USAID

TUBERCULOSIS PROFILE

The Philippines ranks ninth on the list of 22 high-burden tuberculosis (TB) countries in the world, according to the World Health Organizations (WHOs) Global TB Report 2009. After China, it had the second highest number of cases in the WHO Western Pacific Region in 2007, and TB is the sixth greatest cause of morbidity and mortality in the country. In 2007, approximately 100 Filipinos died each day from the disease, but significant strides have been made in increasing case detection and treatment. In 2004, the country achieved a TB case detection rate of 72 percent, exceeding WHOs target of 70 percent, and reached 75 percent in 2007. The DOTS (the internationally recommended strategy for TB control) treatment success rate reached WHOs target of 85 percent in 1999 and has remained around 88 percent since then. While the national performance levels are already high, many provinces are still below target levels due to various systemic and social factors, including the difficulty of breaking down the stigma of TB, which keeps many of those infected from seeking care. The management of multidrug-resistant (MDR) TB is expanding, with support from the Green Light Committee; however, WHO has reported extensively drugresistant TB in the Philippines. The availability of over-the-counter TB drugs and selfmedication by patients continue to contribute to the emergence of TB drug resistance.

Country Population Est. number of new TB cases Est. TB incidence (all cases per 100,000 pop) DOTS population coverage (%) Rate of new SS+ cases (per 100,000 pop) DOTS case detection rate (new SS+) (%) DOTS treatment success rate, 2006 (new SS+) (%) Est. new adult TB cases (HIV) + (%) MDR-TB among all new TB cases (%)

86,960,000 255,084

USAID Approach and Key Activities

290 100

130 75

88 0.3 4.0

USAID has been supporting TB prevention and control activities in the Philippines for the past seven years, aiding Philippines National TB Control Program (NTCP) and the Department of Health (DOH) in strengthening the public and private sectors capacities to implement DOTS. Collaboration with private practitioners is critical to reducing TB prevalence in the Philippines, as people with TB symptoms are more likely to seek treatment from private providers than from public providers. In fiscal year (FY) 2008, USAID funds for TB programming in the Philippines reached more than $5.5 million. In October 2006, USAID launched the Linking Initiatives and Networking to Control Tuberculosis project, the U.S. Government flagship TB project that supports the Philippine Government to continue the coordination and collaboration of TB control within and between the public and private sectors. Specifically, the project aims to improve the policy, financing, and regulatory environments for DOTS; strengthen service delivery; and increase demand for DOTS services through social mobilization and behavior change communication. USAIDs assistance includes the following activities and interventions: Enhancing national- and local-level planning, financing, monitoring, and supervisory capacities Ensuring that health managers and providers 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 behavior change communication activities Assisting the DOH in strengthening the accreditation and reimbursement processes of the national health insurance program Enhancing the DOH and local governments TB policy and financing
arrangements to ensure long-term sustainability of TB services
Strengthening the private sectors role in quality DOTS service delivery and its coordination with the public sector

All data are for 2007, unless otherwise noted. WHO Global TB Report 2009

www.usaid.gov

USAID Program Achievements

USAIDs program has contributed to substantial improvements in human and infrastructure capacities and includes the following achievements: Supported the national achievement of an increased case detection rate from 61 to 75 percent between 2000 and 2007 Strengthened human resource capacity for TB control by developing a TB curriculum and integrating it into the curricula at 10 major medical schools and by training 4,242 providers to deliver quality DOTS services in FY 2008 Increased the use of DOTS services by expanding a community-based information system, enabling local government units to identify people with TB symptoms who were not consulting a health care provider, and implementing strategic communication strategies based on formative research in 14 provinces Improved private sector engagement in DOTS provision by facilitating the establishment of public-private mix DOTS service delivery points, providing quality services with higher patient satisfaction ratings, and assisting the Department of Labor and Employment in piloting workplace TB control programs Ensured quality laboratory services by establishing a national policy standardizing TB laboratory procedures, supporting training on microscopy, and establishing fully equipped microscopy centers in regional health units, resulting in 93 percent of USAID-supported laboratories performing at accepted standards Assisted with ongoing efforts of the national health insurance program to improve the processes for accrediting DOTS centers and reimbursing centers for TB services Strengthened DOTS program planning and management at the national and local levels by strengthening monitoring and supervision and developing 13 provincial investment and operational plans, ensuring consistency with national priorities Supported strategies for a more efficient and cost-effective supply chain for TB commodities Established national policies for management of TB in children and programmatic management of MDR-TB

Partnerships
USAID partners in TB control in the Philippines include the DOHs NTCP and other government departments, including the Department of Education and the Department of Labor and Employment. Nongovernmental partners include the Philippine Coalition Against Tuberculosis, the Philippine College of Occupational Medicine, World Vision International, the Philippine Tuberculosis Society, Inc., and others. In addition, USAID collaborates with multilateral organizations, including WHO and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In 2003, 2006, and 2008, the Philippines was approved for Global Fund TB grants worth $11.4 million, $16.7 million, and $138.7 million, respectively. The Global Fund grants aim to strengthen quality DOTS implementation, engage the private sector in DOTS, increase demand for TB services, and improve management of MDR TB. The Tropical Disease Foundation is the principal recipient of the grants.

May 2009