JICA Tuberculosis Control Project
in the Republic of the Philippines
The Republic of the Philippines is an island nation consisting of over 7,100 islands of various sizes that stretch over 1,851km from north to south and 1,107km from west to east.
The Philippines was ranked as having the seventh highest tuberculosis burden globally and second in the western Pacific region, and TB is considered
to have a major public health problem. The National TB control Program
(NTP) adopted the DOTS strategy in 1994, and had achieved almost 100% coverage
of the country by the end of 2002. Treatment success of smear positive
TB in the NTP has reached 88%, but the detection rate of smear positive
cases is still 58% in 2002, well below the target of 70%. An external program
review conducted in 2002 by the DOH, together with international partners,
identified four main issues affecting the current NTP: (1) inadequate drug
procurement and distribution, (2) inappropriate monitoring and supervision,
(3) low case detection and insufficient quality of laboratory services,
and (4) limited involvement of the private sector in TB control. Technical
assistance has been provided through JICA TB control projects such as the
Philippines Public Health Project/Tuberculosis Control Project (1992-1997),
the Philippine TB Control Project (1997-2002), and the DOH-JICA Project
for the Quality Tuberculosis Control Program (2002-2007). During the first
project, along with introduction of a new TB control strategy named DOTS,
efforts were made to train health staff at all levels, provide counterpart
training in Japan, and develop human resources. Moreover, the laboratory
at the Cebu Chest Center was enlarged and refurbished to give it quality
assurance and reference examination capabilities in the Region 7. During
the second phase, the project expanded the implementation of DOTS to nine
provinces, covering a population of 13 million, which comprises approximately
17% of the total population. In the target areas, the project was able
to achieve a cure rate of 85%. Furthermore, the project supported revision
of the NTP Guideline, which in turn endorsed as “Manual of Procedures
for the NTP 2001”. Based on the experience at the Cebu Regional TB Reference
Laboratory established through JICA’s technical assistance, the project
established a quality assurance system for sputum-smear examinations. The
current project aims to improve monitoring and supervision, to improve
the quality of DOTS, to improve sputum smear examinations by extending
the laboratory network nationwide linking with NTRL, and to assist in planning
and implementing operational researches. The immediate objective is to
achieve a case detection rate of 70% and cure rate of 85%. The project
team plans to improve monitoring and supervision in areas where the average
cure rate is below 85% and the team has developed a manual “Handbook for Quality DOTS in 2004” for
monitoring and supervision in collaboration with NTP. Furthermore, the project
is planning to support and establish regional laboratories except for Region 4
and the National Capital Region where NTRL has direct supervision.
updated 05/5/02