September 2005

TB SITUATION: Global Perspective
22 High-burden countries: 80% of global TB burden
WHO Report 2005
The Philippines ranks 9 th among the High Burden Countries

TB SITUATION: Regional Perspective
World Health Organization
Regional Office for the Western Pacific
Mongolia
WHO Report 2000
Japan
Republic of Korea
People's Republic of China
Tuberculosis Situation in the
Western Pacific Region
(All Types) 2000
Macao
Hong Kong
Viet Nam Philippines Lao People's
Democratic Republic
Cambodia
Malaysia
Brunei
Singapore
Northern Mariana Is.
Guam
Palau
Federated States of Micronesia
Republic of
Marshall Is.
Papua New Guinea Nauru
Solomon Islands
Kiribati
Tuvalu
Tokelau
Cases / 100,000
> 100
25 - 100
< 25 Australia
New Caledonia
Vanuatu
Fiji Samoa
Wallis and Futuna
American Samoa
Niue
Tonga
Cook Is.
French Polynesia
New Zealand
The designations on this map do not imply the expression of any opinion on the part of the Regional Director concerning the legal status of any country or territory or the delimitation of its frontiers.
PIC group of islands not to scale
NOTE: Shaded areas are outside the WHO Region for the Western Pacific

TB SITUATION: Philippines – A National Burden
WHO Report 2005
Alarming incidence
We rank:
9th among 22 countries with the highest number of
TB cases
2nd in the Western Pacific region

TB SITUATION: Philippines
Top 10 Causes of Mortality 1998
1. Diseases of the heart
2. Dis. vascular system
3. Pneumonia
4. Malignant Neoplasm
5. Accidents
6. Tuberculosis, all forms
7. COPD & allied conditions
8. Diabetes Mellitus
9. Other Resp. diseases
10. Nephritis, nephritic syndrome and nephrosis
Male
32,260
23,712
17,632
17,457
24,160
18,874
9,459
4,262
3,780
4,417
Female
23,570
17,668
16,077
14,633
5,714
9,167
4,769
4,557
3,736
3,036
Total
Number
55,830
41,380
33,709
32,090
29,874
28,041
14,228
8,819
7,516
7,453
Rate
76.3
56.6
46.1
43.9
40.8
38.3
19.5
12.1
10.3
10.2
DOH 1998
% of
Total
Deaths
15.8
11.7
9.5
9.1
8.5
7.9
4.0
2.5
2.1
2.1
More Filipinos are dying today than ever before.

Local TB SITUATION: [Site Name, Year]
Local Mortality and Morbidity Rates
[data]
[data]

TB SITUATION: Philippines – A National Burden
1997 NPS, FHSIS
Alarming morbidity & mortality
RP among 22 high burden countries
63% population infected (22-M
Filipinos)
200,000 to 500,000 new cases infect
2 to 10 million Filipinos annually
TB kills 75 Filipinos a day (28,000 deaths per year)

TB SITUATION: Philippines – The Economic and Productivity Costs
2003 BOD,TIPS Study
Economic and Productivity Costs
Increased absenteeism among the workforce
TB costs an average female worker
P 216/day and the average male worker
P 451/day
Estimated annual lost wages: P8 billion
All untreated persons can be treated for P500 million
Annual spending (budget) for TB drugs: P200 million

Health Seeking Behavior of TB Symptomatics
70% of TB symptomatics do not seek professional care
Private MD, 9.6
Govt health center,
6.5
Family members,
2.5
Traditional healer,
2.7
Hospital, 5.3
Self-medication,
24.3
1997 NPS
No action , 49.1
n:1,805

Contextual Realities
Contextual Realities
Numerous, widely dispersed, and strategically located
Commonly the first point of contact for health concerns and information on drugs
Convenient and trusted for medication advice and other services

Contextual Realities
Contextual Realities
Dispensing of drugs largely unregulated
TB drugs readily dispensed without a prescription
24% of TB symptomatics resort to self-medication
Problem of Multiple Drug Resistance

Drug Resistance
Factors that contribute to Drug Resistance
Interrupted Treatment
Monotherapy
Pre-existing Drug Resistance

Drug Resistance
When do we suspect resistance?
Those with treatment failure
Previous intermittent treatment
Interrupted treatment
Exposure to MDR-TB case
Why are we afraid of MDR-TB?
1 st line drugs no longer effective
More side effects
Very difficult to treat
Poor outcomes

Central Roles Pharmacies can play in TB Control

And the best way to do it is through
DOTS

The Comprehensive and Unified Policy on TB Control in the Philippines
CUP 2004
Executive Order No. 187 – March 21, 2003
“Instituting a Comprehensive and Unified Policy on TB Control in the Philippines”
Signed by Her Excellency President Gloria Macapagal Arroyo
Joint effort of the Government (DOH) and the Private Sector
(PhilCAT)
Adoption of the DOTS strategy of the NTP – basis of implementation of their TB control

CUP 2004: Coverage Status of the NTP
BEYOND Health Sector and BEYOND Public Sector
GOVERNMENT
HEALTH SECTOR
OTHER GOVERNMENT
HEALTH- RELATED
SECTORS
PRIVATE
HEALTH SECTOR
CUP 2004

CUP 2004
CUP Agencies
Government
DOH
DEPED
DILG
DND
DOJ
DSWD
DA
DAR
DOST
PHIC
DOLE
OWWA
NEDA
NCIP
GSIS
SSS
ECC
Private
PhilCAT
PMA
TUCP
ECP
AHMOPI

Major Project Accomplishments
PhilTIPS Report 2005
Technical assistance to Dept. of Labor & Employment DOTS in the Workplace Guidelines (D.O. 73-05)
15 covenants signed with major partner institutions
TB policy & financing framework (with LEAD)
Major policy studies: Private Drug Facility, TB Policy Assessment,
Burden of Disease
27 private DOTS clinics in project sites with access to anti-TB medicine

Major Project Accomplishments
PhilTIPS Report 2005
3,000 doctors given Basic DOTS Training
10 medical schools in Master TB Educator program & using TB-DOTS syllabus developed by project
47 private DOTS clinics in project sites certified
10 DOTS service models studied & enhanced
KAP study of 1,500 doctors completed
Operations research: TB in the Labor Force, Single-Practice Network,
Center of Excellence
Evidence-based integrated communications strategy developed
Capacity-building support to PhilCAT

Major Project Accomplishments
4,377 – Total TB patient referrals since July 2004 in 20 private clinics assisted by project
• 86% – Overall TB treatment success rate
• 17.52% – Case Detection Rate
704 – Number of certified DOTS-engaged doctors in project sites
25%– Percentage of TB-treating doctors practicing DOTS in project sites
170 – Number of drugstores in 7 project sites participating in
Pharmacy DOTS Initiative
14 – Number of Workplace DOTS Clinics assisted by project
(with PBSP)

DOTS Fund Grantees
LUZON – Laoag City, Dagupan
City, City of Manila, Quezon
City, Angeles City, Cabanatuan
City, Municipality of Bacoor
(Cavite), Batangas City, Naga
City, Puerto Princesa City
VISAYAS – Roxas City, Iloilo
City, Tacloban City, Cebu City
MINDANAO – Davao City,
Cotabato City, Zamboanga City
Dr. Yu, PhilTIPS 2005

Pharmacy DOTS Initiative Partner Sites
LUZON –Dagupan City,
Quezon City, Municipality of
Bacoor (Cavite)
VISAYAS –Iloilo City, Cebu City
MINDANAO – Cagayan de Oro
City, Davao City
170 drugstore partners contributed ave. of 8% to public sector’s CDR in the 7 sites
PDI, PhilTIPS 2005

Master TB Educator Award Grantees
• De la Salle University (Cavite)
• University of the Philippines-
Manila
• University of Sto. Tomas (Manila)
• Xavier University (Cagayan de
Oro)
• Saint Louis University (Baguio)
• West Visayas State University
(Iloilo)
• Cebu Institute of Medicine
• Davao Medical School Foundation
• University of the East (Quezon
City)
• Angeles University Foundation
(Pampanga)
Total: 10 medical schools
Dr. Yu, PhilTIPS 2005

TB in the Workplace
Luzon:
•American Standard Inc. (Manila)
•Toyota Motor Phil. (Manila)
•Central Azucarera Don Pedro
(Batangas)
•Aboitiz Transport System (Manila)
•Medicard (Manila)
•GST Philippines (Manila)
Visayas:
•Central Azucarera de la Carlota
(Negros)
•Cebu Power (Cebu)
•Lexmark Phil. (Cebu)
•Fairchild Semiconductor (Cebu)
•Pacific Traders & Mfg. Corp. (Cebu)
•DMC Busa Printers (Cebu)
•East Asia Utilities (Cebu)
Mindanao:
•Dole Stanfilco
Dr. Yu, PhilTIPS 2005

What has been done?

What has been done?
Pharmacy DOTS Initiative (PDI)
•A model developed by Philippine TIPS
•Piloted in 7 Sites: Dagupan, Cavite,
Quezon City, Iloilo, Cebu, Davao,
Cagayan de Oro
•Participated in by 170 pharmacies
•Key collaborators are PPhA, DSAP,
DOH, LGU, BFAD, PhilCAT, local coalitions, PPMD advocates

Pharmacy DOTS Initiative
Project Goal
To harness the potentials of pharmacies to contribute to national efforts to control TB in the Philippines
Specific Objectives
• To improve dispensing patterns among pharmacy staff
• Promote the standardized form of TB management (DOTS)
• To improve TB health-seeking behavior of
TB symptomatics/patients
• To promote TB DOTS services (public and
PPM)
• To strengthen and promote collaboration among TB stakeholders

The 7 PDI Pilot Sites

PDI Interventions
At the Pharmacy level
Empower pharmacists and their assistants to:
1. Discourage self-medication, and encourage adherence to NTP guidelines
2. Provide correct information about TB
3. Support DOTS through prescreening and referrals to proper DOTS clinics

Achievements
1. Declarations of Support
(National and Local)
DOH, CHD
LGU
PhilCAT
DSAP
PPhA
PhilTIPS
USAID

Achievements
2. Signing of MOUs
PhilTIPS and all participating pharmacies
PhilTIPS and CHOs
PhilTIPS and participating PPM
DOTS centers

Achievements
3. Pharmacy staff trained: 1,260
4. Training sessions: 45

Performance Summary (July ’04 to June ’05)
7,454 SERVED
2,487 REFERRED
856 ACCESSED
263 TB CASES
129 SMEAR +
Source: PM and DOTS Clinic Data, Jul’04 Jun’05
87 % (or 742) of those who accessed were confirmed TB symptomatics
88 % enrolled in
DOTS

The 3 PDI Saturation Sites

All you need to say is
Yes!

Workshop 1
Green Cards
What do you know about TB?
Yellow Cards
How is TB transmitted?
Pink Cards
How is TB treated?