Progress in the Control of Tuberculosis: How Much Has Been Attained in the Philippines Today?

Abstract

Tuberculosis, from time immemorial, has disproportionately caused misery to the poor. Malnutrition, environmental factors such as crowding and poor living conditions, unemployment, and lack of access to health care are social factors that contribute to making tuberculosis an outcome of social misery. In the Philippines, death due to tuberculosis occurs in 75 persons per day and exerts a significant adverse socioeconomic impact, as it affects young adults, who make up the workforce of the population. It remains the most significant problem in the Philippines at the close of the century.
However, the majority of patients with symptoms of TB either do nothing or self-medicate, and only a quarter seek medical help. Among those who consult, only 30% go to the public health clinics, 46% consult private practitioners, 17% seek help in hospitals, and 7% go to traditional healers. Previous studies in India have shown that, far from providing superior health care, private practitioners may, in fact, hinder the progress of the control program as they do not adhere to the standard regimen, nor do they have subsidized medications to provide, and there is no system of supervision and monitoring response. To ensure a more effective implementation of DOTS in the country, the private health sector, which is utilized more frequently than the public health sector, should therefore be harnessed into the TB control program. Private practitioners could assist in case finding by referring their patients to the appropriate public health center, where subsidized medications under the DOTS strategy could be provided. Alternatively, they could themselves actively participate in the DOTS program of the government, providing a wider scope for the drug distribution system presently available.

There are a number of models in the Philippines of this private-public collaboration in TB control. The Makati Medical Center (MMC) DOTS clinic is just one of them. Established in February 1999, it has enrolled approximately 400 patients by this time, with an 86.3% treatment success rate for new cases and 35.4% for retreatment cases. The dismal result in the latter is due to multi-drug-resistant TB (MDR-TB) among retreatment cases as a consequence of the inadequate previous treatment received by these patients. The control of MDR-TB is a far more complicated and expensive undertaking, and its generation by inadequate TB treatment underscores the urgent need for a more rigorous implementation of DOTS, as it is the most effective measure to prevent the emergence of MDR-TB.

The Philippine Coalition Against Tuberculosis is embarking on developing programs whereby private physicians can be enlisted in the national TB Control Program through a system of accreditation following a training program on DOTS. This strategy would provide the patients with viable choices of health care while still adhering to the DOTS strategy of the government.