TB LINC

LINKING INITIATIVES and NETWORKING to CONTROL TUBERCULOSIS

TB situation
Global Rank: 9th among 22 high TB burden countries
Regional Rank: 3rd among WPR countries
TB Incidence (new smear +) = 133/100,000
Case detection rate (2005) = 73%
Cure rate (new smear +) = 81%
Success rate (new smear +) = 89%

Challenges
Wide variation in program performance across regions and provinces
Inaccessible DOTS services in some areas
Low level of participation by the private practitioners
Poor health-seeking behavior of communities
Weak local health systems

Background of TB LINC
USAID-funded
Managed by the Philippine Business for Social Progress (PBSP) with 5 consortium partners
5 years (2006-2011) $12.5 Million
Primarily, will provide technical assistance (TA)
Will be implemented in 21 provinces / cities

Project Goal
Assist the GOP attain the MDGs (reduce by half the TB prevalence and mortality) by contributing to the achievement of the following targets;
70% case detection rate
85% success rate

Project Objectives
1. Improve the policy, financing and regulatory environment
2. Improve human and systems capacity for quality DOTS implementation
3. Improve utilization of DOTS facilities and services, and influence behaviors/attitudes

Project targets
80% of LGUs increased case notification rate
80% of LGUs with success rate of at least 85%
75% of LGUs purchased Cat. 3 anti-TB drugs
70% of DOTS facilities are PhilHealth-accredited
100 PPMDs established
90% of microscopy centers providing DSSM according to national standards
90% of DOTS facilities are without drug stock-outs
Increased proportion of community adopting appropriate health-seeking behavior

Consortium Partners
CODE NGO
League of Provinces of the Philippines
Philippine Academy of Family Physicians
Philippine College of Occupational Medicine
Philippine Pediatrics Society
Chemonics International (U.S.)

Project Approaches
DOH will be the lead agency
Collaborative and coordinated multi-stakeholder involvement
Complementarity other USAID-funded project
Linkage of national, subnational, and local approaches
Sustainable interventions

Other USAID-funded projects
Health Governance (Health-Gov)
Health Policy and Development Program (HPDP)
Sustainable Health Improvement through Empowerment and Local Dev’t (SHIELD)
A2Z
Health promotion and communication (HPC)**
Private Sector Social Mobilization (PRISM)

Project Components

Component 1
Policy and Finance
Component 2
Systems Strengthening
Component 3
DOTS utilization

PROJECT COMPONENTS
Linking Initiatives and Networking to Control Tuberculosis
Strategic Objective: Desired family health sustainably achieved
ARMM: - Participating units achieving at least 85% treatment success rate for TB
National: - Participating units achieving at least 85% treatment success rate for TB

Component 1:
Policy, Financing and Regulatory
Environment for DOTS Implementation Improved
Subcomponents
1.1: Policy environment improved
1.2: Financing improved
1.3: PPMD DOTS scaled-up and sustained
1.4: Coordination and collaboration strengthened

Component 2:
Systems Capacity for Quality DOTS
Implementation
Improved
Subcomponents
2.1: Human resources and institutional capacity for TB control strengthened
2.2: TB lab network strengthened
2.3: Management and supply of quality anti-TB drugs improved
2.4: Management of MDR-TB improved (PMTM)

Component 3:
Utilization of DOTS Facilities/Services and Behavior and Attitude for TB Control and Treatment
Improved
Subcomponents
3.1: Knowledge and health behaviors improved
3.2: Community involvement in TB detection and treatment improved

Component One – Policy and Finance
1.1 Improved Policy Environment
1.2 Improved and Sustained Financing
1.3 Scaled Up and Sustained PPMDs
1.4 Strengthened Coordination and Collaboration

Goal
Improve national and local policy and financing environment to ensure quality and sustainable DOTS implementation

Key Result areas
National and local policies supportive of DOTS (includes localization of issued-policies like CUP and DOLE guidelines)
Increased financial resources for TB control (include LGU support and PhilHealth)
Financially sustainable public and private DOTS clinics
Stakeholder partnerships for TB control

Component Two – Systems Strengthening
2.1 Strengthened Human Resources and Institutional Capacity for TB Control
2.2 Strengthened TB Laboratory Network
2.3 Continued Supply of Quality Anti-TB Drugs and improved TB drug selection and use
2.4 Improved Management of MDR-TB

Goal
Ensure that health care providers, both public and private, provide quality DOTS

KRAs
All DOTS providers had been trained
200 PPMDs are established
Functional TB laboratory network
TB microscopy laboratories are providing diagnostic services according to standards
DOTS services are accessible in difficult areas
Anti-TB drugs are always available
Contributed to addressing MDR-TB

Component Three – DOTS utilization
3.1 Improved Knowledge and Health Seeking Behavior for TB
3.2 Improved Community Involvement in Improving TB Case Detection and Treatment

Goal
Improve utilization of DOTS facilities and services, and behavior and attitudes to TB control and treatment.

KRAs
Community and households adopting appropriate health-seeking behavior
Increased proportion of TB symptomatics promptly consulting DOTS center
Improved adherence to treatment
Empowered TB clients to do advocacy, communication, and social mobilization (ACSM)
More groups supporting TB control

Some key interventions
Geographic convergence of TB initiatives in supply, demand and policy environment
Strengthening local governance
Networking of DOTS providers
Inter-LGU collaboration to TB control
TB control initiatives in resource-poor areas

Engagement process
Series of CA meetings with DOH, other government agencies, developmental partners,
LGU engagement to be coordinated by HealthGov in non-ARMM areas and by SHIELD in ARMM areas
Orientation of the regional / provincial stakeholders
Coordinated planning with province / LGUs
Regional / provincial investment planning in ARMM
TA to be provided based on local needs

Challenges in ARMM
Making DOTS services available in difficult areas: geographically isolated, conflict-areas
DOTS for mobile TB patients e.g. those traveling to Malaysia or Zamboanga City
Culturally sensitive TB communication materials
LGU support to TB control in non-devolved set-up
PhilHealth accreditation of DOTS facilities in resource poor areas

How to contact TB LINC
Dr. Dolores C. Castillo
Chief of Party
TB LINC
Suite 903, 9F Ma. Natividad Bldg.
470 T.M. Kalaw Avenue corner
Cortada St., Malate, Manila 1000
02-5671434