDP: Gross National Product K: Thousand KKH: KK Women’s and Children’s Hospital HSC: Hematopoietic stem cell IOP: International Outreach Program ISO: International Organization for Standardization JCI: Joint Commission International MRD: Minimal Residual Disease N/A: Not Applicable NCC: National Cancer Center NHG: National Healthcare Group International Outreach Program St Jude Children's Research Hospital 68 Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines NUH: National University Hospital, Singapore NUS: National University of Singapore POND: Pediatric Oncology Networked Database SGH: Singapore General Hospital SHS: Singapore Health Services SJCRH: St Jude Children's Research Hospital Tx: Treatment U.S.: United States of America International Outreach Program St Jude Children's Research Hospital 69 Twinning Feasibility Assessment: Dr Ribeiro & Vélez 70 Singapore-Philippines IX Citations The World Fact Book 2005 Report http://www.cia.gov/cia/publications/factbook/rankorder/2119rank.html Phil Cancer Society Estimated New Cancer Cases Among Children in the Philippines 2005 The Philippine Cancer society www.kanser.com.ph/ The Philippine Society of Pediatric Oncology, Affiliate of Philippine Pediatric Society Manila, Philippines, www.pps.org.ph/ Dolendo, M (2003) The creation of a pediatric oncology center at Davao Medical Center: dedicated to the treatment of childhood cancer in Mindanao and the region A proposal to the International Outreach Program, St Jude Children's Research Hospital, Memphis, TN The World Fact Book 2005 Report, http://www.cia.gov/cia/publications/factbook/index.html http://moneycentral.msn.com/investor/market/rates.asp SJCHR IOP Historical Budget Archives FY 2006 SJCRH IOP Budget International Outreach Program St Jude Children's Research Hospital ...Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines Memphis, Tennessee (USA) 38105-2794... and Exit Barriers International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines b Capabilities Assessment c Scales... Glossary IX Citations International Outreach Program St Jude Children's Research Hospital Twinning Feasibility Assessment: Dr Ribeiro & Vélez Singapore-Philippines I Executive Summary The SJCRH International