Sarip, R. M. (2017). Improving TB outcomes thru community - based approached in Pantao Ragat, Lanao del Norte (Unpublished master's thesis).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 6 Thesis (MPM-HSD)--Development Academy of the Philippines.

Tuberculosis is a highly contagious and airborne. WHO ranks pulmonary tuberculosis as the second leading cause of death from a single infectious agent. Although TB mortality rate has decreased by 45% since 1990, 1.5 million people died from it in 2003. More than half of TB patients come from South-East and Western Pacific Regions. In the Philippines, TB still remains as one of the major public health problem. It is the 6th leading cause of Mortality according to Department of Health. Programs have been implemented by the government to improve TB detection and cure rate in the country as part of its MDG goals and to attain the disease eradication. One of the current programs in the country to TB problem is the DOTS. This was then expanded upon the endorsement of STOP TB Strategy by the WHO. This was then translated by the DOH with the issuance of the 2010-2016 Philippine Plan Action to Control TB (PhilACT) This action plan and project aimed to improve TB outcome by identifying the different barriers, identifying and implementing strategies thru the different health system building blocks namely, governance and leadership, health service delivery, human resource, regulation, policy and health information. Data review revealed that the indicators for TB were all very low. Case detection rate and Care rate was at 16.4% and 0% for 2014 while 13.9% and 100% for 2015. It was also noted that case holding during these years were very poor with 7/12 and 9/15 lost to follow-up patients respectively. KII and FGD were done in order to identify factors that affect the successful implementation of NTP program in the community. Among the identified barriers from the KII were low knowledge on TB, distance, poverty, laziness, low program awareness, and stigma. Knowledge Awareness and Perception survey was also employed in this study which revealed indeed poor knowledge on TB disease especially on the cause of the disease and its transmission. FGD among TB patients on the other hand revealed that contrary to many studies, stigma, cost and distance was not a factor to delayed diagnosis. Majority of the patients identified as not having able to recognize the gravity of their symptoms as the primary reason for their delay. Meanwhile 20% of them attributed their delay to the lack of knowledge of where to go. Furthermore, this study also revealed that the successful implementation of NTP in this municipality is not only due to patient/individual factors but is also due to health facility factors. Assessment revealed there is poor service delivery due to lack of health facility, human resource, governance and medicine and other supplies. The poor TB outcome in the community therefore was not merely a question of poor knowledge but interplay of many factors including governance of leadership, health service, human resource, regulation and policy. It is this context that strategies were formulated building on the different health system building blocks to improve TB outcomes. Identified strategies has improved TB outcomes. Case Detection Rate has doubled from 16.4% to 37.8%. Case holding has also improved with 0 lost to follow-up patients with no recorded mortality. During the conduct of this action plan and project, some problems were encountered as well as strategies encountered with could have helped to improved TB outcomes in the area. Therefore, as part of this study recommendation include the institutionalization of teams in each barangay to augment the workforce in the campaign to end TB and provide incentives to improve high case findings and notifications. It is also recommended to involve the DepEd in the intensive education campaign on TB. Furthermore, to accredit the TBDOTS facility to Philhealth for a better funding of medicines and other supplies. Lastly, to incentivize patient who complete the treatment to further encourage or ensure high case holding case, tratment completion and cure.