1. 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

2. 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

3. 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 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)

4. 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

5. 2010-2016 Philippine Plan of Action to Control TB (PhilPACT)
Objectives
Strategies
Reduce local variation in TB control program performance
Localize implementation of TB control
Monitor health system performance
Scale up and sustain coverage of DOTS implementation
Engage both public and private health care providers
Promote and strengthen positive
behaviour of the communities
Address MDR-TB, TB/HIV, and needs of
vulnerable population
Ensure provision of quality TB services
Regulate and make available quality TB
diagnostic tests and drugs
7. Certify and accredit TB care providers
Reduce out-of-pocket expenses related to TB care
Secure adequate funding and improve
allocation and efficiency of fund utilization

6. Outcome Targets based on PhilPACT
Indicators
Status as of Dec 2013
2016 Targets
Susceptible patients
Case Detection Rate, all forms
87%
90%
Treatment Success Rate, all forms
88%
MDR-TB patients
Notification Rate
16%
62%
Treatment Success Rate
41%
75%

7. Output Targets based on PhilPACT
Indicator
Status as of Dec 2013
2016 Targets
Total no. of presumptive TB examined
2,481,418 (45%)
5.5 million
Total TB cases provided with treatment
855,904 (57%)
1.5 million
Total no. of children given treatment or given INH preventive therapy
102,747 (14%)
730,000
Total MDR-TB cases detected and registered
7,883 (40%)
19,500
Total TB patients who underwent provider initiated counselling and testing on HIV/AIDS
8,623 (19%)
45,000

8. Funding for PhilPACT Per Year 2010 - 2016

9. Reach the Unreached
Updated
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)

10. 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

11. 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

12. Expansion of PMDT Diagnostic and Treatment Facilities
2003-
2007
2008
2009
2011
2012
2013
2014
Regional Expansion
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
No. of Gx Labs 16 17 24 73
New No. of Facilities 5 1 15 12 6 10
Cumulative No. of Facilities 11 26 38 44 54
CAR (1)
RO 2 (1)
RO 1 (2)
RO 1 (1)
RO 3 (1)
RO 4A (6)
RO 4A (1)
RO 4A (2)
RO 4A (5)
NCR (5)
NCR (12)
NCR (16)
NCR (14)
RO 5 (1)
RO 5 (2)
RO 6 (5)
RO 6 (3)
RO 6 (2)
RO 8 (1)
RO 8 (3)
Add expansion of Laboratory
RO 4B (1)
RO 7 (2)
RO 7 (1)
CARAGA (1)
RO 10 (2)
RO 10 (1)
RO 9 (1)
RO 9 (2)
RO 12 (1)
RO 12 (2)
RO 12 (3)
ARMM (1)
RO 11 (2)
RO 11 (1)

13. Trend of Enrollment and Treatment Outcome of Patients under PMDT

14. PMDT Targets and Activities
Other Initiatives
9 month Treatment Regimen
Use of Bedaquiline
e-TAP
Community PMDT Care
Enhancement of Information System
Enhancement of Logistics System
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
Decentralize Quickly
Enrollment:
2015: 4365
2016: 5177
Treatment Success Rate:
75%

15. 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

16. 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

17. Thank you!