National TB Program-Directly Observed
Treatment Short Course (NTP-DOTS)
Tuberculosis is an infectious disease caused by TB bacteria (Mycobacterium
tuberculosis) that primarily affects the lungs. This condition is known as the
pulmonary tuberculosis (PTB). There are also other forms of TB like tuberculosis
in the bones, meninges, joints, genito-urinary tract, liver, kidneys, intestines and
heart and this is called extra pulmonary tuberculosis.
Mode of Transmission
One gets infected with TB if he inhales the germs released from air droplets
when a pulmonary TB patient coughs, sneezes and spits. A PTB patient, whose
sputum is positive for the TB germs/bacteria, if left untreated, may infect
approximately 10-20 persons in two years.
Signs and Symptoms of TB
Manifestations of tuberculosis include cough for more than 2 weeks, fever,
chest and back pains, poor appetite, weight loss, and hemoptysis. The patient
should seek medical consultation and his sputum should be examined to detect the
presence of TB germs/bacteria.
Treatment of Tuberculosis
Tuberculosis is a curable disease. Patients are prescribed with appropriate
regimen to render them non-infectious and cured, as early as possible. The
treatment for TB is a combination of 3-4 anti-TB drugs. A single drug is never
prescribed for TB treatment. This will worsen the patient’s condition.
TB in the Philippines
The Philippines is among the 22 high-burdened countries in the world
according the WHO. TB is the 6th leading cause of illness and the 6th leading cause
of deaths among the Filipinos. Most TB patients belong to the economically
productive age-group (15-54 years old) according to the 2nd National Prevalence
Survey in 1997.
Directly-observed Treatment Short Course (DOTS)
Directly-observed Treatment Short Course is a comprehensive strategy
endorsed by the World Health Organization (WHO) and International Union
against Tuberculosis and Lung Diseases (IUATLD) to detect and cure TB patients.
It aims to control TB by reducing the annual risk of infection (prevalence and
Key prevention strategies include BCG vaccination under the EPI program;
annual identification of at least 45% of its prevalence; public health education
regarding PTB mode of transmission, methods of control, and importance of early
diagnosis; and provision of outreach services for home supervision of patients in
Multi-Drug Therapy and also for preventive treatment of contacts.
Case-finding activities include the following:
1. Direct sputum microscopy for identified TB symptomatics
2. X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam
3. Establishment of passive and active collection points for sputum samples of
all identified TB symptomatics, as well as validation centers to ensure the
standard and quality of sputum exam.
4. Case findings and treatment services shall be made available in the
Treatment guidelines are as follows:
■ All TB cases must be treated for free, on ambulatory and domiciliary (home)
basis, except those with acute complications and emergencies.
■All sputum positive and cavitary cases shall be given priority for short course
chemotherapy or SSC (comvo pack multi-drug therapy) for 6 months.
■ Standard Regimen or SR (isionazid and streptomycin sulphate) for a year or
intermittent SCC for 6 months shall be given to all infiltrative but sputum negative.
There are four elements of DOTS that need to be fulfilled. These are as
1. Political commitment
2. Quality sputum microscopy for diagnosis
3. Regular supply of anti-TB drugs
4. Standardized recording and reporting of TB data
According to the WHO Report on the TB Epidemic (1997)
√DOTS cure TB patients and it can produce cure rates as high as 95% even in the
√DOTS prevent new infections among children and adults
√ DOTS can stop resistance to anti-TB drugs
√ DOTS is cost-effective
DOTS services are available in the rural health units, city health units, city
health centers and government hospitals around the country. Currently, there are
also private facilities that are offering DOTS services to their clients. The
Philippine Coalition against TB (PhilCAT) had already started to adopt DOTS
strategy. They can contact their different medical societies’ officers and member
offices. There are already private DOTS facilities. Those who have symptoms of
TB should go to the nearest health center to be evaluated for TB. Physicians should
assure that patients take their medications regularly and completely.
National TB Program
The National TB Program (NTP) is the government’s commitment to
address the TB problem in the country. The NTP is being implemented nationwide
I all government health centers and government hospitals. Its objectives are to
detect active TB cases (at least 70%) and cure them (at least 85%). Achieving and
sustaining targets will eventually result to the decline of the TB problem in the
Community-based TB Control Program
Alay KapwaKilusangPangkalusugan (AKAP) is supported by international
funding agencies 1978-1988. The impetus for the creation of AKAP was that there
was high prevalence of infectious diseases such as TB and lack of geographical
and financial access to health services in rural communities. The health system was
dependent on professional health workers for services. TB control program was
AKAP aims to increase access to TB services and improve the proportion of
TB cases being treated. It also strives to enable the communities to assess their
health problems and respond to their needs.
AKAP provides technical support to the field health teams, which is usually
composed of a physician and one or two nurses, who worked with the diocesan
community-based health program. A diocesan community organizer helped in
mobilizing the community to identify their needs and intervention plan.
AKAP trained CHWs deliver the following TB control services:
Health education of patients and community
Collection, smearing, and staining of slides
Provision of anti-TB drugs including streptomycin injection;
Basic recording; and
Retrieval of defaulters
Some CHWs were also trained to do sputum microscopy with quality
assurance provided by a centrally based bacteriologist. Training also included basic
health care such as maternal and child care. Because of these, the following results
1. TB cure rate was more than 85%
2. Basic health needs were responded to by the field staff and CHWs
3. CHWs became empowered and active in community affairs
The program was not without issues, however. Some of these included the
issues in sustainability when the project was completed as well as suspicion of
the program staff by the military in the areas where NPAs were suspected.