Country Progress Report
Philippines
The 9th Technical Advisory Group and
National TB Program Mangers meeting for
TB control in the Western Pacific Region
Manila, Philippines
9-12 December 2014
Philippines
• Archipelago of 7,100 islands
• 100 million population, 17 regions
• High TB burden and high MDR TB burden
– 2012 DRS: 2% among new and 21% among retreatment
cases
• 1996 – start of DOTS strategy implementation and in
2003 with 100% DOTS coverage in the public sector,
adoption of PPMD strategy as a national strategy
• 1999 – Start of PMDT in the private sector and 2008
mainstreamed to NTP
• 2013
– Mortality rate: 27/100,000 Prevalence:438/100,000 Incidence:
292/100,000
– Case Detection Rate: 87, Treatment Success Rate: 88
Major Successes
• NTP policies and guidelines are updated to align with international
policies and will be implemented nationwide in 2015
• TB services are provided for free and are integrated with basic
health services nationwide
• With 2010-2016 National TB Control Strategic plan that has been
reviewed and updated
• With multi-sectoral involvement – private sector and other
government agencies
• With scale-up of diagnostic and treatment services for drug
resistant TB cases
• With strong political commitment from the government
(increasing budget for the TB program)
• With financing package for TB (Philhealth package)
Major Challenges
• Still many missing TB cases due to;
– Lack of access to quality assured TB diagnostic services and
passive casefinding, TB is not a reportable disease
– Limited involvement of non-NTP care providers
– Persisting stigma on TB
• Low number of detected and enrolled MDR-TB cases and with high
number of default.
• Weak TB HIV collaboration especially at the service delivery level
and limited geographic coverage
• Slow development and implementation of initiatives to increase
access to TB services by vulnerable groups
• Weak health system
– Weak logistics and information management systems
– Variable capacity in TB control program management by TB
teams at all levels
– Lack of manpower at the service delivery levels
2010-2016
Philippine Plan of Action to Control TB (PhilPACT)
Objectives
Reduce local variation in TB
control program
performance
Scale up and sustain
coverage of DOTS
implementation
Strategies
1. Localize implementation of TB control
2. Monitor health system performance
3. Engage both public and private health care
providers
4. Promote and strengthen positive
behaviour of the communities
5. Address MDR-TB, TB/HIV, and needs of
vulnerable population
Ensure provision of quality 6. Regulate and make available quality TB
diagnostic tests and drugs
TB services
7. Certify and accredit TB care providers
8. Secure adequate funding and improve
Reduce out-of-pocket
allocation and efficiency of fund utilization
expenses related to TB care
Outcome Targets based on PhilPACT
Indicators
Status as of
Dec 2013
Susceptible patients
Case Detection Rate, all
87%
forms
Treatment Success Rate, all
88%
forms
MDR-TB patients
Notification Rate
16%
Treatment Success Rate
41%
2016 Targets
90%
90%
62%
75%
Output Targets based on PhilPACT
Indicator
Total no. of presumptive TB examined
Total TB cases provided with treatment
Total no. of children given treatment or
given INH preventive therapy
Total MDR-TB cases detected and
registered
Total TB patients who underwent
provider initiated counselling and
testing on HIV/AIDS
Status as of
Dec 2013
2016
Targets
2,481,418 (45%) 5.5 million
855,904 (57%)
1.5 million
102,747 (14%)
730,000
7,883 (40%)
19,500
8,623 (19%)
45,000
Funding for PhilPACT Per Year
2010 - 2016
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
2010
2011
2012
2013
2014
2015
2016
TOTAL
750
756
792
1,465
2,689
2,598
2,971
TOTAL (20142016)
8,258
OOP
587
567
568
588
661
543
558
1,762
PHIC
0
0
0
0
0
0
0
0
FAPS
0
0
0
160
1,099
639
943
2,681
LGU
163
189
224
717
824
878
908
2,609
NG
0
0
0
0
105
538
562
1,205
Reach the Unreached
• Policy on intensified casefinding among close contacts,
high-risk clinical groups (PLHIV, DM, etc), high risk
populations (inmates, elderly, urban and rural poor)
• Screening of presumptive TB using DSSM, GenExpert and Chest X-ray
for bacteriologically confirmed and clinically diagnosed cases
• Hiring of additional staff (AIDERS), deployed to hard to reach and
poor areas
• With TB HIV collaboration – HIV counseling and testing for
registered TB cases in category A and B areas and all PMDT
treatment facilities. PLHIV screened for TB in HIV treatment hubs.
• Engagement of public (35%) and private hospitals (18%)
• 54% of inmates with access to DOTS services
• Engagement of pharmacies for referring patients
• With final draft policy for TB during disaster (for signature)
Laboratory Strengthening
• Improvement of access to diagnostic services through
– Introduction of LED FM in 60 intermediate and peripheral
laboratories
– Expansion of GenExpert sites (73), culture (20) and DST centers (3)
– Involvement of the private sector
• Ensuring quality services through EQA for microscopy, monitoring of
workload, Turn-Around-Time and error rates for GenExpert sites,
monitoring of culture and DST laboratory performance indicator and
annual proficiency testing for DST laboratories
• Technical assistance for system strengthening of
– Laboratory information system linked to ITIS
– Quality assurance
– Policy formulation (use of rapid tests and diagnostic algorithm)
– Monitoring and evaluation
Surveillance
• New case definitions are already used by all
PMDT facilities and in 2015 by all DOTS facilities
nationwide
• With Integrated TB information system (in 6/17
regions). For enhancement to include Modules
for laboratory, inventory and pharmacovigilance
(routine and CEM)
• Data are analyzed during monitoring, program
implementation reviews and program
evaluation
Expansion of PMDT Diagnostic and
Treatment Facilities
CAR (1)
2003
2007
2008
2009
2011
2012
2013
2014
NCR
Region
7
Region
1
CAR
Region
4B
Region
2
ARMM
Region
4A
Region 6
Region
3
Region
5
Region 9
Region
8
Region
10
Region
12
Region
11
CARAGA
RO 1 (2)
(1)
Regional Expansion
RO 2 (1)
RO 3 (1)
RO4A
4A(6)
(5)
(1)
(2)
RO
NCR(12)
(5)
NCR
NCR
(14)
(16)
RO 5 (2)
(1)
(3)
RO 6 (5)
(2)
RO 4B (1)
RO 8 (1)
(3)
RO 7 (2)
(1)
CARAGA (1)
New No. of
Facilities
RO 10 (2)
(1)
RO 9 (2)
(1)
ARMM (1)
No. of Gx
Labs
RO
(1)
RO 12
12 (2)
(3)
RO 11 (2)
(1)
Cumulative
No. of
Facilities
5
16
17
24
73
1
5
15
12
6
10
6
11
26
38
44
54
Trend of Enrollment and Treatment
Outcome of Patients under PMDT
Enrollment
Treatment Outcome
PMDT Targets and Activities
Diagnostic Facilities:
• 199 GeneXpert sites
• 180 thru GF
• 19 from other
sources
• 28 culture laboratories
• 7 DST Centers
Treatment
Facilities:
• TC: 20
• STC: 110
• iDOTS facilities
Other Initiatives
• 9 month Treatment Regimen
• Use of Bedaquiline
• e-TAP
• Community PMDT Care
• Enhancement of Information
System
• Enhancement of Logistics
System
Enrollment:
2015: 4365
2016: 5177
Treatment Success Rate:
75%
Decentralize
Quickly
Bold Policies and Supportive Systems
• With existing PhilHealth package for Drug Susceptible
TB (90U$ per TB case)
• Expansion to include a package for Drug Resistant TB –
situational analysis for dissemination; actuarial study in
2015; policy in 2016
• TB case notification to coordinate with other DOH
offices and to include in the pending bill on TB control
• Meeting with FDA and other stakeholders
– Pharmaco-vigilance system enhancement
– Limit commercial access of anti-TB drugs
Patient Centered care: involvement of patients
and Community
• Patient groups are involved in NTP activities on advocacy,
planning and evaluation and as treatment partner
• Plan
– Capacitate patients as counselors or peer educators
– Provide funds for patient activities and link patient group to
other government agencies for livelihood opportunities
– Provide enablers through the enhance transportation
allowance package (e-TAP) as well as food package
– Hire staff (AIDERS) to assist in detecting and following-up of TB
cases
• Involvement of NGOs, Community Health Teams, community
groups for referral of cases, providers of services and to follow-up
cases
Thank you!