Bringing TB control to Zamboanga's remote islands

If people cannot come to clinics for TB control services, then services must be brought to the people. Sometimes all it takes are local governments determined to fund TB programs, train volunteer health workers, and set up laboratory services. This was the experience of the province of Zamboanga de Sibugay, particularly of its impoverished island health district of MaTaOl, composed of three municipalities – Mabuhay, Talusan and Olutanga. MaTaOl is considered geographically isolated and deprived area with about 81,000 population. Until recently, the much needed laboratory services were placed at the Olutanga Municipal Hospital, in the center of the island. But with the bad road conditions, it was quite inaccessible. Motorcycles are the main means of transportation, and passengers have to pay at least PhP100 for a single trip to traverse the poor roads, equivalent to their average daily income. This discouraged people with TB symptoms from seeking consultation and diagnosis. It proved to be a challenge for the TB program considering that a sputum test, which requires laboratory facilities, is the primary diagnostic test for TB.

To address the challenges, government doctors and local officials took steps to make TB services accessible to the residents. First, the mayors allotted funds and manpower to increase number of functional laboratories from one to four. Satellite units called Remote Smearing Stations (RSS) were utilized for specimen collection and smear preparation done by trained informal laboratory workers. Quality assurance systems were applied to laboratories to ensure reliable results. People with TB symptoms no longer have to travel a long distance for consultation and diagnosis but can just visit their local health stations. These steps were catalyzed by USAID assistance in terms of support for training of informal laboratory workers by providing resource persons, modules and materials, as well as advice on and templates of municipal ordinances allocating funds for the local TB control program. These combined initiatives resulted in an overall increase in the health district’s case detection rate or the number of persons seeking consultation and being diagnosed with TB. During the first three quarters of 2009, 226 persons with TB symptoms consulted with health centers, up from 170 in 2008 and 139 in 2007. Of these, 27 (first three quarters of 2009), 42 (2008) and 33 (2007) were diagnosed with TB through sputum examinations and microscopy at the health center’s TB laboratory. There was also improvement in the quality of microscopy services, with all four laboratories attaining more than 95 percent correct results. The trained volunteer health workers also helped increase community awareness about TB and of the TB program. The accuracy of laboratory results and encouragement for symptomatic individuals to seek care contributed to the increase in case detection described above. By 2011, the activities of these volunteer health workers in the whole province would contribute 11 percent to the province’s case detection rate. Meanwhile, the Remote Smearing Stations piloted in the health district would be replicated province-wide with the setting up of 60 stations in all 16 municipalities of the province. While previously, the municipalities of Talusan, Mabuhay and Olutanga did not have budgets specific for TB program, their local government units passed in the past two years municipal ordinances allocating annual TB program budgets of PhP20,000 in Talusan and PhP35,000 each for Mabuhay and Olutanga, with planned annual increases. According to then Provincial Health Officer Dr. Ulysses Chiong, “We convinced mayors that expanded laboratory services and training of health staff would benefit their constituents." This article was contributed by the Philippine Business for Social Progress (PBSP), the largest corporate-led social development foundation in the Philippines, which manages the Linking Initiatives and Networking to Control Tuberculosis (TB LINC) project. Led by the Department of Health, TB LINC is a five-year, USAID-funded technical assistance project that aims to reduce TB prevalence, morbidity, and mortality. The project supports the Business Roadmap to the Millennium Development Goals by contributing to the global target of at least 70 percent case detection rate and 85 percent cure rate.