change is coming - philippine coalition against...

Change is Coming to Philippine NTP

23rd PhilCAT’s Annual Convention

August 18, 2016 Crowne Plaza Hotel Manila Galleria

Anna Marie Celina G. Garfin, MD, MM Disease Prevention and Control Bureau

Objectives

• To provide updates on the current situation of TB in the Philippines

• To share the direction of the DOH viz-a-viz the current national leadership

• To share a glimpse of the ongoing development of the 2017-2022 TB Strategic Plan

2016 End of the Millennium Development Goals,

Start of the Sustainable Development Goals,

Start of a new presidential administration.

Change is bound to happen!

Is it true for the TB Program?

Our Plan, our Commitment

2016 Joint

Program Review

2017 - 2022 TB National Strategic

Plan

Indicator 1983

(1st)

1997

(2nd)

2007

(3rd)

2016 (4th)

Prevalence of Xpert MTB (+)

------- ------- ------- ?

Prevalence of Smear (+)

6.6/1000 3.1/1000 2.0/1000 ?

Prevalence of Culture (+)

8.6/1000 8.1/1000 4.7/1000 ?

DOTS Strategy

Strengthened NTP

6-point agenda

Comparison of National TB Prevalence Surveys

2010-2016 PhilPACT

2015 Accomplishment - Impact

Impact Indicators

2016 Target Accomplishment 2015

(WHO estimate)

Remarks

Mortality rate 23/100,000 14/100,000 (13-14) Achieved

Incidence rate 246/100,000 322/100,000 (277-

370) Final verdict will be based on the results of the 2016

National TB Prevalence Survey

Prevalence rate 414/100,000

2015 Accomplishment - Outcome

Outcome Indicators 2016 Target 2015

Accomplishment Remarks

Case Notification rate 221/100,000 272/100,000 Achieved

Case Detection rate 90% 91% Achieved

Treatment Success rate

90% 92% Achieved

Notification rate of MDR TB

62% 27% Not

Achieved

Treatment Success rate MDR TB (2013 cohort)

75% 49% Not

Achieved

2015 Accomplishment - Output

TB Case notification 2015

Total cases notified 308,267

Total new and relapse 299,207

- % tested with rapid diagnostics at time of diagnosis 20%

- % with known HIV status 13%

- % pulmonary 97%

- % bacteriologically confirmed among pulmonary 36%

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

CDR, All forms Success Rate

Trend of Case Detection Rate (All Forms) and Treatment Success Rate, 2000 to 2015

0

20

40

60

80

100

120

Case Detection Rate per Region, 2015

0

10

20

30

40

50

60

70

80

90

100

Treatment Success Rate per Region, 2015

TB in Children - Susceptible

• 2015 Case Finding on Children (0-14 years old)

• 35,873 (13% of all TB cases) children identified and started on treatment

• 6,700 cases of latent TB infection given Isoniazid Preventive Therapy (IPT)

• Treatment Success Rate – no data specific for children

TB in Children - Resistant

2011 2012 2013 2014 2015 MDR-TB Children 0-14 years old

12 7 15 16 30

• Treatment Success Rate: 50% • Lost to Follow-Up (Defaulters): 14% • Death Rate: 14%

0

10

20

30

40

50

60

70

80

90

100

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Public Public and Private

Contribution of the Private Sector (All Forms, 2003 to 2015)

14%

Cascade of PMDT Care, 2015

• 1% New, • 45% Re-treatment

27%

PMDT Enrolment per Region, 2015

0

200

400

600

800

1000

1200

1400

1 2 3 4A

4B 5 6 7 8 9 10

11

12

13

CAR

NCR

ARMM

Trend of Enrollment of Patients under PMDT, 1999-2015

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

New patients 7 15 86 56 22 99 191 134 315 530 569 870 2569 2056 2390 2010 4063

Cumulative 7 22 108 164 186 285 476 610 925 1455 2024 2894 5463 7519 9909 11919 15982

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Trend of Treatment Outcome of Patients under PMDT 1999 to 2012

1999-2000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

LosttoFf-up 9% 14% 23% 23% 15% 13% 18% 20% 25% 33% 38% 44% 36%

Died 9% 15% 11% 5% 8% 12% 17% 11% 10% 9% 14% 12% 13%

Failure 18% 14% 7% 0% 4% 1% 2% 4% 1% 2% 2% 2% 1%

Success 64% 57% 59% 73% 73% 74% 63% 63% 64% 57% 46% 41% 49%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Achievements – 2013 Joint Program Review

Considerable

progress 2011-2016

The 2016 Joint

Program Review

found the strategic

direction of the NTP

to be technically

sound and well

focused.

Case notification increasing

Overall program is well managed;

fully decentralized

Multi-sectoral &

high-level commitment for TB; TB law to be

passed

Innovation & uptake of new

tools, at all levels, reflects

commitment to quality

Proposed TB Law

will be considered a

flagship for the

region

Key Challenges

• Insufficient number of permanent human resources

• Services are not yet fully integrated – TB HIV, TB DM

• Very low uptake of IPT for children, low detection of TB in children

• Barriers to access continue: financial, geographic, knowledge, provider support according to patient needs

• Low detection and treatment outcome of drug resistant TB cases

• Supply management system is not yielding uninterrupted, quality drug or laboratory supplies

• Information flow is not reliable; limited use of data to enhance program implementation

• Sustainability of collaboration with the private sector

D

Innovate: Be bold to solve problems

B

Act on the TB Law, once passed

A

Develop a roadmap toward sustainability

C Embrace and scale-up new technologies,

medicines and approaches

Joint Program Review Recommendations

Our Plan, our Commitment

2016 Joint

Program Review

2017 - 2022 TB National Strategic

Plan

Millennium Development Goals

1990 to 2015

Considerations for 2017 and beyond activities

Sustainable Development Goals 2016 to 2030

By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected

tropical diseases and combat hepatitis, water-borne diseases and other

communicable diseases

Filipino families are entitled to…

The government is committed to…

Comprehensive range of services that protect everyone at all ages and all stages

Receive coordinated, appropriate, quality and respectful care

Financial freedom when utilizing health care services

Guarantee services that provide care for ALL LIFE STAGES & ADDRESS THE TRIPLE BURDEN OF DISEASES

Ensure these services are accessible in functional SERVICE DELIVERY NETWORK

Sustainably finance these services through UNIVERSAL HEALTH INSURANCE

All for Health towards Health for All Duterte Health Agenda

UNIVERSAL HEALTH INSURANCE

Our Strategies

A

C

H

I

E

V

E

Advance primary care and quality

Cover all Filipinos against financial catastrophe

Harness power of strategic health human resource

Invest in digital health and data for decision-making

Enforce standards, accountability and transparency

Value clients and patients

Elicit multi-sector, multi-stakeholder support for health

Pillar 1 Integrated

patient-centered TB care

and prevention

Pillar 2 Bold

policies and supportive

systems

Pillar 3 Intensified research

and innovation

The END TB Strategy: Pillars and Principles

Lecture of Diana Weil, WHO-HQ

Republic Act No. 10767

Comprehensive

Tuberculosis Elimination Plan Act

of 2016

What to do to Address the Challenges

2017 - 2022 TB National

Strategic Plan

2017-2022 NTP National Strategic Plan 6 Reform Areas

Governance

Service Delivery

Regulation

Financing

Information and

research

Human Resource

Objectives of 2017-2022 NSP

1. Ensure that all regions and 90% of LGUs are adopting multi-sectoral collaboration in implementing the Comprehensive Tuberculosis Elimination Plan (Governance)

2. Ensure adequate TB care providers who are providing patient centered TB services (Human resource development)

3. Increase to at least 90% of all health facilities and providers that are providing patient centered, integrated and expanded TB care and prevention services (Service delivery)

4. Make available quality TB products and diagnostic tools (Regulation)

5. Reduce to zero the proportion of affected families facing catastrophic costs due to TB among those seen in the TB DOTS network (Financing)

6. Improve utilization of adequate, timely and accurate TB information (Information Management)

2017-2022 NTP National Strategic Plan 5 Principles

One national plan but locally adapted

Led by DOH with strong public-private sector collaboration

Active participation of patients and communities

Promotion of human rights and equity

Efficient resource utilization

1

2

3

4

5

Commitments for 2017 to 2022

2015 2022 2030 2035

Baseline National Strategic Plan

SDG End TB Strategy

Reduction in the number of TB deaths from 2015 (14,000)

55% reduction (6,300)

90 % Reduction

(1,400)

95% Reduction

(400)

Reduction in TB incidence rate from 2015 (322/100,000)

35% reduction (209/100,000)

80% Reduction

(64/100,000)

90% Reduction

(32/100,000)

Catastrophic cost 0 0 0

What are the Changes?

TB Control

• Systematic screening of contacts

• Provision of Preventive Therapy

TB Elimination

1


• CUP partnership

• Private sector

Health Sector involvement

• DOH & other government agencies

• Private sector

• Patient groups

• Community

Multi-Sectoral involvement

2


Health Worker decision

• Patient centered care

Patient participation

3


Fragmented Service Delivery

• Service Delivery Network

• Integrated TB services

Network of Providers

4


Availability of Products

• FDC for children

• New drugs – Bedaquiline, shorter treatment regimen

Quality and safety of products

5


Passive casefinding

• Mass screening of inmates, urban poor

• TB caravans

Targeted active casefinding

6


Manual Paper-based reporting

• Integrated TB Information System

• Mandatory reporting of TB cases

• Contact tracing

Electronic Information System

7

Dream, Believe and Achieve!

Thank You!

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