Strengthening Linkage On Tuberculosis Control In Urban Marginalized Communities In Metro Manila

Background: The Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association Philippines, Inc. was established in 2008 to improve access to tuberculosis (TB) services in the urban marginalized communities by strengthening the linkage between the government (GOs) and non-government organizations (NGOs). This study aims to evaluate its activities, identify challenges and recommend possible solutions. Methods & Materials: This is a retrospective descriptive summary of TB control interventions in urban marginalized communities of District I–Tondo, Manila and Payatas, Quezon City, both within Metro Manila, Philippines. The 2007 to 2012 data of GO and NGO health facilities were collected using the National TB Control Program (NTP) monitoring tools and the project reports. The key interventions used were networking/linkage strengthening between GOs and NGOs, capacity building of Community Health Volunteers (CHVs) and Health Care Workers (HCWs), introduction of TB symptomatic referral mechanism for CHVs and DOTS Facilities and joint monitoring and evaluation visits. A free discussion session among HCWs and CHVs was conducted to assess the performance of program implementation. Results: The NGOs engaged with the project increased from 7 in 2008 to 20 in 2012. The number of TB symptomatic increased by 61% from 4355 in 2007 to 6998 in 2012. This was attributed to the NGO DOTS and CHVs’ contribution by 30% (2093/6998) and 3% (211/6998) in 2012, respectively. From the CHV referrals, the access rates improved from 53% (188/386) in 2010 to 61% (211/347) in 2012. The new smear positive TB patients identified increased by 28% from 683 in 2007 to 875 in 2012. The treatment success rate in Tondo was maintained from 83% in 2007 to 84% in 2011, while in Payatas, from 92% in 2007 to 88% in 2011 due to high defaulter (3.8%) and transferred out rates (4.3%). Transportation costs and daily visits to health facilities were some of the barriers identified. A community-based Directly-Observed Treatment or supervised drug intake in a place convenient for patient and HCWs was agreed upon. Conclusion: The study showed the significant contribution of NGOs in improving program accomplishment that can be replicated in other sites which can be a relevant reference for possible NTP policy change.