PhilCAT Bares Gains in Anti-TB Campaign

It is a great day for tuberculosis control in the country," said Health secretary Manuel Dayrit as he unveiled the New Integrated Policy for Tuberculosis Control in the Philippines.

    Together with World Health Organization-Western Pacific Region Office (WHO-WPRO) chief Dr. Shigeru Omi, Philippine Coalition against Tuberculosis (PhilCAT) chair Dr. Charles Yu, and other representatives from the private and government sectors, Dr. Dayrit spoke at length about the policy at the ninth annual PhilCAT convention held mid-August at the Manila Midtown Hotel.

    Secretary Dayrit said that the country is making significant headway in the fight against TB--given the global targets (70 percent case-finding rate, and 85 percent cure rate), the Philippines has now reached a 58-percent case-finding rate, and 80-plus-percent cure rate.

    He added that the national Directly Observed Therapy Short Course (DOTS) program, which remains to be the best way to curb the disease, has reached 97-percent national coverage in the public sector--a tremendous improvement from the two percent in 1996.

    He said that if the trend continues, the country would be able to reduce the national incidence of the disease by seven percent every year. "At that rate we will reduce by half the TB problem in ten years," he said. "And if that rate continues we can [virtually] eliminate the TB problem in 20 years."

National TB Policy

    In March, at the commemoration of World TB Day, a memorandum of agreement was signed by representatives from government, nongovernment, professional, and corporate groups to signify their dedication to the fight against the disease. They also swore to take part in the National TB Summit slated for August.

    The summit, coordinated by PhilCAT immediate past chair Dr. Rodrigo Romulo, came up with the Integrated Policy on the Control of TB in the Philippines. The policy is based on the National Tuberculosis Program, which among other policies upholds the use of sputum microscopy as the gold standard in the detection of the disease and DOTS as the preferred method of treatment.

    By involving all concerned parties in the program, everybody see the importance in following the standard diagnostic and treatment methods for the disease.

    Aside from government institutions like the Departments of Education, Interior and Local Government, Agrarian Reform, Agriculture, Science and Technology, and Social Welfare and Development, other agencies like the Bureau of Corrections, National Council for Indigenous Peoples, National Economic and Development Agency, and the Philippine Information Agency will take an active role not only in information dissemination but in case reporting as well.

    Another significant aspect of the program is the major part the Philippine Health Insurance Corporation (PHIC/PhilHealth), Government Service Insurance System (GSIS), Social Security System (SSS), and the Employees Compensation Commission will be playing. "[They will] align their disbursement of benefits for members along with the TB policy," Dr. Dayrit said. "No longer will a patient go to them with an X-ray and make a claim, this patient has to show that they have actually been treated."

    Dr. Dayrit also said that PhilHealth is currently developing an outpatient package for TB treatment. Dr. Francisco Duque III, president and CEO of PhilHealth, had said at the opening of the PhilCAT convention that the agency is going to give "preferential reimbursement among TB patients." Also, he had informed the delegates to the convention that PhilHealth has been urging their local government partners to enroll indigent people in PhilHealth.

"Private Docs Don't Follow Standard Treatment Regimens"

    One of the areas the Program wants to pay more attention to are the private practitioners, given that the successes in the public sector would go to waste if the private sector would not make a similar action. Already steps have been made in that direction, most notable of which is the official statement released by the Philippine College of Radiology to clear up the role of X-ray in the diagnosis of TB. In the statement the PCR said "definite diagnosis of TB cannot be deduced from a single radiographic exam but rather in conjunction with clinical evaluation and other diagnostic modalities."

    While this is a milestone in TB management in the country, Dr. Dayrit said more need to be done in the private sector. He said, "Private doctors don't follow standard regimens of treatment." Dr. Romulo agreed, saying that there is a possibility that less than one percent of all private doctors closely follow the DOTS system of management.

    The involvement of financial institutions will be crucial to making private doctors obey, because in order for their patients to avail themselves of compensation, the doctors will have to abide by the rules enunciated in the National TB Program.

Global Standards

    Meanwhile, Dr. Omi congratulated the multisectoral effort being put in solving the TB problem. He said that recently, representatives from different international agencies led by the WHO came to the country to review the progress of the National TB Program (See related story). He said that the 97-percent national DOTS coverage was a major success. However, he mentioned that there is still need for improvement, especially in the areas of drug procurement and delivery and human resource capacity development. Jin Paul de Guzman