The Philippines has a high maternal neonatal mortality and incidence of tuberculosis (TB); the country ranked eighth among the 22 countries with a high burden of TB.[1]The 2016 review of TB services[2] identified key programmatic gaps: missed TB cases due to poor health-seeking behavior of patients; lack of engagement of private health care providers; limited implementation of targeted interventions for DR-B, TB/HIV, latent TB, and those at high risk for TB; weak health systems, especially in human resources, surveillance, and logistics management; and varying support from local government units (LGUs). SIAPS Philippines strengthened the capacity of TB stakeholders at all levels—national, regional, provincial, city, and barangay (grassroots)—to reduce the burden of TB through increased access to quality and effective pharmaceutical and laboratory services. SIAPS worked with the Department of Health (DOH) and its agencies: the National TB Control Program (NTP), Food and Drug Administration (FDA), Pharmaceutical Division, Logistics Management Division, Central Office Bids and Awards Committee, Knowledge Management Information Technology, Family Health Office, National TB Reference Laboratory, and LGUs in Quezon City and Region 4-A.
Project Highlights
Regional lab managers discuss their regional plans on rapid TB diagnostic laboratory (RTDL) expansion. (Photo credit: J. Dizon, SIAPS) [Click to enlarge]Strengthened the TB laboratory network: SIAPS supported the NTP and the National TB Reference Laboratory to strengthen governance, leadership, human resources, service delivery, and information management.
Strengthened the pharmacovigilance system: SIAPS supported the NTP and FDA to enhance PV and post-market surveillance capacity and performance and to develop a comprehensive national pharmacovigilance system. Training on clinical management of bedaquiline (BDQ) and other novel anti-TB drugs was conducted, data migration and interoperability of the Pharmacovigilance Information Management System (PViMS) and the ITIS data management system was facilitated, PViMS was installed at all health facilities practicing programmatic management of drug-resistant TB, and a data reporting tool for MDR-TB drugs was developed.
Designed standard operating procedures for active pharmacovigilance for new TB medicines and novel TB regimens: Procedures cover signal management in pharmacovigilance, safety communication, preparing reports for submission to the National Drug Advisory Committee, and information sharing with market authorization holders and public health programs. SIAPS also improved the infrastructure capacity of DOH by putting in place essential software and licenses to host and operationalize PViMS.
Strengthened pharmaceutical supply chain management systems: SIAPS supported the DOH in formulating the strategic road map for supply chain management from 2018 to 2022. SIAPS conducted the TB supply chain options analysis and a study on the economic cost of nonadherence to TB medicines resulting from stock-outs and loss to follow-up in the Philippines. SIAPS established and operationalized the Drugs and Supplies Management Sub-Technical Working at the central and regional levels, developed quantification guidelines, and rolled out QuanTB. A reverse distribution and stock transfer plans for stock-outs and expiries at facilities and warehouses were developed. A total of 412 health staff from the central and peripheral levels were also trained in PGMP.
Improved community-level health leadership, management, and governance: SIAPS and the Quezon City Health Department (QCHD) developed and implemented the Barangay Health Management Council (BHMC).
Results
[Click to enlarge]Increase in the number of Xpert MTB/Rif laboratories from only 16 in 2011 to 167 by the end of 2016 as a result of the policy developed for the use and scale-up of these labs; in addition, the number of GX sites increased to 207 in 2016 from 11 in 2011
Scale-up of the establishment of rapid smearing stations
Regional plans developed for the RTDL expansion
Philippines became one of the first countries to develop guidelines and SOPs for active pharmacovigilance surveillance for the new MDR-TB and novel TB regimens; design and roll-out of training on clinical management of BDQ and other new medicines (48 staff from central and regional levels participated)
[Click to enlarge]Design and roll-out of orientation on PViMS and training of 328 NTP staff from the central and regional levels
Interoperability of PViMS with ITIS established
Database of adverse and serious adverse events recorded under clinical study conditions for standard shorter-treatment regimen and BDQ established
Using QuanTB, the DOH accurately estimated and allocated distribution quantities of MDR-TB drugs for health facilities that facilitated six procurement orders and a delivery plan for TB drugs with a approximate value of $8,456,900
By the end of 2016, SIAPS and the QCHD established 17 BHMCs covering 45 barangays and reaching 1.1 million people or 35% of the city’s population
Project Legacy
[Click to enlarge]SIAPS Philippines’ extensive work on national health systems from the central to the community level has resulted in an assortment of tools for strengthening and measuring various elements of pharmaceutical systems. DOH developed and enacted practical, enforceable policies consistent with national laws and international standards and best practices. Skilled health care workers, managers, and leaders are now better equipped to effectively implement activities related to health systems strengthening. Through the introduction and application of appropriate technologies, the quality and availability of information improved, helping managers and decision makers to develop sound policies and monitor supplies and services.
Background 
