National TB Control Program

A Tuberculosis-free Philippines

Zero deaths, disease, and suffering due to tuberculosis

Long Term Goal (2035):

Reduce TB burden by decreasing TB mortality by 95% and TB incidence by 90%.

Medium Term Goals (2022):

Reduce TB burden by:
- Decreasing the number of TB deaths by 50% from 22,000 to 11,000
- Decreasing TB incidence rate by 15% from 554/100,000 to 470/100,000
Reduce catastrophic costs incurred by TB-affected households from 35% to 0%.
At least 90% of patients are satisfied with the services of the DOTS facilities.

Specific objectives by 2022

Improve the utilization of TB care and prevention services by patients and communities.
Reduce catastrophic cost of TB-affected households accessing DOTS facilities to 0%.
Ensure adequate and competent human resources for TB elimination efforts.
Improve the use of TB data for effective TB elimination efforts.
Enhance quality of all TB care and prevention services.
Increase to at least 90% of DOTS facilities that are providing expanded integrated patient centered TB care and prevention services.
Enhance the political stewardship through high-level political commitment of national government agencies and LGUs to implement localized TB elimination plan in coordination with different sectors.

About NTP

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 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 programs TB diagnostic and treatment protocols and strategies, issued through the Manual of Procedures, are in accordance with the policies of World Health Organization (WHO) and the International Standards for TB Care (ISTC). Its last strategic plan was the 2010-16 Philippine Plan of Action to Control TB or PhilPACT.

    The NTP closely works with various offices of the DOH, such as the National Center for Health Promotion (NCHP) for advocacy, communication, and social mobilization; the Epidemiology Bureau (EB), and the Knowledge and Management Information and Technology Services (KMITS) for data management; Health Policy Development and Planning Bureau (HPDPB) for policy and strategic plan formulation; Material Management Division (MMD), Central Office Bids and Awards Committee (COBAC) and Food and Drug Administration (FDA) for drug and supplies management; the National TB Reference Laboratory of the Research Institute for Tropical Medicine (NTRL-RITM) for laboratory network management; Lung Center of the Philippines (LCP) for PMDT-related researches and training activities and the 17 regional offices (ROs) for technical support to the provincial health offices (PHO) and implementing units; and the Philippine Health Insurance Corporation(PhilHealth) for the TB-DOTS accreditation and utilization of the TB-DOTS outpatient benefit package.

    The 17 ROs through its regional NTP teams manages TB at the regional level while the PHOs and city health offices (CHOs), through its provincial/city teams are responsible for the TB control efforts in the provinces and cities. TB diagnostic and treatment services are part of the basic integrated health services which are provided by DOTS (Directly Observed Treatment, Short Course, current means of delivery of treatment Services) facilities which could either be the public health facilities, such as the RHUs, health centers, hospitals; other public health facilities, such as school clinics, military hospitals, prison/jail clinics; NTP-engaged private facilities, such as the private clinics, private hospitals, private laboratories, drugstores and others. Community groups, such as the community health teams and barangay health workers participate in community-level activities.

    NTP closely works with the 17 government offices and 5 private organizations in compliance with the Comprehensive and Unified Policy (CUP) issued by the Office of the President in 2003. Under the framework of public-private mix (PPM) collaboration in TB-DOTS, NTP collaborates with non-governmental organizations, such as the Philippine Coalition Against TB (PhilCAT), a consortium of 60 groups, and the 100-year old Philippine TB Society, Inc. (PTSI) and many others. Various developmental partners and their projects provide technical and financial support to NTP, such as the World Health Organization (WHO), United States Agency for International Development (USAID), Global Fund Against AIDS, TB and Malaria (Global Fund), Research Institute of TB/Japan Anti-TB Association (RIT/JATA), Korean Foundation for International Health (KOFIH) and Korean International Cooperation Agency (KOICA) and KNCV Tuberculosis Foundation.

Program Accomplishments

    Tables below show the status of the various targets (impact, outcome, outputs and performance targets) set to be accomplished in 2016 through 2010-s2016 PhilPACT implementation.

    In support of the Millennium Development Goals (MDGs), three (3) impact targets were adopted by the Stop TB Strategy to monitor the progress of implementation. Philippines as one of the Member States of the United Nations adopted also the said impact indicators in PhilPACT. These targets are decreasing the trend of the TB incidence rate and reducing by half the TB mortality and prevalence rates against the 1990 baseline data.

    By the end of 2015, based on the 2016 Global TB report of the WHO, Philippines is one of the nine high TB burden countries that have reached the millennium development goals or MDGs. This is based on the WHO estimate prior to the 2016 NTPS. Table 1 shows the accomplishment of the Philippines in addressing the problem of tuberculosis.

Table 1. Status of the impact targets

Indicators	Target	2015 accomplishment	Status
Incidence Rate	Less than the baseline	322/100,000	Achieved
Mortality Rate	23/100,000	13/100,000	Achieved
Prevalence Rate	414/100,000	<414/100,000	Achieved
Source: WHO Global TB Report, 2016 (prior to 2016 NTPS)

For the outcome targets, the case detection rate and treatment success rate for drug susceptible TB were achieved by the end of 2016. However, the targets for case detection rate and treatment success rate for drug resistant TB cases were not achieved. Table 2 shows the accomplishment for the outcome targets.

Table 2. Status of the outcome targets

Indicators	Target	2016 accomplishment	Status
Case Detection Rate, Drug Susceptible (All forms)	90%	92%	Achieved
Treatment Success Rate, Drug Susceptible (All Forms)	90%	92%	Achieved
Case Detection Rate,Drug Resistant TB	62%	32%	Not Achieved
Treatment Success Rate, Drug Resistant TB	75%	49%(2012 cohort)	Not Achieved
Source: Data submitted by the regional TB coordinators as of February 2017

Of the five (5) output targets, only two (40%) were achieved. These are the number of TB patients provided with treatment and number of TB patients counseled and tested on HIV. See Table 3 for the status of the said indicators.

Table 3. Outcome Indicators

Indicators	Target	Accomplishment	Status
No. of TB symptomatics provided with DSSM	5.5 million	4,717,535	Not achieved;Patients who underwent examination using Xpert MTB/Rif as a primary diagnostic tool is not accounted for.
No. of TB patients provided with treatment	1.5 million	1,701,059	Achieved
No. of children provided with treatment or preventive therapy	730,000	181,728	Not achieved; There were inadequate stocks of drugs for children due to quality issues of the procured drugs and low uptake of IPT.
No. of MDR-TB detected and provided with second line anti-TB drugs	19,500	18,886	Not achieved due to lack of access to diagnostic and treatment facilities for drug resistant TB cases.
No. of TB patients provided with PICT on HIV/AIDS	45,000	57,590	Achieved