It takes a village to stop TB in Sarangani

Tuberculosis is the fifth leading cause of death in Sarangani. The number of TB cases is high (96 per 100,000 population in 2008, up from 89 in 2007) but number of patients cured is below the national target of 85 percent and decreasing (73% in 2006 and 69% in 2007). This is due mainly to lack of community volunteers, treatment partners and health educators. Often, when people do not know the signs and symptoms, or are ashamed of being perceived as having TB, they do not consult with health facilities. If they do not have someone to help them complete treatment, they stop.

Previously, no policies or dedicated funds for TB control existed in Sarangani. Laboratory staff was not hired and health workers had no transportation allowances to supervise TB services in the barangays (villages). Access to TB services was difficult due to high transport and opportunity costs. The USAID TB project engaged local community-based organizations as technical assistance partners (TAPs) to mobilize local government units (LGUs) and grassroots support for TB control. These TAPs provided advice and templates to help LGUs pass TB control ordinances with budget allocations. The TAPs also organized community support groups (CSG) whose members provided health education and helped identify and refer potential TB cases to local health centers. The TAPs encouraged LGU officials and CSGs to form multisectoral TB councils to better coordinate efforts in municipalities. One example is Maitum municipality. The LGU provided hazard pay to health workers as form of compensation for being exposed to contagious diseases at work. It also provided transportation allowances and motorcycles to transport health workers who follow up on those who discontinue treatment and bring slides from barangays to laboratories. The health workers receive additional monthly honorarium of US$11 monthly when they are able to identify and refer for treatment TB symptomatic persons. In Maitum, the community support group set up the People’s Empowerment Saves One (PESO) to raise funds through personal donations and charity events like boxing matches and dance balls. PESO raised PhP87,000 for TB control activities, which was matched by the provincial government. Throughout the province, 35 barangay resolutions and six municipal ordinances were passed in a year, allocating over US$2,600 at the barangay and US$25,000 at the municipal level to buy TB drugs and supplies and to fund activities and incentives for health workers. Community TB health education reached about 15,000 residents, while CSGs in 35 pilot barangays had over 500 members. Provincial data show encouraging results: In the first quarter of 2009, the number of TB cases detected was up from 17 percent to 22 percent; 988 people with possible TB symptoms consulted health centers. Of these, 148 turned up positive for TB and all have begun treatment, with treatment partners. The Maitum model of a village-led TB program has been shared with other municipalities in the province. It was presented as a replicable good practice before some 125 municipalities at last year’s national convention of local chief executives. According to Sarangani Governor Miguel Rene Dominguez, “It takes a whole community to care for TB patients. Every sector must do its share." 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.