22 Mar “It’s Time” to Stop Tuberculosis in the Philippines: World TB Day 2019 Podcast
Audio interview with HRH2030 Philippines Project Director Dr. Marilyn Lorenzo (Running time 8:07)
On March 24, the USAID-funded HRH2030 program in the Philippines joins partners around the world to commemorate World Tuberculosis (TB) Day to raise public awareness on the impact of TB and challenges towards elimination of the disease. The 2019 theme for World TB Day is “It’s Time.”
In the Philippines, TB is a serious public health problem affecting an estimated 2.5 million people, many who are unaware they have the disease. It is the sixth leading cause of death and illness, with at least 60 Filipinos dying every day from TB, and inflicts huge costs to the family household and Philippines economy.
USAID partners with the Philippine government to detect, treat, and prevent the spread of TB, and because of this partnership, the number of TB patients diagnosed and treated in the Philippines has more than doubled since 2006. USAID is currently working with the Philippine government to detect and successfully treat another 2.5 million people with TB in the next five years. In order to achieve this result, increased investments in health workers are needed to save more lives. The USAID HRH2030 program is working to strengthen the health workforce to improve TB services.
It’s time to stop TB in the Philippines. HRH2030 sits down with Philippines Project Director Dr. Marilyn Lorenzo to hear more about TB in the Philippines and the work the activity is implementing.
What are the major challenges in eliminating TB in the Philippines?
There are a few of them that are very important; the first is to maintain continuity of care. Right now, TB treatment fails because of patients being lost to follow up and what we call a loss of case holding. We identify cases of TB, but they are not completely treated and healed, and we do not know if they really comply with the treatment regimen.
As a result of that, a lot of TB patients have now converted to a type of TB that is very hard to treat or what we call a “multiple drug resistant TB.” And as a result of that, we now have a few cases that are extremely difficult to treat. Those are the ones that do not subscribe to any treatment for TB, and that is a death sentence for anyone who gets that kind of TB.
What changes are needed to strengthen the health workforce and improve TB control?
Well the workers for TB have to be really highly-motivated, very highly-skilled, and compassionate. They have to be highly-motivated because one of the things we found out in TB care is that because health workers do have a multiple case load, the first cases that they will drop will be their TB work. And that is because TB is hazardous, some of them are afraid to catch TB. Second, it takes a long time to be successful in treating one TB patient. And third, there are other health activities that they can accomplish and get instant accomplishment, whereas for TB you have to take at least six months to treat one TB case.
The motivation is very important, but competency is a second important ingredient. Not everyone knows about TB infection control, if they did, they would not be scared to handle TB cases because once a TB patient starts taking drugs, he or she is safe and will not be able to convert others into tuberculosis.
The third is compassion. TB is not an easy disease because it takes long to cure. There are a lot of problems in the treatment, side effects of the drugs, having to incur transportation problems in going to the health centers to get treatment, and so a lot of health workers resort to scolding their patients because of their failure to comply with any or all of the treatment requirements. Compassion is very short for cases like TB. It is not a sexy disease, but this is what health workers need in order to really connect with their patients and be successful.
How will USAID through its HRH2030 program contribute to the goal of detecting and treating more than 2.5 million Filipinos infected with TB?
The goal of detecting and treating over 2.5 million Filipinos in two or three years is very ambitious. For this, HRH2030 is directly contributing to all of these in two or three key interventions that we are mounting.
The first is taking inventory of the Global Fund supported staff that are now manning the TB Centers around the country. These people are funded by an external fund from the United Nations. But since they are pulling out in two years, the threat of losing people who are now giving life to the TB program is very high. So HRH2030 is doing inventory of all these people and for now we know there are about a thousand of them. We are now looking for how they can be transitioned into the permanent positions of the healthcare system, either through the government or the private sector.
Secondly, we can actually make a difference in improving the training of the health workers to improve their competencies. And through this training, we also hope to be able to influence the development of compassion for patients through our patient experience program.
So more importantly, HRH interventions are geared towards establishing systems to develop and manage health human resources for health, so that even when HRH2030 is not around anymore, these systems will continue so that the right people can be recruited, they can be developed and trained well, and they can be retained to do the work that they love and contributing to the elimination of TB in the process.
Photo: Merly Estrada, a registered nurse and the Genexpert Technician at Tarlac Provincial Hospital, gives instructions to a patient on how to safely collect a sputum sample for lab testing. Credit: HRH2030 Philippines