The Philippines Health Care Delivery System

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     The Philippines, an archipelago with 7,100 islands, has a population of around 97 million in 2012 with a population growth rate of 1.9%. Geographically, it is divided into three main islands, namely Luzon, Visayas and Mindanao. There are 17 regions, including the Autonomous Region of Muslim Mindanao (ARMM), 82 provinces, 135 cities, and 1,493 municipalities. Functional literacy rate is high at 86%. In 2011, the country was categorized as a low-to middle-income country with gross national income per capita of $4,160.

    The decentralized health care system is managed, coordinated and regulated by the Department of Health (DOH) that is composed of the Central Office, 17 Regional Offices (ROs) and retained hospitals. Integrated basic health services, including TB diagnostic and treatment services, are provided by 2,314 rural health units (RHUs)/health centers (HCs) and 16,219 barangay health stations (BHS) that are under the local municipal/city government units. Majority of the RHUs/HCs have a TB microscopy laboratory that provides Direct Sputum Smear Microscopy (DSSM). The locally-managed provincial health office (PHO)/city health office (CHO) provides technical oversight over these peripheral health units. Communities support these health units through the community health teams (CHTs) that include barangay health workers (BHWs).

     The private sector is also engaged in the production and provision of health goods and services through private clinics, hospitals and laboratories, drugstores, and other facilities. The DOH encourages public-private sector collaboration in health.

     DOH priorities and strategies are contained in its health agenda called Universal Health Care (UHC) or Kalusugang Pangkalahatan (KP) that aims to ensure financial risk protection for the poor, provide access to quality health services, and attain health-related Millennium Development Goals (MDGs). Specific health targets including that for TB control are contained in the National Objectives for Health.

Magnitude of Tuberculosis in the Philippines

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      Tuberculosis or TB is an infectious disease caused by the bacteria called Mycobacterium tuberculosis. It is transmitted from a TB patient to another person through coughing, sneezing and spitting. Thus, close contacts, especially household members, could be infected with TB. Lungs are commonly affected but it could also affect other organs such as the kidney, bones, liver, and others. TB is curable and preventable. However, incomplete or irregular treatment may lead to drug-resistant TB or even death.

      Tuberculosis is a major public health problem in the Philippines. In 2010, TB was the 6th leading cause of mortality with a rate of 26.3 deaths for every 100,000 population and accounts for 5.1% of total deaths. This is slightly lower than the five-year average of 28.6 deaths per 100,000 population. More males died (17,103) compared to females (7,611).

       The country had conducted three National TB Prevalence Survey (NTPS) that describe the magnitude and the trend of the TB problem. The results were as follows:

National TB Prevalence Surveys 1983-2007

Indicators	NTPS 1983	NTPS 1997	NTPS 2007
Prevalence of culture-positive TB	6.6/1,000	3.1/1,000	2.0/1,000
Prevalence of sputum smear-positive TB	4.2%	4.2%	6.3%
Prevalence of those with CXR findings suggestive of TB	2.5%	2.3%	2.1%
Rate of TB symptomatic	17.0%	18.4%	13.5%
Prevalence of those with CXR findings suggestive of TB	8.6/1,000	3.1/1,000	4.7/1,000

      TB is more prevalent among males compared to females and among the 25–55 year old age group. It is also higher among the malnourished and diabetics. The 1997 survey showed that prevalence of TB among the urban poor in Metro Manila is twice that of the general population.

     The first national Drug Resistance Survey was done in 2003–2004 and revealed the following prevalence of drug resistance: 4% among the new cases, 21% among the re-treatment cases, and 5.7% combined. The second National Drug Resistance Survey was done in 2011–2012 and showed a decrease in the prevalence of drug resistance among new cases from 4% to 2%. However, there was no change in the prevalence of drug resistance re-treatment cases which remained at 21%.