National Tuberculosis Control Program in the Philippines
Phyo Theingi1, Akane Fudo1, Damian Akapoeh Nsoh1, Gifty Abla Gakpo1,Naomi Pora Pank 1, Patrick Mukadi Kakoni1, Atsuko Imoto1, Miho Sato1

Introduction:

1 Nagasaki University School of Tropical Medicine and Global Health

The Philippines is listed as one of the 30 tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) burden countries in theworld.(1) In 2017, the estimated Philippines TB incidence rate was the 3rd highest globally.(1)The National Tuberculosis Control Program (NTP) was established in 1978 and operates within a devolved health delivery system atdifferent levels.(2)In 2017, Philippines NTP notified and treated 55% of WHO estimated TB cases and a 91% treatment success rate was achieved.(3)NTP developed the Philippines Strategic TB Elimination Plan 1 (PhilSTEP1) in line with the WHO END TB strategy and is currently
implementing activities at different levels according to this strategy.(2)Objectives:
To observe and gain a broader knowledge of the NTP in the Philippines.

Eastern Visayas Regional Medical Centre DOTS clinic,Layte , group activity 20th May. 20191) To observe each institution’s function at district2) To observe how TB control program is implemented at different levels
3) To observe the relationship between community level and district /national level institutions

Method:We visited organizations at various levels from community level to national
level: [Layte] Tolosa Rural Health Unit; Tolosa Barangay Health Station;
Provincial Health Office; Eastern Visayas Regional Medical Centre DOTS clinic;
Department of Health Region-8 (DOH R-8); and [Manila] DOH.
Data collection was conducted by using both quantitative and qualitative
data collection methods. Interviews and open discussions with NTP
representatives at all levels were conducted to collect qualitative data. As forthe quantitative method, secondary data was utilized, which included thenumber of notified new TB cases and DOTS coverage rate.

Old Balara health center, group activity 14th May. 2019

Observing and finding:１）Achievement of NTP in the Philippines⁽²⁾
Even though the bacteriologically confirmed rate is still stable, theproportion of clinically diagnosed (CD) has dramatically increased,
which means community awareness may have risen as well.

２）Health education and promotion related to TB in thePhilippines
At the national level, NTP have engaged with other ministries anddeveloped the 2016-2020 communication plan. The NTP’s Health
Promotion Strategy and Media Broadcasting Program werescheduled to be launched in April 2019.

Fig1. Flow of NTP Activities

３）Community DOTS approach
At the national level, NTP provides training for health care providers
to deliver proper DOTS to patients in line with the WHO
recommendations. NTP also collaborates with community-basedorganizations and other private sectors.

４）Notification of TB cases from the community level to thenational level (Reporting Flow)NTP gathers reports quarterly from all levels and has a case based
electronic recording and reporting (R&R) system for both drug
sensitive and resistant TB.

５）Integration of NTP, a vertical program, in the horizontal
services
In the Philippines health system, the TB program is integrated intodistrict/ provincial/ regional/ private hospitals and clinics.
Fig2..

Strengths and Challenges:(3)＊Dedicated and motivated Barangay Health Workers (BHWs)＊BHWs bridge health facility and community relations＊Multisectoral cooperation for TB care and prevention between NTPand other ministries/community organizations^ High loss to follow up rate for MDR-TB patients^ Need to intensify active case finding and contact tracing to reduce
the number of missing cases

Conclusion
Exposure to the overseas field trip and the opportunity to learn about Philippines’ NTP was a great experience. We could learn not
only about the achievements, but also the strengths and challenges to conduct NTP in the Philippines. Likewise, we could learn theimportant roles of community health volunteers in implementing NTP activities. This knowledge will be useful for our future in thefield.

Acknowledgements
We would like to thank Department of Health and all facilities for their collaboration, and the BHWs, whose valiant efforts madeduring our field trip in the Philippines. In addition, we wish to thank our school faculty members and admin staff for their support.

References(1). Global tuberculosis report 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO(2). The Philippines’ NTP for the Innovative TB Control Strategies to Reach the Goal of TB Elimination by 2035 (2015)(3). The National Tuberculosis Control Program of the Philippines, Department of Health, presentation data on 12th March 2019

Disclosure of conflicts of interest
The authors declare no conflicts of interest associated with this manuscript.