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Mobilizing TB prevention initiatives through CorCat
by Charis Taguibos

Tuberculosis continues to be one of the most dreaded but easily treatable infectious diseases. It is one of the oldest diseases that plagues the world and causes death, mostly in developing countries.

In the Philippines, there are 265 estimated TB cases out of every 100,000 people, according to the 2013 report of the World Health Organization. An infected person can transmit the bacteria to 10 to 15 individuals in a year.

After the Millennium Summit of the United Nations in 2000, the then 189 member-States established what is dubbed as the Millennium Development Goals (MDGs). These are eight international development goals that are geared towards alleviating various conditions ranging from combating hunger and poverty to impro-ving health and education. There are economic and health indicators set for each goal to be achieved by 2015. TB is one of the major diseases included in Goal 6.

Specifically, MDG target 6.C states that by 2015, TB has been halted and its incidence have been reversed. Prevalence and death rates should also be halved compared to 1990 baseline data. Other indicators are the proportion of TB cases detected and cured under the Directly-Observed Treatment Short Course (DOTS) strategy.

As of the latest WHO report, the Philippines is one of seven countries that has already achieved the goal in 2011. This is a mean feat.

However, there is still work to be done because according to the same report, we have yet to find 35,000 missing cases nationwide.

Even before the MDGs, the journey was steady but slow. Several concerted efforts from the government, partner agencies, non-government organizations, and private institutions were put into motion to mobilize TB control. The earliest recorded organized TB initiative is by the Philippine TB Society, Inc. (PTSI) in 1910. They established the Santol Sanatorium in Quezon City currently known as the Quezon Institute. Back in those days, it was believed that bed rest, isolation, and hospitalization will cure TB. Thus, the Society put up 14 nipa huts for TB patients.

In 1934, then president Manuel Quezon signed Republic Act 4130 to form the Philippine Charity Sweepstakes Office to funnel funds to the PTSI. Cognizant of the need for TB care, Quezon Institute was built, a tertiary hospital catering to more patients.

Immense steps were taken worldwide from 1950s onwards. Bacillus Calmette-Guerin or BCG vaccination was introduced as a preventive measure in the country. It was also about this time when the triple therapy was initiated. Various organizational changes and the subsequent passing of the TB Law were also implemented leading to expanded services and strengthening of the National Tuberculosis Control Program (NTP) of the Department of Health. In the late 1960s to mid-70s, the involvement of the Rural Health Units greatly accelerated the response to TB control especially when health services were devolved in the early 1990s.

In 1994, the Philippine Coalition Against TB (PhilCAT) came into life to function as the coordinating body for the various partners in TB control. Significant improvement has been reached especially with the introduction of the DOTS strategy in 1996.

With the advent of DOTS, the national campaign to raise awareness about TB and the clamor for support for its prevention and control was intensified. The NTP eventually became one of the flagship programs and was pronounced as the highest priority program of local government units. Several milestones were reached in the ensuing years. This included the adoption of guidelines based on the WHO, establishment of Quality Assurance under the National TB Reference Laboratory, Comprehensive Unified Policy among 17 national agencies, the Public-Private Mix DOTS (PPMD), and other schemes to reinforce the NTP.

The DOH regional office also collaborated with private organizations to strengthen TB control in the Cordillera. In 2004, the local representative of PhilCAT was formed through the Infectious Disease Surveillance and Control Project of the US Agency for International Development.

This gave birth to the Cordillera Coalition Against TB (CorCaT) consisting of private practitioners, civic individuals, and champions in government who are one in their advocacy to fight the dreaded disease. A regional coordinating committee was also formed as the overall coordinating body for the region’s TB efforts.

The PPMD units were also established spearheaded by the PhilCAT. This involves public and private facilities to broaden the scope of coverage. According to the National TB Prevalence Survey of 2007, the health-seeking behavior of TB patients vary. This is why all sectors of the health spectrum should be involved. Looking at graph 1, it can be observed that the biggest chunk seek medical attention from public health providers. However, the private sector also services a substantial portion of the pie. Wider coverage means a bigger audience to capture. This is also the reason why the program saw it fit to also penetrate TV airtime with its banner “TB ay tuldukan!”

Graph 1

Source: 2007 National TB Prevalence Survey (TDFI)

As the DOH central office polishes its efforts to fortify the program, the Cordillera also aligned its goals according to national policies. Guidelines downloaded was implemented and spread to the grassroots level.

Empowerment of the LGUs is important since they are the main implementers of the program. Various advocacies, orientations, and trainings were conducted to ensure infiltration of the NTP to public and the health service providers. Part of these activities is documentation. Recording and reporting of data is a must to guarantee that cases are appropriately accounted for in the statistics.

The numbers are crucial to monitor the progress of the disease in the area. To illustrate the accomplishment of the Philippines, graph 2 shows the prevalence and mortality rate of TB for every 100,000 population. Prevalence is defined as the number of TB cases at a given point in time. The 1990 baseline data for prevalence rate is at 1,003/100,000. It continuously decreased to 484 and 461 for 2011 and 2012, respectively. On the other hand, the number of deaths due to TB also shows significant improvement. From the 1990 data of 47/100,000, it was reduced to 29 in 2011 and to 24 in 2012. The graph shows that the two MDG indicators have been halved.

Graph 2

Prevalence and Mortality Rates from Tuberculosis,

Philippines 1990 - 2015

(per 100,000 population)\s

Source: WHO Global TB Control

Incidence rate is another indicator. This is the number of new and relapse TB cases arising in a given time period, usually one year. Graph 3 indicates that the incidence is falling. From the 1990 data of 393, it plummeted to 270 in 2011 and further dropped to 265 in 2012.

Graph 3

Incidence of Tuberculosis, Philippines (per 100,000 population per year)

Source: WHO Global TB Report 2013

All of the above indicators are estimated TB disease burdens. Prevalence and mortality rates are based on national prevalence surveys conducted at the national level. According to the WHO, TB incidence has never been measured at the national level because this would require long-term studies among a large group of people at high cost and with challenging logistics. Proxy indicators are used to come up with incidence.

Another indicator is Case Detection Rate, which in the Cordillera is steadily increasing, as shown in graph 4.

Although the cumulative data for the region did not reach the national target of 70 percent (now 90 percent), the number of patients being tested in RHU laboratories indicates that many are being screened. There may be factors affecting this such as geographical location, health-seeking behavior, and case finding. Treatment facilities generally employ passive case finding, which means patients present themselves at the health facilities. This is a good reason for us to be more proactive in taking care of our health while services are readily available.

Graph 4

Case Detection Rate, CAR

2010 – 2013

The good news for CAR is its treatment success rate. This simply signifies that among patients who are enrolled, outcomes are successful, meaning they have been cured or they have completed their whole treatment regimen. Data in graph 5 displays performance among the provinces. Cordillera has surpassed the target of 90 percent. This is an important indicator as it suggests these enrolled patients will no longer transmit the bacteria.

Preventing transmission is vital since 75 Filipinos die of TB daily. Fortunately, in CAR, the disease is not among the top 10 causes of morbidity and mortality.

Graph 5

Treatment Success Rate, CAR

2007 – 2011

As we continue to strive to sustain all these struggles to combat TB, we should not forget that prevention is still better than cure. With the rising number of drug-resistant TB, a more aggressive kind of TB, we are all encouraged to visit the nearest health center or RHU when experiencing cough for two weeks or more. Diagnostic tests and medicines are free. This can be attributed to the global financing and partnership resources that are now available for poverty reduction, health systems improvement, and disease control that strengthen and offer new opportunities for TB control programs. People are strongly enjoined to avail themselves of these health services as TB is easily curable with the right diagnosis and treatment.

Under the tutelage of Director Valeriano Lopez, the regional office of the DOH will carry on with its quest to deliver quality health services.

As what the WHO said, political commitment is also required to support the overall structural and financial changes needed to improve the availability, distribution, and motivation of competent health workers. That is why even after the attainment of the MDGs for TB, our work is not done. We will tread on and proceed with the knowledge that so long as we toil hard, we will eventually eradicate the existence of the disease.

As Thomas Jefferson once said, “Nothing can stop the man with the right mental attitude from achieving his goal. Nothing on Earth can help the man with the wrong mental attitude.”
Other news
:: CAR’s toilet and water woes, issues on hygiene addressed
:: The electric dream goes on for Cordillera’s remote sitios
:: Rising above poverty –– still an MDG challenge in CAR
:: Bridging traditional and modern maternal care
:: CAR needs to double efforts in gender equality
:: Perspective on Cordillera’s progress along the MDGs
:: Aiming for a responsible and AIDS–free generation
:: Increasing forest covers and wildlife conservation glitches
:: The rewards, challenges of bringing children to school
:: The Millenium Dev’t Goals: Towards a better future
:: CAR’s own ‘branchifying’ festival–versions
:: Convergence efforts key to sustain gains beyond 2015

Informatics Institute
InterContinental Hotels Group
Medline International Training Institute Baguio
National Economic and Development Authority
SiTEL

Baguio Central University
Congressman Ronald M. Cosalan
Department of Agriculture – CAR
Department of Education – CAR
Department of Health – CAR
Mayor Mauricio G. Domogan
MMS Development Training Center Corporation
Municipality of La Trinidad
National Grid Corporation of the Philippines
Philex Mining Corporation
Pines City Colleges
SiTEL
Sutherland
University of the Philippines

Ahead Tutorial and Review
Baguio Memorial Chapels Inc.
BCSAT
Benguet Electric Cooperative Inc.
Benguet State University
BSBT College Inc.
Bureau of Fisheries and Aquatic Resources – CAR
Commission on Higher Education – CAR
Congressman Nicasio M. Aliping Jr.
Cordillera School of Digital Arts
Department of Environment and Natural Resources – CAR
Department of Trade and Industry – CAR
Dreamforce Review and Training Center
Fabulo Beauty and Image Salon
Far East Pacific Commercial
Filipino–Japanese Foundation of Northern Luzon, Inc.
Ganza and Solibao Restaurants
Governor Nestor B. Fongwan
John Hay Management Corporation
La Funeraria Paz, Inc.
Maybank
Mother Earth Deli Basket
Nagomi Spa
NARDA’S / WINACA Eco Cultural Village
NIIT Baguio
Our Lady of Mt. Carmel Montessori
Pag–IBIG / HDMF
Philippine Information Agency – CAR
Philippine National Police – Police Regional Office – COR
Sangguniang Panlalawigan of Benguet
STI College Baguio
The Manor

 



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