2017 – 2022 Philippine Strategic TB

Elimination Plan: Phase 1 (PhilSTEP1)

24th PhilCAT Convention

August 16, 2017

Dr. Anna Marie Celina Garfin

NTP-DCPB, Department of Health
 Reasons for developing the NTP strategic plan

TB is still a major
2010 – 2016
health problem WHO End TB
PhilPACT already
based on the 2016 Strategy (2035)
completed
NTPS

DOH: Philippine
TB law – RA 10767
Health Agenda
 Key Programmatic Gaps based on the Joint Program
Review and stakeholders consultation
1. Missing TB cases due to;
• Poor health seeking behavior of patients / communities
• Inadequate access by patients to sensitive TB diagnostic services arising from geographical,
financial and information barriers
• Unreported cases who consult health facilities and health care providers outside the NTP
network
2. Inadequate implementation of TB services for latent TB infected patients,
drug resistant TB cases, TB/HIV and those who are high risk for TB
3. Limited reach of the poor and other vulnerable groups
4. Lack of human resources who have varying capabilities and commitment
5. Weak health systems support especially the supply chain management, TB
surveillance and data generation
6. Varying performance and support to local TB program by the local
government units
 Processes in the formulation of PhilSTEP1

Steering Task Force Conducted Revised

Joint Committee held series 5 plan and
Program and Task of consultative presented
Review Force on meetings workshops to Steering
(JPR) NSP and committee
drafted the nationwide
conducted organized
plan

Mar 2016 Jun 2016

Jul to Aug Aug to Oct Dec 2016
2016 2016 & Jan 2017
 Logical Framework of the 2017 – 2022 PhilSTEP1
Vision TB-free Philippines

Impact Reduced TB burden – TB Zero catastrophic cost Responsive delivery of TB

mortality and TB incidence services

Increased case High treatment High LTBI Reduced out-of-pocket

Outcomes
notification success rate coverage expenses

Outputs 30 Performance Targets

Strategies 7 ACHIEVE strategies

 Principles

Government stewardship and accountability,

with monitoring and evaluation

Engagement of the private sector, civil society

organizations and communities

Protection and promotion of human rights,

ethics and equity

Adaptation of the strategies and targets at the

local levels
 Impact Targets for 2022

•Reduce number of TB deaths by 50% from 14,000 to 7,000

deaths
•Reduce TB incidence rate
•Reduce to 0 the number of TB affected households that
experience catastrophic costs due to TB
•At least 90% of patients are satisfied with the services of
the DOTS facilities
 Outcome Targets for 2022

Indicators Baseline 2015 Target in 2022

• Case notification rate per 100,000 297 525
• TB treatment success rate
Susceptible 92%* >92 %
MDR 49% 85%
• Case Fatality Ratio 4% < 4%
• LTBI treatment coverage among HH child Children: 14% 90%
contacts aged less than 5 yo and HIV PLHIV: 43% 90%

* based on underestimated TB incidence rate and over-diagnosed TB cases

1. Activate TB patient support groups and communities to
access quality TB services
Performance targets Key activities
15% of total TB notifications o Mobilize NGOs and CSOs to organize
came from community referrals communities
o Implement Integrated Marketing
50% reduction of non-action Communications
takers among the presumptive TB

Patient's agenda incorporated o Support the organization and activities of

into NTP plan and policies patient groups
o Promote patient's rights and active participation
in program management
 2. Collaborate with other government agencies and partners to
reduce out of pocket expenses of TB patients and expand social
protection measures
Performance targets Key activities
25% average annual o Obtain from DOH an increase in funding for TB, particularly
increase of DOH budget for for drug resistant and complicated TB cases.
TB elimination o Mobilize other sources of funds and financing schemes for
patients and health facilities

70% of TB patients are o Revise the design of the TB DOTS benefit package
supported by PhilHealth o Implement a communication strategy to make members
Outpatient Benefit package aware of their benefits.
o Provide incentives to staff of TB DOTS facilities to obtain
accreditation and avail of the PhilHealth TB DOTS benefit
package
 2. Collaborate with other government agencies and partners to
reduce out of pocket expenses of TB patients and expand social
protection measures
Performance targets Key activities
80% of NHTS members o Link 4Ps TB patients to poverty reduction initiatives
with TB are availing of o Strengthen communication strategies and lobby for
social protection additional health benefits from social protection
programs programs
o Regularly measure catastrophic costs
 3. Harmonize national and local efforts to mobilize
adequate and capable human resources for TB elimination
Performance targets Key activities
20% increase in the LGU hired o Conduct HHR inventory study for the NTP
health care o Conduct policy scan for HHR development &
providers management
o Advocate for policy reform to National agencies DOH,
DBM, and DILG
DOH deployed human o Conduct stakeholders consultation and coordinate with
resources are involved in TB HHRDB
elimination efforts o Issue guidelines
o Train deployed personnel
 3. Harmonize national and local efforts to mobilize
adequate and capable human resources for TB elimination
Performance targets Key activities
o Conduct competency-based mapping and analysis
90% of HR are conducting o Develop Comprehensive Capacity Building Packages
tasks according to NTP o Facilitate PRC certification
protocol o Conduct of Trainings
o Implement performance assessment tool
o Develop alternative teaching/learning platforms for all
NTP HCWs
o Integrate NTP modules in the school curricula
 4. Innovate TB surveillance, research and data generation
for decision-making
Performance targets Key activities

90% of health care o Fully implement the integrated TB information system (iTIS)
providers are notifying o Link iTIS to other information systems and new technologies
TB cases (e-learning, mHealth, automated work management)
o Do other iTIS enhancements (data analysis tools, new
technologies)
o Implement mandatory TB notification as per TB Law IRR
4. Innovate TB surveillance, research and data generation for
decision-making
Performance targets Key activities
Accurate TB information o Regularly update NTP recording and reporting system to
are generated on time comply with DOH and WHO standards
o Conduct data and system quality check activities
WHO standards for TB o Conduct research according to the updated Research Agenda
surveillance and vital o Conduct regular monitoring of all health facilities and lower
registrations systems met organizational levels

100% of program o Implement capacity building on data management and

managers use utilization for all program managers
information for evidence- o Conduct annual TB Performance Assessment and Improvement
based decision making Planning activity
o Publish and disseminate annual National and Regional TB
reports
5. Enforce NTP TB care and prevention standards and use of
quality TB products and services
Performance targets Key activities
95% of DOTS facilities are certified to o Update the NTP Manual of Procedures and train
be complying with the revised NTP health care providers
standards o Implement the revised DOTS certification system
Proportion of staff of DOTS / o Strengthen the infection control measures in the
laboratory facilities lower than the TB DOTS facilities and laboratories
incidence
95% of TB labs are under a well- o Implement quality assurance system for TB
functioning quality assurance system laboratory services at all levels (QA system,
maintenance, biosafety)
All TB culture and DST laboratories o Improve capacity of QA centers
meet biosafety standards
 5. Enforce NTP TB care and prevention standards and use
of quality TB products and services
Performance targets Key activities

No stock-outs of quality o Select only anti-TB medicines that are FDA registered and
and economical included in the Philippine National Drug formulary and
laboratory supplies and laboratory supplies approved by NTRL
TB pharmaceutical o Systematize the procurement of anti-TB medicines and
products in all service laboratory supplies
delivery points o Implement a systematic distribution mechanism
o Enhance quality management system for anti TB medicines
and NTP supplies
o Enhance safety monitoring system of anti TB medicines and
NTP products through pharmacovigilance
 6. Value clients and patients through provision of
integrated patient-centered services
Performance targets Key activities
100% new and relapse TB o Expand and sustain TB laboratories operations
patients tested using WRD as o Support patients to undergo Xray examination
a primary diagnostic tool o Conduct systematic screening for TB among the high risk
100% DST coverage groups
95% of detected DRTB o Build capacity of DOTS facilities to provide services to both
patients are enrolled DS and DRTB patients
o Implement shortened treatment regimen for DRTB patients
Less than 10% of DRTB are and use new anti-TB medicines
lost-to-follow up (interim) o Build capacity of DOTS facilities for prompt treatment and
adherence to treatment of DRTB patients
 6. Value clients and patients through provision of
integrated patient-centered services
Performance targets Key activities
90% of TB patients are with o Provide services beyond Category A and B areas
documented HIV status o Ensure TB-HIV co-infected patients are treated

90% of DOTS facilities are o Develop models for TB services with focus on gender,
adapting integrated patient- human rights and patient centeredness
centered approach o Support DOTS facilities to provide TB services that are
patient-centered, gender sensitive and human rights
promoting
o
 6. Value clients and patients through provision of
integrated patient-centered services
Performance Target Key activities
30% of notified TB cases o Develop national action plan on PPM
came from the private o Conduct inventory and mapping
sector
o Advocate participation of private health care
providers
o Orient / train
o Provide incentives and enablers
o Implement innovative payment mechanisms
 6. Value clients and patients through provision of
integrated patient-centered services
Performance targets Key activities
80% of provinces/HUCs are o Integrate TB (both DS and DR) with other health
with functional DOTS network programs such as MNCHN, NCD, other infectious disease
providing expanded and program, drug rehab, nutrition
integrated TB care and o Treat Latent TB infection among priority groups
prevention services o Build capacity of DOTS facilities to improve adherence of
DSTB patients to treatment
o Establish, support and sustain provincial/city DOTS
network
 7. Engage national government agencies, legislative branch
and local government units on multi-sectoral
implementation of localized TB elimination plan
Performance targets Key activities
All regions, provinces, HUCs, o Formulate and implement policy and guidelines for the
and municipalities have development and implementation of local strategic &
clear and costed localized TB operational TB elimination plan including “TB elimination
elimination plans packages”
o Support LCEs to lead in mobilizing support in the adoption
of TB elimination package and in the development and
implementation of the local TB elimination plans
 7. Engage national government agencies, legislative branch
and local government units on multi-sectoral
implementation of localized TB elimination plan
Performance targets Key activities
National, all regions, o Develop policy and implementing guidelines on multi-
provinces, cities and sectoral coordinating committees for the implementation
municipalities have active of TB elimination plans in accordance with the IRR of RA
multi-sectoral committees 10767
supporting TB elimination o Build the capability of the multi-sectoral coordinating
efforts committees in TB elimination efforts
o Develop and implement an annual implementation plan
aligned with PhilSTEP1
 TB elimination package for provinces and cities:
REACHING TB cases

1 Replaced sputum microscopy with Xpert

2 Engaged private providers
3 Accessible patient centered health facilities providing quality services
4 Community health seeking behavior positively changed
5 High Risk Group screened with X-ray examination
6 Intensive supervision and monitoring based on ITIS data
7 Networked with other government agencies working on social
determinants
8 Governed and funded by LGUs
Thank you!