Mocorro, C. L. (2014). Strengthening health system to increase case detection rate of tuberculosis-all forms in Socorrom Surigao Del Norte (Unpublished master's thesis). Graduate School of Public and Development Management, Development Academy of the Philippines.

Graduate School of Public and Development Management Health Systems and Development Batch 4 Thesis (MPM-HSD)--Development Academy of the Philippines.

An Action Plan Project (APP) was conducted to strengthen health systems to increase Case Detection Rate (CDR) of Tuberculosis (TB) all forms in Socorro Surigao del Norte. In 2012, CDR of TB-all forms was only 61% with national target of 85%. Previous years since 2008 also show low CDR for TB. The persistent low CDR of TB all forms and high number of TB symptomatic was the motivation for this APP The goal of the study is to determine status of implementation of Local National Tuberculosis Program (NTP) implementation prior to Doctors to the Barrio (DTTB) deployment, determine the factors causing the low case detection rate of TB-all forms, develop strategies to strengthen Health Systems, and determine the relationship of health system and CDR of TB-All Forms. Methodologies used for this APP include Focus Group Discussion (FGD), Key Informant Interview (KII), Survey and Document Review. A Local Health System Score Card was created for this APP to quantify the Health System. During the APP Implementation, It was noted that the NTP Implementation prior to DTTB Deployment was not maximized to its full potential with a low HS Score Card. It has no (Local Government Unit) LGU financial support, no local TB policies, no initiated programs, no partnership established, non Philhealth accredited and a less prioritized program pf the Rural Health Unit (RHU) personnel. The weak health system is probably the major factor causing a low CDR. Other factors noted to cause low CDR includes poor knowledge attitude and practice of the people towards TB, the social stigma of TB, and poor health seeking behavior of the community. Upon assessing the gaps and challenges of the NTP, several strategies were done aligned with the Philippine Plan of Action to Control Tuberculosis (PHILPACT) Strategies which eventually strengthened the Health System quantified using the Local Health System Score Card using Key indicators. The strategies utilized for this activity for the period of July 2013 to August 2014 included the following: Activation of the Local Health Board (LHB), Lobbying of TB Ordinance, GIDA/RNHEALS nurses given catchment barangays, active case finding, performance-based incentives, regulation of Barangay Drive Workers (BHW), BHW training on TB, Regular Program Implementation Review (PIR), Engagement of Barangay LGUs and private partners, Information Education, Communication (IEC)Campaign with 4Ps members, advocacy via social marketing scheme, Tuberculosis - Directly Observed Treatment Shortcourse (TB-DOTS) Accreditation from Philhealth, and financial support for Tuberculin Skin Testing (TST) and chest x-ray. The strategies mentioned above significantly increased the CDR of TB-All Forms during a six-month period upon start of the APP implementation with 48% and 46% CDR-all forms from June to December 2013 and January to June 2014 respectively. The national target is currently 45% for a six month period. Using the Health System, it was noted that there was a direct relationship of health System and the CDR of TB-all forms. CDR trend increased upon the strengthening of the Health System on two six-month periods from July to December 2013 and January to June 2014 upon the implementation of the APP thereby achieving the national target. However, it was also found out in this study that strengthening the health system has its limit and that it cannot address other determinants of health outcomes such as social determinants and human behavior. Some recommendations for this APP include: institutionalizing Health Systems Framework in Annual Health Plan, consideration of Health Systems, Human Behavior and Social Determinants Framework to aggregate these to be able to create a holistic approach in achieving better health outcomes, and consider RNHEALS Nurses as health manager in a barangay. Several public management concepts were utilized in the implementation of this APP. These includes the bridging leadership framework in engaging the BLGU and LGU to gain support for the local TB program; the health sector reform agenda in regulation and payment (in the form of incentives) were tweaked to improve the efficiency of the BHWs on case finding of TB Symptomatic; the new Public Management Concepts and the Participative Management style of the Organizational Behavior Theory were mostly integrated in the authors function as municipal health officer.