Philippines
The Philippines has the ninth highest burden of tuberculosis in the world, according to the World Health Organization (WHO) Global TB Report 2006. TB is the sixth greatest cause of morbidity and mortality in the country. Approximately 78 Filipinos die from the disease every day, but significant strides have been made in recent years in increasing case detection and treatment. By 2004, the country achieved a TB case detection rate of 73 percent, exceeding the national and global target of 70 percent. The national TB treatment success rate is currently at 88 percent, above the national target of 85 percent. While the national performance levels are already high, many locales are still below target levels, given the difficulty of breaking down the stigma of TB that keeps many of those infected from seeking care.
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| Note: All data are for 2004 except where noted otherwise. Source: Global Tuberculosis Control: WHO Report 2006. |
USAID Approach and Key Activities
USAID is helping to fight TB in the Philippines on two fronts — enhancing the public sector National TB Control Program (NTP) and strengthening the private sector's capacity to implement Directly Observed Therapy, Short-Course (DOTS). Between 2000 and 2005, USAID funds for TB programming in the Philippines averaged $1.9 million per year. USAID assistance has contributed significantly to increasing the availability of quality DOTS in the National Capital Region and in five provinces of the country where service delivery is especially difficult.
In the Philippines, people with TB symptoms are more likely to seek treatment from private providers than from public providers. Implementation of DOTS among private sector practitioners is thus critical to reducing TB prevalence. Between 2002 and 2005, the USAID-supported Philippines Tuberculosis Initiatives in the Private Sector (PhilTIPS) project improved cooperation with the NTP and strengthened TB diagnosis and treatment by private providers in 25 selected sites nationwide. In 2005, the private sector expanded provision of quality TB services to 30 service delivery points, including multispecialty clinics, hospital-based public-private physician practices, clinics, and workplace models; an additional public-private TB control project has also recently begun.
USAID's assistance includes the following activities and interventions:
- Enhancing national-level planning, monitoring, and supervisory capacity
- Ensuring that health personnel are knowledgeable in all aspects of DOTS, policy reform, and advocacy
- Strengthening TB surveillance, laboratory capacity, and quality control
- Improving TB drug management
- Implementing information, education, and communication activities
- Providing microscopes, laboratory equipment and reagents, and vehicles to enable supervisors to monitor program activities
- Conducting operations research
- Providing grants to nongovernmental organizations to carry out TB education and replicate private sector efforts at the local level
USAID Program Achievements
USAID's program has contributed to substantial improvements in human and infrastructure capacity and includes the following achievements:
- Met its fiscal year 2005 target of 73 percent of participating units (facilities accredited in DOTS) achieving an 85 percent TB success rate
- Assisted the Department of Health (DOH) in increasing the use of a community-based management information system by 18 percent in public and private clinics, thus enabling local government units (LGUs) to identify people with TB symptoms who are not consulting any health care provider
- Improved case detection rates from 54 to 73 percent between 2000 and 2004
- Facilitated substantial improvements in health worker capacity to implement DOTS by training 470 LGU health workers; 3,314 barangay (administrative unit) health workers; and 3,000 private sector physicians
- Implemented through a DOH order a certification system for accrediting public and private sector DOTS centers by the Philippine Health Insurance Corporation (PHIC), with 303 centers certified to date and 200 of these accredited by PHIC, of which 20 percent are private clinics
- Facilitated the establishment of 30 public-private mix DOTS service delivery points providing quality services with high patient satisfaction ratings
- Assisted PHIC in developing a TB-DOTS outpatient benefit package, thus enabling accredited public and private centers to generate reimbursements from PHIC
- Assisted the Department of Labor and Employment in implementing an order promoting TB control in the workplace
- Developed a TB/DOTS core curriculum for medical schools and integrated DOTS into the curriculum at 10 major medical schools
- Established 48 fully equipped TB microscopy centers in regional health units and quality control centers in three provinces and cities, coupling this with improved practice of 51 LGU medical technologists in laboratory diagnosis and 15 staff in laboratory management
- Strengthened DOTS program monitoring and supervision as well as field management by personnel at the regional, provincial, and city levels
Case Detection and Treatment Success Rates Under DOTS
Partnerships
USAID partners in TB control include WHO, the Philippines NTP, the U.S. Centers for Disease Control and Prevention, the Philippines Coalition Against TB, the Tropical Disease Foundation, Inc., Chemonics International, the ReachOut Foundation International, and the New Tropical Medicine Foundation, Inc. WHO leads the technical collaboration of external partners. In addition to USAID, other key donors include the World Bank, the Canadian International Development Agency, and the Japan International Cooperation Agency. In 2003 and 2006, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved the Philippines' TB proposals for funding of $58.6 million over five years.
September 2006
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