National Tuberculosis Program

NTP Manager: Dr. Anna Marie Celina G. Garfin

DOH-Disease Prevention Control Bureau

Program Medical Coordinator (Cebu): Dr. Sharon Azenith O. Laurel

The National TB Control Program, organized in 1978 and operating within a devolved health
care delivery system, is one of the public health programs being managed and coordinated by
the Infectious Diseases for Prevention and Control Division (IDPCD) of the Disease Prevention
and Control Bureau (DPCB) of the Department of Health (DOH).  Headed by a Program Manager
and supported by 20 technical and administrative staff it has the following mandate; (1)
develop policies, standards and the national strategic plan, (2) manage program logistics, (3)
provide leadership and technical assistance to the lower health offices / units, (4) manage data,
and (5) conduct monitoring and evaluation.  The program’s TB diagnostic and treatment
protocols and strategies, issued through the Manual of Procedures, are in accordance the
policies of World Health Organization (WHO) and the International Standards for TB Care
(ISTC).  The roadmap for TB control towards TB elimination is the 2017-2022 Philippine Strategic
TB Elimination Plan (PhilSTEP).

Past Efforts to Control TB in the Country

National efforts to control TB in the country started more than 100 years ago with the
establishment of a non-governmental organization, the Philippine TB Society, Inc. (PTSI). It
included Quezon Institute and many provincial branches. The Sweepstakes Law (RA 4130) was
passed to establish the Philippine Charity Sweepstakes Office primarily to fund the operations
of PTSI. The Philippine TB Commission, under the Philippine Health Service, was organized in
1932 through the passage of Republic Act 3743. In 1950, the Commission evolved into the
Division of Tuberculosis under the Secretary of Health that, in turn, created the TB Center that
collaborated with the TB ward of the San Lazaro Hospital. In 1954, the Philippine Congress
passed the Tuberculosis Law (RA 1136). The Division of TB was placed under the Director of the
National Tuberculosis Center of the Philippines (NTCP) jul11MOP.indd 4 8/9/2014 5:18:25 PM
National Tuberculosis Control Program Manual of Procedures, 5th ed. 5 established at the DOH
compound. The close collaboration between the Ministry of Health and the PTSI led to the
establishment of the National Institute of Tuberculosis in 1976 that conducted operational
studies including the first National TB Prevalence Survey (NTPS) that helped NTP strengthen its
strategies. The TB Control Service (TBCS), with around 30 staff, was created under the Office of
Public Health Services of the Department of Heath after the EDSA People Power in 1986. In
2000, with the re-organization of the DOH, the TBCS was disbanded and some of its staff were
absorbed by the newly created Infectious Disease Office (IDO) of the National Center for
Disease Prevention and Control (NCDPC). In 2013, rationalization of the DOH central and
regional offices was implemented and the number of staff was decreased. Integration of
programs and activities was advocated to cope with the changes. Technical approaches to TB
management have substantially changed over the years. Before the 1970s, BCG immunization
as a preventive tool was implemented nationwide with the help of UNICEF. Chest X-ray (CXR)
examination was then utilized as the main diagnostic tool. The 12-month standardized
treatment composed of INH and Streptomycin was used to treat TB and patients were
hospitalized. In 1978, sputum microscopy as a primary TB diagnostic tool and ambulatory
treatment were adopted as policies of the organized National TB Control Program (NTP). The
short course chemotherapy composed of Isoniazid, Rifampicin, and Pyrazinamide was
prescribed as the indicative mode of treatment over a period of six (6) months since 1987.
Public-private mix DOTS (PPMD) was implemented in 2003 together with DOTS certification and
accreditation of health facilities. Guidelines for the diagnosis and treatment of children was
issued by DOH in 2004.8 Management of multi-drug resistant TB cases started in 1999 and was
mainstreamed into the NTP in 2008 through the integration of Programmatic Management of
Drug-resistant -TB (PMDT) into NTP.9 In 2011, the NTP introduced rapid TB diagnostic tools
such as Line Probe Assay (LPA), Mycobacterium Growth Indicator Tube (MGIT) and Xpert
MTB/RIF.

Current key initiatives to respond to the TB problem

The overarching strategy of the NTP is the DOTS or directly observed treatment short
course that was started in the country in 1996. It has five basic elements, (a) availability of
quality assured sputum microscopy, (b) uninterrupted supply of anti-TB drugs, (c) supervised
treatment, (d) patient and program monitoring, and (e) political will. This was expanded under
the WHO-endorsed STOP TB strategy that the country adopted from 2006 – 2010. In 2010, DOH
issued the 2010 – 2016 Philippine Plan of Action to Control TB (PhilPACT) as the roadmap for
controlling TB.

Key Initiatives of the NTP

1. Public-private mix DOTS (PPMD) – Engagement of the private sector such as private
practitioners, pharmacies, and hospitals to adopt the NTP policies and guidelines and, hence,
support the TB control efforts. PPMD staff were trained on TB-DOTS including the referral
system. They either manage TB cases or refer them to other DOTS facilities. Around 6% of total
TB cases nationwide were contributed by this initiative in 2008.

2. Enhanced hospital TB-DOTS – Strengthening of the internal and external referral systems and
quality of TB diagnosis and treatment in hospitals.10 Hospitals could either act as a referring
hospital or DOTS-providing hospital. All or most of the TB cases are referred to the DOTS
facilities and the outcomes are tracked. A pilot study from 2010-2012 showed that 73% of
around 13,000 TB cases were successfully referred to health centers and RHUs.

3. Programmatic Management of Drug-resistant TB (PMDT) – Provision of diagnostic and

treatment services to drug-resistant TB through the treatment centers, satellite treatment
centers and treatment sites. The NTP coordinates PMDT while the Lung Center of the
Philippines (LCP) is responsible for research and capability-building. In 2012, only 23% of
estimated MDR-TB cases had been provided with quality assured second line anti-TB drugs.
4. TB HIV collaborative activities – Close coordination between the NTP and National AIDS/ STI
Prevention and Control Program (NASPCP) to provide services to those patients with TB and HIV
co-infection. Key activities include provider-initiated HIV counselling and testing (PICT) for TB
patients and screening for TB among people living with HIV (PLHIV).

5. TB in jails/prisons - Ensuring access to TB diagnosis and treatment by the inmates of jails and
prisons. The Department of Justice (DOJ) through the Bureau of Corrections (BuCor) and the
Department of Interior and Local Governments (DILG) through the Bureau of Jail Management
and Penology (BJMP) coordinates with DOH in implementing this program.

6. TB-DOTS certification and accreditation – Ensuring the provision of quality TB services and
generating financial support through the PhilHealth TB-DOTS outpatient benefit package. DOTS
facilities are certified by DOH through the ROs based on ten DOTS standards. These facilities are
later accredited by PhilHealth. Reimbursements amounting to PHP 4, 000 per new TB patient
from PhilHealth could be used for the referring physician, purchase of other drugs, support for
EQA, monetary incentive to health workers and other activities that will improve program
implementation.

7. Expansion of TB laboratory services – Enabling better access to TB microscopy services

through the establishment of more TB microscopy centers such as those in the hospitals and in
the private sector. There are currently 18 culture centers. Plans are underway to expand this
number to 29 culture centers by 2016. There are currently three (3) DST centers, with plans
equally underway to expand to seven (7) by 2016. Sixteen health facilities were provided with
Xpert MTB/RIF – a new rapid diagnostic tool that detects rifampicin resistance in just two hours.
There are plans to expand access to Xpert MTB/ RIF through the provision of at least one (1)
machine per province or highly urbanized city.

8. Community TB care – Ensuring community participation to improve TB diagnosis and

management. TB task forces consisting of former TB patients, community volunteers and
members of faith-based organizations were organized to educate the community about TB,
refer presumptive TB to DOTS facilities, and act as treatment partners. This also includes the
formation and strengthening of TB patient support groups.

NATIONAL HIV/STI PREVENTION PROGRAM

Program Manager: Dr. Jose Gerard B. Belimac

Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC)

Program Medical Coordinator (Cebu): Dr. Van Philip A. Baton

Objective:
Reduce the transmission of HIV and STI among the Most At Risk Population and General
Population and mitigate its impact at the individual, family, and community level.

 Program Activities:

 With regard to the prevention and fight against stigma and discrimination, the following are
the strategies and interventions:

1. Availability of free voluntary HIV Counseling and Testing Service;

2. 100% Condom Use Program (CUP) especially for entertainment establishments;

3.  Peer education and outreach;

4.  Multi-sectoral coordination through Philippine National AIDS Council (PNAC);

5.  Empowerment of communities;

6. Community assemblies and for a to reduce stigma;

7.  Augmentation of resources of social Hygiene Clinics; and

8. Procured male condoms distributed as education materials during outreach.

Program Accomplishments:

As of the first quarter of 2011, the program has attained particular targets for the three major
final outputs: health policy and program development; capability building of local government
units (LGUs) and other stakeholders; and leveraging services for priority health programs.

For the health policy and program development, the Manual of Procedures/ Standards/
Guidelines is already finalized and disseminated. The ARV Resistance surveillance among People
Living with HIV (PLHIV) on Treatment is being implemented through the Research Institute for
Tropical Medicine (RITM). Moreover, both the Strategic Plan 2012-2016 for Prevention of
Mother to Child Transmission and the Strategic Plan 2012-2016 for Most at Risk Young People
and HIV Prevention and Treatment are being drafted.

With regard to capability building, the Training Curriculum for HIV Counseling and Testing is
already revised. Twenty five priority LGUs provided support in strengthening Local AIDS
councils. as of March 2011, there were already 17 Treatment Hubs nationwide.
Lastly, for the leveraging services, baseline laboratory testing is being provided while male
condoms are being distributed through social Hygiene Clinics. A total of 1,250 PLHIV were
provided with treatment and 4,000 STI were treated

SCHISTOSOMIASIS CONTROL PROGRAM

Program Manager:
             Ms. Ruth M. Martinez
             Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC)

Program Medical Coordinator (Cebu): Dr. Al Patrick C. Alajas

 Goal: To reduce the disease prevalence by 50% with a vision of eliminating the disease
eventually in all endemic areas

                   Schistosomiasis is an infection caused by blood fluke, specifically Schistosoma

japonicum. An individual may acquire the infection from fresh water contaminated with larval
cercariae, which develop in snails. Infected yet untreated individuals could transmit the disease
through discharging schistosome eggs in feces into bodies of water.

                    Long term infections can result to severe development of lesions, which can lead to
blockage of blood flow. The infection can also cause portal hypertension, which can make
collateral circulation, hence, redirecting the eggs to other parts of the body.

                   Schistosomiasis is still endemic in 12 regions with 28 provinces, 190 municipalities,

and 2,230 barangays. Approximately 12 million people are affected and about 2.5 million are
directly exposed

Objectives:

The Schistosomiasis control Program has the following objectives:

1.       Reduce the Prevalence Rate by 50% in endemic provinces; and

2.       Increase the coverage of mass treatment of population in endemic provinces.

 
Program Strategies:

The Schistosomiasis Control Program employs the following key interventions:

1.       Morbidity control: Mass Treatment

2.       Infection control: Active Surveillance

3.       Surveillance of School Children

4.       Transmission Control

5.       Advocacy and Promotion

Its enabling activities include; linkaging and networking; policy guidelines and CPGs;
institutional capacity building; competency enhancement of frontline service provider; and
monitoring and supervision.

 National Integrated Helminth Control Program

Program Managers: Dr. Yvonne CF Lumampao
Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC)

Program Medical Coordinator (Cebu): Dr. Al Patrick C. Alajas

Given the relatively high prevalence rate of STH infections in the country and the existing issues
confronting the implementation of the STHCP nationwide, there is a need to integrate all
related efforts and strengthen coordination of those involved to ensure better
complementation of resource, obtain higher coverage and generate better health outcomes.
Within the Department of Health (DOH), several programs exist which are viable mechanisms
to operationalize an integrated approach in preventing and controlling STH infections more
effectively and efficiently. This needs to expand to the other national and local agencies and
organizations engaged in the same endeavor.

The IHCP envisions healthy and productive Filipinos. It aims to reduce the deaths and diseases
due to STH infections by reducing the prevalence of the infection among population groups
found most at risk. Helminth infections adversely affect the health of the children and women.
Program interventions and related measures have to be focused on them. Children are
classified into preschoolers and school children while women include adolescent females and
pregnant women. In addition, there are also special groups, which by the nature of their work
and situation, are gravely exposed to helminthes infection.  These include the soldiers, farmers,
food handlers and operators as well as indigenous people.  They also require the necessary
attention.

The IHCP interventions consist primarily of chemotherapy, WASH and several behavior
changing approaches. Chemotherapy remains as the core package in helminth infection control.
The IHCP identifies the corresponding approach of deworming that must be applied for each
identified population group. Water, sanitation and hygiene (WASH) serves as the cornerstone in
reducing the prevalence of worm infection. The expansion of these measures reduces more
effectively the transmission of worm infection. The promotion of desired behaviors ensures
that these efforts on chemotheraphy and WASH are translated into actual healthy practices and
better utilization of these facilities.

These interventions only become viable and effective if they are carried out in a supportive
environment. Enabling mechanisms must therefore be established to support their
implementation. An enabling environment entails good governance of the IHCP at all levels of
operations. The political will and support of national and local leaders are essential to propel
the cause of the IHCP.  Quality of deworming services and expansion of service outlet to
increase access must be given due to consideration. Financing reforms must likewise introduce.
The LGUs must begin to allocate budget for their own deworming program. A more equitable or
rationalized allocation of deworming assistance from the DOH must be established. Local
financing mechanisms to sustain the delivery of STHCP services need to be explored and
established. Strict monitoring of LGUs compliance to national laws and policies must be
undertaken while several program support systems (e.g., procurement and logistics
management, information management system, surveillance and research) have to be installed.

Central to the achievement of the IHCP vision is the commitment and participation of all sectors
concerned considering that helminth infection is a multi-faceted problem. While the LGUs are
expected to be primarily responsible for the controlling helminth infection, the support of DOH,
DepEd and other national government agencies including the private sector, civil society and
the community is very critical to the success of IHCP.

Vision:                  Healthy and Productive Filipinos in the 21st Century

Mission:              To reduce the morbidity and mortality due to STH infections.

Goals/Objectives

The program aims to reduce the prevalence of STH infection to below 50.0% among the 1-12
years old children by 2010 and lower STH infection among adolescent females, pregnant
women and other special population group.
 

Stakeholders/Beneficiaries:

The DOH is the lead agency in the deworming of children while the Department of Education
(DepEd) is in charge of deworming all children aged 6-12 years old enrolled in public schools
(Grade 1-VI).  Deworming is done by teachers under the supervision of school nurses or any
health personnel.

Program Strategies:

1.        Improve governance through:

a.       Policies/resolutions;

b.      Securing budget for STH prevention and control;

c.       Mobilization and coordination of sectoral support; and

2.       Improve service quality and scale-up coverage.

a.       Capacity building

1.       Areas for training

·         Epidemiology, life cycle etc.

·         Proficiency training on lab diagnosis for med techs/lab techs

·         Annual/biannual updates on current technology in lab diagnosis

·         Training on drug administration, side effects, etc

2.       Target participants

3.       Training mechanisms

b.      Development and issuance of protocols and guidelines

c.       Expansion of service delivery points

d.      Availability and affordability of deworming drugs

3.       Institute financing reforms

a.       Efficiency in program implementation

 b.      Mobilization of resources

c.       Strengthening LGU financing schemes

4.       Strengthen regulations

5.       Installation of management support systems

a.       Drug procurement

b.      Research

c.       Surveillance