Rapid response against TB in Zamboanga City

The Zamboanga City experience in TB control Zamboanga City, with a population over 774,000, is the sixth largest city in the Philippines. Tuberculosis (TB) has been consistently among its top 10 leading causes of illness (8th in 2003 and 9th in 2007) and death (8th in 2003 and 5th in 2008). In late 2003, the local government launched Unidad na Pelea Contra TB (Unity in the Fight Against TB) as its version of the TB Directly Observed Treatment, Short-course (DOTS) strategy. When the program began there was a low number of TB cases registered (case notification) and a low number of people who entered treatment that were eventually cured (cure rate). In response, USAID assistance has helped to improve implementation of the Unidad na Pelea Contra TB. The program has increased the number of microscopy laboratories from seven to 20; led to the formation of a multisectoral, local TB Council (the Hermosa TB Council) to oversee the entire program; established public-private-supported DOTS units where public doctors could refer patients to private physicians and vice versa; and strengthened TB education at the barangay level. Persons with TB symptoms – especially the poor – now have easy access to diagnostic services leading to earlier detection and treatment. The educational campaign reaches virtually all sectors of Zamboanga City society - community residents, nursing students and doctors-in-training, teachers, government employees, police and military personnel and members of faith-based groups. To date, there is an almost 100% increase in the number of TB laboratories from 15 in 2007 to 28 in 2010, which now covers five (5) private tertiary, public and military hospitals. All of these laboratories operate with over 95 percent correct microscopy results. Informal laboratory workers and remote smearing stations have brought TB services to the City’s island and remote barangays, and now contribute five (5) percent to the City’s identification of persons with TB symptoms. The Barangay TB Task Forces are community-based groups composed of residents and village officials which are tasked to educate people about TB and also volunteer as treatment partners to ensure that patients receive their daily dose of anti-TB drugs. These Task Forces, spread throughout the different barangays (villages), are federated and represented in the Hermosa TB Council, which coordinates TB control efforts throughout Zamboanga City. In addition, 19 companies (mostly in the fishing and sardine canning industry) and two pharmacies have joined the anti-TB fight, respectively by setting up workplace TB DOTS programs and enforcing the “No Prescription, No Dispensing" policy passed by the City Council to prevent self-medication and the rise of multi-drug resistant TB. Meanwhile, the workplace TB DOTS programs offer potential benefits to the companies’ combined 20,000 workers, both land and sea-based, as well as their 60,000 dependents. By 2008, TB as a cause of illness in Zamboanga City had dropped to 14th place. The case notification rate rose from 122 per 100,000 population (2006) to 158 (2007). The cure rate also rose from 82 percent (2005) to 83 percent (2006) to 85 percent (2007), bringing the cure rate up to national and global benchmarks. Over the past three years, an average of 2,520 people received treatment under the program annually. The program owes its success to three “R’s": resolve - the political will to pass the necessary legislation and allocate resources for TB; resources – the readiness of the local government unit and other stakeholders to put funds and expertise where their commitments lie; and, ready response - rapid, multisectoral and effective action on the ground, at community level and among all sectors which have a stake in TB control in the city. According to City Mayor Celso Lobregat, “TB does not respect age, gender, culture or religion. Stopping TB therefore involves the whole community." 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.