Peters, L. D. A. (2017). Improving access to TB services using a health system approach in Agutaya, Palawan (Unpublished master's thesis).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 7 Thesis (MPM-HSD)--Development Academy of the Philippines.

Tuberculosis remains a global health concern today despite decades of programs targeted against it. In the Philippines, gains have been made in achieving targets such as the Millennium Development Goals regarding TB, but significant variations in health indicators across localities still exist. This is evident in Agutaya, Palawan, a 5th class island municipality where TB was found to be one of the leading causes of mortalities in 2015, and whose TB Case Detection Rate (CDR) has consistently remained below national targets, tallying a dismal 44% in 2015. This study aimed to address the problem pf tuberculosis in Agutaya by employing a dynamic health systems approach. Using document review, key informant interviews, and focused group discussion, gaps in the current implementation of TB control were assessed, revealing poor NTP implementation and notably poor access to TB services. Proposed interventions were elicited and framed within a health systems approach, coming up with measures to be implemented for each health system component, in particular completion and equipping of TB DOTS Facility, Training of Midwife as Microscopist, Training of BHWs on TB and TB Remote Procurement Plan and Schedule, Certification and Accreditation of TB DOTS, an Adoption of a Local Ordinance on TB. The actual implemented interventions included measures adopted for each health system building block. Effects of the implemented interventions were assessed, showing significant increase in the TB indicator of interest CDR, which increased by 136% from the year prior to the study as well as subjective benefits among community members, such as patient satisfaction with the increased access to services and less out of pocket expenses. This Action Plan and Project revealed that with an integrated community driven and context based approach to health systems gaps, considerable gains can be achieved in attaining health targets.