USAID/ TB PLATFORMS FOR SUSTAINABLE DETECTION, CARE AND TREATMENT

Agreement Information: This program is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Agreement Number 72049218CA00005 (USAID TB Platforms Project) held by prime recipient University Research Co., LLC (URC). The TB Platforms Project is funded and managed by USAID/Philippines.

Prepared by: University Research Co., LLC

Submitted by: Marianne Calnan Chief of Party University Research Co., LLC 17/F Luz Building, 116 Gamboa St., San Lorenzo, City Phone: 09176209812 E-mail: [email protected]

Submitted to: Tito F. Rodrigo Project Management Specialist (Infectious Disease) USAID/Philippines Email: [email protected]

Bryn Sakagawa Director, Office of Public Health Email: [email protected] Phone: +632-301-2000 ext. 4869

For More Information: Neeraj Kak, Ph.D. Senior Vice President University Research Co., LLC Tel: +1-301-941-8626 Cell: +1-240-460-6250 Email: [email protected] Web: www.urc-chs.com

USAIDTB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October 1, 2019 – December 31, 2019 i

Table of Contents

1. Activity Overview ...... 7 1.1 Activity Information ...... 7 1.2 Activity Description...... 7 1.3 Key Achievements for the Quarter ...... 9 2. Performance Status ...... 12 2.1 Summary of Performance for the Quarter ...... 12 A.1 Performance of Key Indicators by Objective ...... 12 A.2 Performance of Key Activities ...... 25 3. Key Challenges and Proposed Solutions ...... 32 4. Cross-Cutting Issues ...... 36 4.1 Update on Sustainability and Self-Reliance ...... 36 4.2 Update on Gender ...... 37 4.3 Update on Private Sector Engagement ...... 37 4.4 Update on Environmental Compliance and Climate Risk Mitigation ...... 38 5. Collaboration, Learning, and Adapting ...... 38 5.1 Coordination and Collaboration ...... 38 5.2 Learning...... 40 5.3 Adaptive Management ...... 42

7. High-Level Planned Activities for Next Quarter Including Upcoming Events ...... 43 8. Annexes ...... 46 8.1 Progress on the Activity MEL Plan ...... 46

8.3 Potential Success Stories, Pictures, etc...... 50 8.4 Summary of Local Legislations in TBP supported sites ...... 53

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Table of Figures: Figure 1: An open forum on how to utilize the USAIDs TB Platform community screening and referral tools encourages participants to raise their concerns...... 13 Figure 2: USAID’s TB Platforms and DOH-R3 led by Ms. Geliza Recede, NTP Nurse Coordinator discuss policy development for the Regional Policy for TB-HIV in the Workplace...... 13 Figure 3: FAST Cascades by Region ...... 14 Figure 4: Trends in Bacteriological Confirmation of TB Cases by Region, October 2018 to December 2019 ...... 15 Figure 5: Engaging Mayor Francisco “Isko” Domagoso to sign the City TB Ordinance ...... 20 Figure 6: presenting the results of the economic analysis to the LCE of the Municipality of Castillejos, in Zambales. The analysis produced evidence that convinced the Local Health Board to increase the budget allocation for the Local TB Program...... 21 Figure 7: BHWs reviewing community-based screening data in picture to the left. In picture to the right, BHWs conducting community -based TB screening ...... 21 Figure 8: A participant during the Mentoring Workshop for the Enhanced FDS-TB module in Bataan and Nueva Ecija, presenting their group output for the “Kwentong May Kwenta”, Session 2 of the Enhanced DSWD FDS-TB module (Photographer: PKV Sarmiento) ...... 22 Figure 9: DOH-R3 NTP Nurse Coordinator, Ms. Geliza Recede, doing a feedback of the monitoring findings and recommendations to the Chief Nurse and Chief Med Tech of Baliuag District Hospital, during the joint monitoring visit (Photographer: TBP-R3 CJ Candari) ...... 23 Figure 10: Group photo of the technical team of Central Luzon Joint Program Review taken at the Central Luzon Doctors’ Hospital, Province of Tarlac (Photographer: AC Yusi) ...... 23 Figure 11: Hon. Nasif Marangit [standing in the middle], City Councilor of Marawi, proposed to tap the help of muslim religious leaders and traditional leaders in increasing awareness of the community regarding tuberculosis. 24 Figure 12: DOH Region 3 and the Province of Tarlac sponsored the Training of Trainors for the Community Health Workers for the Province of Tarlac last October 23-25, 2019...... 36 Figure 13: Snapshots of the TB Platforms’ Tibay ng Dibdib Interactive Panels being used during COME ALIVE trainings and medical missions ...... 37 Figure 14: Miss Earth 2019 Janelle Lazo Tee attended the TB 101 session provided by TB Platforms as she will be #EndTB Celebrity Ambassador during her reign and will join various advocacy events to help raise public awareness and reduce the stigma of tuberculosis ...... 37 Figure 15: Rev. Fr. Anton Pascual, Caritas Manila’s Executive Director pledged his full support to the EndTB Campaign and committed to work with TB Platforms in line with community TB screening and raising TB awareness...... 38 Figure 16: TB Platforms and DOH-Region 3 staff having a joint learning session ...... 39 Figure 17: TB Platforms staff discusses the findings of the 2016 National Tuberculosis Prevalence Survey (NTPS) as introduction to and rationale of the Learning Session on the Establishment of TB-DOTS Facility at Ramon Magsaysay Memorial Hospital ...... 39 Figure 18: TB Platforms provided five cellphones with the ConnecTB app that will monitor treatment adherence of and adverse drug reactions among an initial 12 TB patients from five barangays in the municipality of Polillo...... 40 Figure 19: Antipolo STC nurse interviewed and counseled DR TB patients during the training. The information derived from this encounter will be recorded in the ConnecTB application for real-time monitoring. (Photo: APascua/URC)...... 41 Figure 20: TB Platforms MDR TB PCC Specialist Dr. Christian Villacorte oriented treatment partners on DR TB and explained the importance of adherence to MDR treatment regimen and DR TB management. He also stressed how to identify and ad-dress adverse drug reactions: (Photo: Apascual/URC)...... 41 Figure 21: TB Platforms led by its Chief of Party, Dra. Marianne Calnan (third from left) turned over to Antipolo City Mayor Andrea Ynares 14 units of mobile phones for ConnecTB...... 41 Figure 22: A cluster of patients projected in a map generated by ConnecTB this can eventually help identify potential hot spots areas ...... 42 Figure 23: USAID’s TB Platforms met with Rogaciano Mercado Memorial Hospital staff and the family of Whiskey and Champagne for documentation and follow up medical consultation...... 45

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October 1, 2019 – December 31, 2019 iii

List of Abbreviations

4Ps Pantawid Pamilyang Pilipino Program ACCESS TB Advancing Client-centered Care and Expanding Sustainable Services for Tuberculosis ACF Active Case Finding ADR Adverse Drug Reaction ADSM Active Drug Safety Monitoring AFB Acid-Fast Bacillus AIPI Angeles Industrial Park, Inc. ALIVE Ask-Listen-Inform-Verify-Encourage AMELP Activity Monitoring, Evaluation, and Learning Plan AOR Agreement Officer’s Representative BC Bacteriologically Confirmed BCC Behavior Change Communication BHW (Village) Health Worker CBO Community-Based Organization CD Clinically Diagnosed CFZ Clark Freeport Zone CHD Center for Health Development CHO City Health Office/Officer CHV Community Health Volunteer CLA Collaborating, Adapting, Learning CLAimHealth Collaborating, Learning and Adapting for Improved Health CNR Case Notification Rate COME ALIVE Communicate and Mentor Effectively through Asking questions, Listening, Informing, Verifying, and Encouraging COP Chief of Party CRM Climate Risk Management CXR chest X-ray CSO Civil Society Organization DOH Department of Health DOH CHD Department of Health Center for Health Development DOH-NTP Department of Health National Tuberculosis Control Program DOTS Directly Observed Treatment Short Course DQC Data Quality Check DR-TB Drug-Resistant Tuberculosis DS-TB Drug-Susceptible Tuberculosis DSWD Department of Social Welfare and Development EMMP Environmental Monitoring and Mitigation Plan FAST Find Cases Actively, Separate Safely, and Treat Effectively FFCAT Full-scale Focused Campaign against Tuberculosis FY Fiscal Year Xpert MTB/RIF GeneXpert Mycobacterium tuberculosis/Rifampicin assay GEWE Gender Equity and Women Empowerment GFATM Global Fund to Fight Acquired Immunodeficiency Syndrome, USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October 1, 2019 – December 31, 2019 iv

Tuberculosis and Malaria GF Global Fund HCPN Health Care Provider Network HCW Health Care Worker HEPO Health Education and Promotion Office/Officer HIV Human Immunodeficiency Virus IC Infection Control ICF Intensive Case Finding iDOTS Integrated Delivery of TB Services IHLGP Institutionalization of Health Leadership and Governance Program IHSS Tuberculosis Innovations and Health Systems Strengthening IP Implementing Partner IP Connect Infection Prevention Connect IPT Isoniazid Preventive Therapy ITIS Integrated Tuberculosis Information System LCE Local Chief Executive LGU Local Government Unit LPA Line Probe Assay LTFU Lost to Follow-Up MHD Manila Health Department MNCH Maternal, Newborn, And Child Health MNCHN Maternal, Newborn, And Child Health and Nutrition MDR/RR TB Multidrug-Resistant/Rifampicin-Resistant Tuberculosis MDR TB Multidrug-Resistant Tuberculosis MHO Municipal Health Office/Officer MOP DOH NTP Manual of Procedures MTaPS Medicines, Technologies and Pharmaceutical Services MTB/RIF Mycobacterium tuberculosis/rifampicin NCR National Capital Region NGO Nongovernmental Organization NNS Number Needed to Screen NTP National Tuberculosis Control Program OFW Overseas Filipino Workers OP/PPR Operational Plan/Performance Plan and Report PBSP-GF Philippine Business for Social Progress – Global Fund PCC patient-centered care/ Provincial Coordinating Committee PCUP Philippine Commission for the Urban Poor PHIC Philippine Health Insurance Corporation PhilCAT Philippine Coalition against Tuberculosis PhilHealth Philippine Health Insurance Corporation PhilSTEP 1 Philippine Strategic Tuberculosis Elimination Plan 1 PHO Provincial Health Office/Officer PHO/CHO Provincial Health Office/City Health Office PhP Philippine Peso PIR Program Implementation Review PITT Performance Indicator Tracking Table

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PLHIV Person Living with Human Immunodeficiency Virus PLM Pamantasan ng Lungsod ng Maynila (University of the City of Manila) PMDT Programmatic Management of Drug-Resistant TB PRC Philippine Red Cross Q1 Quarter 1 Q2 Quarter 2 Q3 Quarter 3 Q4 Quarter 4 QI Quality Improvement RO Regional Office RR/MDR Rifampicin-Resistant/Multidrug-Resistant Tuberculosis RR TB Rifampicin-Resistant Tuberculosis RTDL Rapid TB Diagnostic Laboratory SBC Social and Behavior Change SBCC Social and Behavior Change Communication SBFZ Subic Bay Freeport Zone SDN Service Delivery Network SOP Standard Operating Procedure SSS Social Security System STC Satellite Treatment Center STRider Sputum Transport Rider TA Technical Assistance TB/HIV Tuberculosis Human Immunodeficiency Virus TBP8 Tuberculosis Elimination Plan TB Platforms Tuberculosis Platforms for Sustainable Detection, Care and Treatment TBTF Tuberculosis Task Force ToT Training of Trainers TPM Third Party Monitoring TREAT TB Technology, Research, Education and Technical Assistance for Tuberculosis UHC Universal Health Care URC University Research Co., LLC USAID United States Agency for International Development USD United States Dollar USG United States Government WHO World Health Organization

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1.3 Key Achievements for the Quarter

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019

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Achievement for the quarter: 44%

Screening and Diagnosis • During this reporting period, USAID’s TB Platforms provided technical assistance to DOH to diagnose and treat 32,552 DSTB patients and 954 DRTB patients. • The COME ALIVE strategy was embraced by DOH Regions 3 and 4-A. Both regions committed funding for the continuous roll out of COME ALIVE workshops. DOH Region 3 in partnership with the Provincial Government of Tarlac provided leverage funding of P384,000 for the COME ALIVE Training of Trainers which included BHW Presidents of all barangays in the Province. The Tarlac BHW presidents committed to echo their learnings to their community health workers and support the TB-related activities in the province. DOH Region 4-A included in their annual budget a fund allocation covering COME ALIVE activities for Year 2020. • A total of 602 BHWs were mentored using the COME ALIVE strategy and contributed to 1,044 notified TB cases in Region IV-A.

Objective 2: Deliver high-quality patient-centered TB and DR-TB treatment for adults, children and vulnerable populations Outcome Result: 85% of DR-TB patients will be treated successfully by 2022 Achievement of the quarter: 61% Treatment and Care • USAID’s TB Platforms has engaged 2 hospitals and 23 RHUs in Bataan Province for implementation of Patient-centered care package and a total of 150 patients were enrolled as of this quarter. • The project introduced an Mhealth app, ConnecTB for monitoring of DRTB patients. During this reporting period, a total of 51 patients were enrolled (12 in Polillo, Island and 39 in Antipolo) and are being monitored through ConnecTB app. To date, none of the enrolled clients have been lost to follow up and no serious adverse events have been reported. Workplace TB Programs • USAID’s TB Platforms through the Gerry Roxas Foundation (GRF) partnered with the Araneta Group of Companies in assisting informal workers to claim SSS benefits amounting to around Php18,000 while undergoing TB treatment (the HR department issued a policy for affiliate agencies to require prior and annual X-ray screening of its employees; with the assurance that the company will provide for the diagnosis and treatment of identified patients).

Objective 3: Expand Local Health Systems capacity to deliver TB and DR-TB services to targeted populations Outcome Result: 84 assisted local administrative units will have clear and costed localized TB elimination plans • USAID’s TB Platforms technical assistance to LGUs include the passing of the TB Ordinances in and Manila. For Pasig, an annual budget of Php 2M, creation of a local TB Council and implementation of FAST in hospitals were the 3 major components in the TB Ordinance. In Manila City, USAID’s TB Platforms was able to encourage the local to raise the annual TB allocation to Php 3M under TB Ordinance No. 8592 passed in December 2019. • During this reporting period, the project led and organized 6 joint monitoring visits involving DOH, WHO and other TB implementing partners. The purpose of these visits was to provide comprehensive monitoring and mentoring for TB services as well as identify gaps in provision that need strengthening. • USAID’s TB Platforms also participated in the drafting of the Regional Policy about TB in the Workplace and Regional TB-HIV Guideline which once approved will be implemented regionwide.

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TB Platforms is working out an evidence- based financing plan for local TB programs. TB Platforms embarked on a cost-benefit analysis of multiple TB investment scenarios in the Municipality of Castillejos, Zambales. The results of the cost-benefit analysis convinced the Municipal LCE that TB is indeed a major public health concern in the community and that resources must be augmented to address this problem. As a result of the evidence presentation, the budget for health allocated by the LGU increased by 42% from PhP 24 million in 2019 to PhP Figure 6: presenting the results of the economic analysis to the LCE of the Municipality 34 million in 2020. Of the PhP 34 million, of Castillejos, in Zambales. The analysis produced evidence that convinced the Local PhP 3.25 million (10%) was allocated to Health Board to increase the budget allocation for the Local TB Program. TB. This amount will be spent to procure TB drugs for children as well as supportive drugs for TB patients, and to finance TB screening activities.

(4) Capacity-Building COME ALIVE Mentoring Program

Through TB Platforms’ COME ALIVE mentoring module, 1,674 community health workers in partner LGUs in Regions 3, 4-A, NCR and Marawi City were trained as of last quarter. The COME ALIVE approach was recognized by the DOH as an effective strategy to do case-finding among high-risk groups, through active community-based screening and contact investigation. Recognizing the potential of the approach, DOH Region 3 allotted Php 384,000 (USD 7,519) to fund the capacity-building of BHWs in the Provinces of Tarlac and Bataan using the COME ALIVE approach. Region IV A also committed to allocate funds for the roll-out of COME ALIVE in selected areas. The approach aims to complement the National Communication Strategy proposed by the DOH.

Figure 7: BHWs reviewing community-based screening data in picture to the left. In picture to the right, BHWs conducting community -based TB screening Usapang Dibdiban: TB 101 Orientation for LCEs, TB Council and Community Members TB Platforms designed and implemented the ‘Usapang Dibdiban’ TB orientation for LCEs and TB Council members. Aimed at securing local ownership of the TB program, TB Platforms conducted the orientation in cities of Pasig, , Manila and Paranaque, to sensitize LCEs, TB Councils and community members on the health and economic burden of TB, build awareness and motivate action. The orientation also USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019

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Technical assistance to help TB-DOTS Facilities acquire DOH Certification has also been provided by the project. In Region 3, TB Platforms has helped 3 TB-DOTS Facilities acquire TB-DOTS Certification – Romana Pangan District Hospital, Floridablanca RHU I and Floridablanca RHU II – all in the Province of Pampanga. In particular, the TA consists of educating the TB Program Coordinators about the requirements for the certification, as stated in the DOH Self-Assessment Form for TB-DOTS Certification. Ocular surveys of the TB-DOTS facilities were done to verify if the facilities could comply with the requirements. In cases where requirements are not met, TB Platforms provides technical advice. The project also conducted ‘mock’ validation visits to prepare the facility, prior to the actual validation visits and certification processes to be conducted by the DOH.

(7) Joint Monitoring Activities During this reporting period, TB Platforms joined other projects and external stakeholders in monitoring TB facilities and mentoring and coaching local TB personnel. In October 2019, TB Platforms joined the DOH-Region 3 and Philippine Business for Social Progress (PBSP) in its monitoring visit to three facilities in the Province of Bulacan. Sites covered by the monitoring include TMLs, RTDLs, TB-DOTS Facility and PMDT-STCs. In the same period, the project team participated in the monitoring visits of 8 facilities in Tarlac Province These visits included representatives from the Global Fund, WHO, Taiwan CDC, PBSP, DOH-Region 3, RITM-NTRL, Tarlac PHO and MHOs. The objective of the visits was to assess the progress of strategic TB elimination efforts in the different service delivery points and evaluate best practices and challenges in the TB cascade of care.

From November to December 2019, TB Platforms also conducted joint monitoring visits in Region IV-A covering the provinces of Batangas, Cavite, Laguna and Quezon and in NCR. A total of 7 facilities were visited, composed of 4 health centers and three district hospitals. Sites monitored include RTDLs, PMDT-STCs, TMLs and TB-DOTS Facilities. Joining the visits were representatives from the DOH-Region 4-A, WHO and TB Innovations. In all cases, findings from the monitoring visits were collated and discussed with the respective TB Program Coordinators of the facilities visited, for their appropriate action.

Figure 9: DOH-R3 NTP Nurse Coordinator, Ms. Figure 10: Group photo of the technical team of Central Geliza Recede, doing a feedback of the monitoring Luzon Joint Program Review taken at the Central Luzon findings and recommendations to the Chief Nurse Doctors’ Hospital, Province of Tarlac (Photographer: AC and Chief Med Tech of Baliuag District Hospital, Yusi) during the joint monitoring visit (Photographer: TBP- R3 CJ Candari)

(8) Coordination, Collaboration and Partnerships for Program Planning and/or Implementation USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019

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Community volunteers (other Assist in setting up tracking USAIDs TB Platforms will than BHWs, such as TBTF and mechanism together with partner work with respective CHOs LGU health officials) are not able CHOs/HCs. and HCs. to follow up on outcome of cases referred since they are engaged only to screen and refer TB presumptive persons. They lack the resources to follow up on the results of their referrals. There are still practices within Continue to mentor and coach Strengthen partnership with FAST implementing hospitals to hospital staff to immediately request FAST implementing hospitals request for CXR among already for Xpert MTB/RIF or DSSM (in identified presumptive TB parallel to CXR if they deem it still patients in hospitals. This creates necessary to rule out other diseases) an additional step which makes it more difficult for patients to Continue to advocate for sputum comply (due to factors related to collection onsite for those with no cost, time, accessibility of CXR TML or RTDL services) Link more hospitals to the ACCESS TB STRIDERS for sputum transport and enhance feedback mechanism between the hospitals and RTDLs Not all RTDLs are aware of the Assist in disseminating the memo on Disseminate and reorient memo that Xpert MTB/RIF test is Xpert MTB/RIF testing partners on the Xpert already the primary diagnostic MTB/RIF testing guidelines tool in certain catchment areas Possible overdiagnosis among Indicator TBP4 Improve clinical diagnosis through Advocate and strengthen clinically diagnosed TB patients Percentage of quality improvement procedures partnership with health • Initiating treatment among Notified New and facilities implementing TB those with CXR findings but Relapse TB cases program. with no signs and symptoms with Bacteriological of TB Confirmation • There are patients with CXR findings are not necessarily referred to physicians for assessment Not all LGUs procure INH (adult Indicator TBP5 Continue/Include in advocacy to LCE Encourage CHOs/MHOs to and children) Number of eligible and local health offices to include influence the local TB patients with INH in their annual procurement Council to appropriate funds negative TB test plan specifically for TB drugs in started on annual budget plan preventive therapy Contact tracing done in facilities Strengthen linkage of community Promote public awareness where community screening by screening of household contacts with on TB BHWs are done; however, these TPT are not necessarily linked to TPT

Not all clients who undergo TPT Mentor and coach health facilities on Continuous monitoring of are recorded and reported recording and reporting of patients mentored health workers on provided TPT recording and reporting of TB cases

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Indicator TBP11 Promote public awareness Number of on TB Individuals targeted by CSOs with TB outreach, care, advocacy and case- finding activities Objective 2: Deliver high-quality patient-centered TB and DR-TB care and treatment for adults, children, and vulnerable populations Irregular supply of Xpert TB7 Advocacy for LGU support in MTB/RIF cartridges procurement of Xpert MTB/RIF cartridges Limited criteria for Xpert TB7 MTB/RIF eligibility Non-functional iDOTS TBP6/TB4 Monitoring and supportive facilities supervision Poor ADR management TBP6/TB4 Capacity building of healthcare workers on management of severe ADRs Objective 3: Expand Local Health Systems capacity to deliver TB and DR-TB services to targeted populations *Data to be derived from the 2022 Proportion of TB- Catastrophic Cost Study affected families with catastrophic TB-related expense (TB2) • Delayed delivery of drugs to Average stock-out • TBP to link local TB Personnel the local facilities (due to rate of selected to Technical Assistance Provider geographic and administrative anti-TB drugs and (mTAPs) on functional supply barriers) TB laboratory chain and logistics management • Lack of or weak re- tracer commodities (i.e. accurate forecasting, timely distributions systems for TB at USG-supported distribution, appropriate storage commodities between NTP facilities in and dispensing and waste facilities USG-assisted sites disposal) • Lack of LGU budget for (TB9) • Assist in the passage of local procurement of drugs and ordinance that will mandate LGU other commodities ownership of the TB program • Inadequate capacity for and ensure budget allocation for accurate forecasting TB drugs, creation of the TB council to supervise all TB program activities (facilities, commodities, etc.) • TBP to assist in the training of LGU local procurement officers on the new procurement law, in line with the Universal Health Care approach

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• Most LGUs have no funds Number of • TBP to continually help LGUs earmarked specifically for TB. administrative units pass local ordinances that would The earmarked budget for (provinces, cities earmark funding specifically for health is divided across and municipalities) TB multiple programs, all with clear and • Provide continuous technical competing for resources. This costed localized TB assistance on the development of restricts budget planning for elimination plans clear and costed TB plans TB. (TBP8) • Inadequate local capacity for evidence-based TB program planning and costing • Inadequate knowledge of Percentage of • Educate health personnel on the health personnel on the DOTS facilities that requirements and process of requirements for and process are DOH/PhilCAT- DOH certification and Philhealth of DOH certification and certified and accreditation, and assist them in Philhealth accreditation Philhealth- their preparations • Health workers do not accredited at the • Advocate to LCEs to allow a directly benefit from same time (TBP9) reasonable proportion of the Philhealth capitation funds reimbursements to directly because all reimbursements benefit TB program proceed directly to the implementers municipal trust fund • Work with the DOH and dedicated to all health Philhealth on how to make programs certification and reimbursements • Some LGUs are discouraged processing more efficient and from applying for Philhealth less tedious accreditation, given the tedious requirements and bottlenecks in reimbursements processing and claims • Lack of med techs to perform Proportion of • Advocate to LCEs to recognize EQA laboratories the efforts of controllers and • Multi-tasked/overworked providing TB develop an incentive mechanism med techs examinations that • Engage private TMLs to • Delayed feedbacking of EQA participate in the participate in the EQA results due to lack of NTRL-prescribed • Collaborate with TB Innovations controllers at the sub- EQA system for all national level TB laboratory • No incentive provided to methods, expressed controllers for performing as a percentage EQA work (outside of their (TBP10) official job description) • While all public TMLs are performing adequately to EQA standard, engagement of private TMLs is sub-optimal.

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• In some cases, regions are Percentage of • Capacitate local health personnel inclined to make program Regions using on how to analyze TB data and decisions based on history Information for use it for programmatic decision- rather than current evidence Evidence-Based making • Inadequate capacity of some Decision-Making local TB personnel on TB (TBP12) data analysis and utilization for programmatic decision- making • Irregular monitoring visits Number of joint • Assist in the orientation of local • Need to capacitate local TB supervision/monitor TB personnel on the DOH TB personnel on the use of ing conducted with Program Monitoring Tool and DOH TB Program another how they can comply with its Monitoring Tool project/external requirements • Absence of mechanisms to stakeholders per • Clarify with health workers their follow-up on the actions done year (TBP15) deliverables in terms of TB to address findings of the program targets monitoring visits (Lack of • Assist the DOH in establishing a reporting and feedback reporting and feedback mechanisms for monitoring mechanism for monitoring activities) activities) • Engage local TB councils to oversee monitoring visits on a regular basis

4. CROSS-CUTTING ISSUES

4.1 Update on Sustainability and Self-Reliance

During this reporting period, TB Platforms, in partnership with DOH Region 3, continued its COME ALIVE workshops. This time, LGUs committed to fund the training costs and some logistical requirements. The local government of Tarlac, during its roll-out of the COME ALIVE training for community health workers, funded around Php 384,000 for the workshop expenses of 45 participants from the whole province of Tarlac representing 17 LGUs. This consists of reproduction of training materials and logistical requirements. Last December, DOH Region 3 reproduced TB Platforms’

Tibay ng Dibdib Interactive Panels which will be distributed Figure 12: DOH Region 3 and the Province of Tarlac sponsored to its 27 centers as tools for their TB education. These the Training of Trainors for the Community Health Workers for interactive panels are conceptualized and produced by TB the Province of Tarlac last October 23-25, 2019. Platforms to inform, educate and entertain stakeholders during TB Education activities. DOH Region 3 allocated Php 2 million for the reproduction of these interactive panels. TB Platforms and DOH Region 3 will have a ceremonial turn over and roll out of TB education next month.

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Figure 13: Snapshots of the TB Platforms’ Tibay ng Dibdib Interactive Panels being used during COME ALIVE trainings and medical missions

4.2 Update on Gender

To address the higher TB prevalence among men, TB Platforms worked in male-frequented settings. The project conducted ACF events and pursue intensive case-finding interventions in facilities offering male- dominated services (like drug rehabilitation centers and training centers for Overseas Filipino Workers (OFW) seafarers), as well as TB screening for women and children in health facilities.

4.3 Update on Private Sector Engagement

Last quarter, TB Platforms started its collaboration with Miss Earth 2019 Janelle Lazo Tee for the #EndTB campaign. Carousel Productions, the official carrier of the Miss Earth pageant, and TB Platforms will support Ms. Tee’s activities as the #EndTB Celebrity Ambassador. She will be joining major health education campaigns and activities in Regions 3, 4-A, NCR, and Marawi. Using Miss Earth’s network and social media accounts, Ms. Tee will be promoting TB Platforms’ activities. She will be joining LGU visits and mobilization campaigns along with other TB implementing partners during the World TB Month celebration. During press conferences and media interviews, she will speak about why Miss Earth joined the #EndTB campaign and how health education relates with their campaign promoting the Figure 14: Miss Earth 2019 Janelle Lazo Tee attended the TB 101 session provided by TB Platforms as she will be #EndTB Celebrity Sustainable Development Goals especially in the context of Ambassador during her reign and will join various advocacy events to environment and health. help raise public awareness and reduce the stigma of tuberculosis

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During this quarter, TB Platforms started its partnership with E-Artistshop, a leading advertising agency who committed to provide free use of their LED Billboards in Ayala-Rufino Avenue underpass in Makati City, LED TVs in major airports and universities. To date, TB Platforms is developing advocacy materials which will be featured through E-Artistshop’s channels.

Additionally, TB Platforms started collaborating with Sa Iyo Lolo at Lola Yantok Aming Alay (SILYA), a nationwide program which promotes care for the senior citizens, one of the demographics most at risk of tuberculosis. SILYA partnered with major malls and restaurants in Luzon, Visayas and Mindanao and provided rocking chairs for senior citizens. Their private partners, in return, provided free stations for these rocking chairs and free use of the events venue for advocacy campaigns. TB Platforms and SILYA will have joint activities for the senior citizens in line with TB education. SILYA committed to promote TB Platforms advocacy using their social media platforms (Facebook, Twitter, website, magazines) as additional support.

Finally, TB Platforms, through the Gerry Roxas Foundation, signed a Memorandum of Understanding with Caritas Manila. Fr. Anton Pascual, Caritas Executive Director committed to Figure 15: Rev. Fr. Anton Pascual, Caritas Manila’s Executive Director pledged his full support to the EndTB Campaign and engage their volunteers in community TB screening and committed to work with TB Platforms in line with community TB provide a one-hour radio program at Radio Veritas 846khz screening and raising TB awareness. which can include a discussion about success stories on health advocacy specifically activities on eradicating TB in the country.

4.4 Update on Environmental Compliance and Climate Risk Mitigation

TB Platforms introduced to LGU partners and health facilities the “Guidelines for Managing TB program During Disasters” (DOH AO 2015-0039). Continuous mentoring of health workers will be done in the next quarter and TB Platforms will reiterate some of the important highlights of the guidelines. To date, FAST-implementing hospitals, health centers and RHUs were provided important reference materials on TB and local NTP Managers are mentored on disaster-resilient activities. Initial discussions on the implementation of TOT was conducted by TB Platforms in December 2019. For the next quarter, TB Platforms will provide technical assistance to pilot LGUs in the drafting of their local actions related to how the environmental compliance and climate risk mitigation guidelines will be implemented in the facilities under their jurisdiction.

5. COLLABORATION, LEARNING, AND ADAPTING

5.1 Coordination and Collaboration

Todas ang TB Todits: Collaboration and Partnership with the City of Manila to End TB TB Platforms has collaborated with the City of Manila to hold a ceremonial event, where the Manila LCE will declare his commitment to end TB in Manila and engage all private and public sectors and communities in the city to support this endeavor.

Usapang Dibdiban: Collaboration with the Development Authority (MMDA) – Metro Manila Council on Ending TB TB Platforms facilitated the development of the resolution to end TB at NCR, which was approved by the

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MMDA’s Metro Manila Council. In relation to this, TB Platforms planned an ‘Usapang Dibdiban’, an open forum which will serve as the venue for council members and citizens of Manila to be informed of the status of TB in their community, discuss issues and challenges, and collaboratively identify solutions.

Collaboration with the DOH-NTP, WHO and GCF for the Updating of the Philippine Strategic TB Elimination Plan (PhilSTEP) TB Platforms participated in the updating of the PhilSTEP, spearheaded by the DOH-NTP. In particular, TB Platforms was consulted for critical interventions that can push for social behavioral change, TB stigma reduction, and promotion of health-seeking behavior.

Collaboration with the DOH-Region 3 NTP for a Learning Session on the TB Dashboard for Evidence-Based Decision-Making TB Platforms held a joint learning session on the TB Dashboard developed by WHO, in collaboration with the DOH-Region 3. The session consisted of interactive learning on how to use and manage the applications of the dashboard, in relation to TB program and project implementation in the field. To help increase the population testing rate, DOH- Region 3 committed to providing TB Platforms free Styrofoam boxes for the BHWs’ sputum collection during COME ALIVE case-finding activities.

TB Platforms also participated in the conduct of the Figure 16: TB Platforms and DOH-Region 3 staff having a joint learning TB Dashboard Orientation for all TB Program session Managers in Region 3. The activity was spearheaded by DOH-Region 3, in collaboration with WHO.

Collaboration with Hospitals for the Establishment of the hospital’s TB-DOTS Facility In Region 3, FAST-implementing hospitals include the Ramon Magsaysay Memorial Hospital, Diosdado M. Macapagal Memorial Hospital and DOH Drug Abuse Treatment and Rehabilitation Center.

Currently in TB-DOTS-referring hospitals, numbers of patients tend to be lost to follow-up, when they refuse to go to catchment RHUs where they are referred for treatment. To address this, TB Platforms has collaborated with the 3 hospitals to facilitate the establishment of their own TB-DOTS Facility. This include Ramon Magsaysay Memorial Hospital, Diosdado Macapagal Memorial Hospital and DOH Drug Abuse. The project provided technical advice on what are the requirements to put up a TB -DOTS facility. Additionally, the project also provided technical assistance on how to eventually apply for the DOH-Certification and Philhealth accreditation of the TB- Figure 17: TB Platforms staff discusses the findings of the 2016 National Tuberculosis Prevalence Survey (NTPS) as introduction to DOTS facilities. Once the hospitals become providers of and rationale of the Learning Session on the Establishment of TB- TB-DOTS, TB patients captured by the hospitals’ FAST DOTS Facility at Ramon Magsaysay Memorial Hospital strategy can receive treatment directly from the hospital. This eliminates the need for referral and minimizes the likelihood of losing patients to follow-up.

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019 39

5.2 Learning

5.2.1 ConnecTB to support referrals, patient care and coordination with community organization

To address the problem of high loss to follow up rates in South Africa, University Research Co., LLC (URC) developed a mHealth application, ConnecTB. This was based on the URC’s experience in successfully implementing mHealth packages in Bangladesh to improve patient retention. ConnecTB uses technologies that are accessible and cost-effective to provide invaluable real-time insight into the quality of program performance.

TB Platforms presented ConnecTB mobile health application to DOH KMITS and had been granted approval to roll out ConnecTB to support TB patient care and management within the community. TB Platforms is completing the adaptation of the Philippine context and will roll out the use of ConnecTB in seven LGUs by the end of FY 2020.

TB Platforms set the following criteria for the initial roll-out of ConnecTB;

• LGUs with a high number of lost to follow up • Availability of HCWs to conduct home visits and to supervise the DOT care providers • Patients living in a hard to reach areas, where ensuring DOT visits is a challenge • High-risk zones: densely populated areas with a high number of TB patients.

During a meeting with the DOH Region 4A office, these criteria were presented. Based on the above criteria DOH Region 4A office suggested two sites. First is Antipolo STC and Polillo RHU second respectively.

Polillo is an island in the province of Quezon with a population of 30,582. There were 74 DSTB patients recorded in 2019. The island is remote in terms of accessibility and communication. Passenger boats are the only way to and from the island. Mobile cellphone coverage is fair with a signal strength of 3G and mostly available in the town center. On September 26, TB Platforms turned five cellphone units over to the Polillo RHU with the ConnecTB mobile health app as part of DOH Center for Health Development in Region IV-A launch of the TB-free Island Initiative in Polillo. Identified treatment partners will use the app to track 12 TB patients’ adherence to treatment. This exercise will help determine how ConnecTB could be adapted to the Philippine context and optimize its effectiveness, particularly in remote areas such as Polillo. Figure 18: TB Platforms provided five cellphones with the ConnecTB app that will monitor treatment adherence of and adverse drug reactions among an initial 12 TB patients from five Since some of the TB patients were in very barangays in the municipality of Polillo.

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019 40

remote areas and it may not be viable for the DOT provider to visit daily 12 TB patients who are residing nearby were selected as pilot. Antipolo City had 70 MDR cases in 2019, however, the team was unable to follow up with 24 of them. Among the 24, 8 were lost to follow up due to ADRs (Adverse Drug Reaction). On November 15, 2019, TB Platforms, in partnership with the City Health Office of Antipolo, conducted a capacity building session on how to improve TB treatment success rates through the adherence of TB protocols. A total of 18 DOT partners, with the supervision of the National Tuberculosis Program (NTP) Nurse Coordinator of Antipolo, attended this training held at the City Satellite Treatment Center. TB Platforms also conducted a hands-on demonstration on how to use ConnecTB.

Figure 19: Antipolo STC nurse interviewed and counseled DR TB patients during the training. The information derived from this Figure 20: TB Platforms MDR TB PCC Specialist Dr. Christian encounter will be recorded in the ConnecTB application for real-time Villacorte oriented treatment partners on DR TB and explained monitoring. (Photo: APascua/URC) the importance of adherence to MDR treatment regimen and DR TB management. He also stressed how to identify and ad- dress adverse drug reactions: (Photo: Apascual/URC)

Currently, there are 39 MDR TB patients enrolled in ConnecTB. They are monitored for daily DOT and signs of Adverse Drug Reaction. In addition, 3 MDR TB patients have their residence geo-tag and can now be projected on a map.

Figure 21: TB Platforms led by its Chief of Party, Dra. Marianne Calnan (third from left) turned over to Antipolo City Mayor Andrea Ynares 14 units of mobile phones for ConnecTB.

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019 41

7. HIGH-LEVEL PLANNED ACTIVITIES FOR NEXT QUARTER INCLUDING UPCOMING EVENTS

Launching of Todas ang TB, Todits! TB Platforms and the City Government of Manila’s #EndTB Campaign

Last year, TB Platforms collaborated with Manila CHO for several TB-related activities. One of the sustainable initiatives identified was the passage of a Local TB Ordinance which will be able to support the Philippine Government’s target of 2.5 million Filipinos with TB completely treated by Year 2022. This Local TB Ordinance was passed on December 27, 2019 by the through the leadership of Mayor . TB Platforms provided TA in the drafting of the ordinance, which also included an annual budget appropriation of Php 3 million specifically for TB-related projects which includes the procurement of TB medicines, the creation of a local TB Council, and implementation of FAST strategies in hospitals.

The Mayor’s Office, with support from TB Platforms, plans to launch their Todas ang TB, Todits! (We end TB, here!) campaign on February 13, 2020 in Tondo Manila. The CHO will also conduct a medical mission and health education activity for around 1,000 residents who will be the initial beneficiaries of free medical consultation and TB screening. Participants will include representatives from USAID, DOH NCR, and other TB Implementing partners. #EndTB Ambassador Ms. Janelle Lazo Tee will join this event and conduct TB 101 education using Tibay ng Dibdib interactive panels.

The Manila CHO is leading this activity as well as the media partnerships to raise public awareness through television, radio, and social media platforms.

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019 43

TB Platforms – The Philippine Daily Inquirer Read Along Session March 14, 2020, 10AM, PDI Headquarters, Makati City

In line with the World TB Month Celebration this coming March, USAID’s TB Platforms in partnership with the Philippine Daily Inquirer (PDI) through its Read Along program will be holding a Special Read Along Session which will feature a children’s storybook about two sisters who were diagnosed with TB and completed treatment successfully last year. The younger sister, Whiskey, 4 years old, was diagnosed with Drug Resistant (DR) TB while her sister Champagne, 8 years old, was diagnosed with Drug Sensitive (DS) TB. The story will revolve around how TB affected the lives of these children, their family and their community. This Read Along session will try to share the challenges faced by families of TB patients and how they cope during detection and treatment. This session will also highlight how the healthcare providers and community health workers play a vital role in the community affected by TB.

The Inquirer Read Along Program is a multi-awarded Corporate Social Responsibility Project which aims to bring back the love of reading among children. Since it started in 2007, they have invited hundreds of celebrities and advocates. Every 2nd and 4th Saturday of the month, they feature stories that inspire and provide a call to action campaign not only to children but also to the adult participants. They have engaged public and private institutions as well as civil society groups to lead various advocacy campaigns on education, environment, women empowerment, human rights, peace and governance. They celebrate March as the Women’s Month. This year, in line with USAID’s TB Platforms-PDI Read Along partnership, March will be World TB Month Celebration and the theme will be Public Health: TB in Children. The financial burden of TB treatment is USAID’s TB Platforms, through this Read Along session, will high and this is one of the reasons why many patients cannot finish treatment. raise public awareness on the symptoms of TB and the Many community health workers importance of TB detection, care and treatment and feature confessed that they share their own the impact of forging public-private partnerships. PDI money with TB patients to cover the committed to have a live streaming session of the actual Read transport costs of patients who come to Along session, a news feature about TB in Children in their the health facility to receive free medical newspaper, a radio interview through the Radyo Inquirer AM consultation as well as supply of TB band and an online news story in Inquirer.net online portal medicines. The 6-9 months of going back USAID’s TB Platforms will involve the participation of US and forth to the health facilities puts an Embassy, USAID Office of Health, Department of Health economic burden to patients who ended (Central and Region 3 Offices), Rogaciano M. Mercado up leaving their jobs for treatment or family member sacrificing his time to Memorial Hospital (RMMMH), Bulacan Provincial Health accompany a loved one under TB Office and other partners. USAID’s TB Platforms #EndTB treatment. Additionally, USAID’s TB Ambassador, Miss Earth Janelle Lazo Tee will be reading the Platforms conducted several interviews storybook along with USAID representative for this session. among patients and one of the most recurring reasons why they are hesitant to PDI will be inviting 100-150 children from their partner accept that they have TB and need schools and non-governmental organizations. Sophia School, treatment is because of the stigma that if a long-time Read Along partner and whose campus is in other people know that they have Meycauayan Bulacan will be joining this activity. USAID’s TB tuberculosis, they will suffer from being Platforms will be working with Sophia School this quarter as alienated or will lose their jobs. they committed to embrace the #EndTB campaign and will develop programs related to USAID’s TB Platforms social behavior change strategies. Ms. Ann Abacan, the owner of the school said that TB awareness can be included in their elementary subjects and high school courses. They can encourage the student councils and the Parent-Teacher Associations to join the campaign. Being a dynamic college, they committed to inspire the other private schools specifically in Bulacan to do the same. Sophia School is known for their innovative children and teen’s theater as well as animated video campaigns. The Inquirer Read Along Session is one of the USAID’s TB Platforms activities

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019 44

8.3 Potential Success Stories, Pictures, etc.

Story pitch for USAID success stories:

1•sentence summary of story idea

Collaboration on Quality Improvement

The story will highlight how USAID Office of Health will engage its TB implementing partners on the proposed Quality Improvement Collaborative which will be led by TB Platforms.

2- 3 sentences of supporting information

In this story, learn how the USAID Office of Health and its implementing TB partners such as DOH, PBSP ACCESS TB, World Health Organization (WHO) and TB Platforms and TB Innovations will work together for a Quality Improvement Collaborative (QIC) – a structured method for testing and implementing evidence-based changes quickly across organizations. This will be used to achieve significant improvements in TB case finding and treatment activities. This collaboration will focus on improving the cascade of care, identifying targets and indicators that will contribute to the target of 2.5 million Filipinos with TB completely treated by Year 2022.

Details of who will be interviewed (names/titles or general description •• for example, three beneficiaries in the impacted town)

TB Platforms DOH NTP World Health Organization

Description of anticipated photos/graphics that will accompany main article

Figures from WHO TB Dashboard Milestones from USAID’s TB Platform

1•sentence summary of story idea

Partnership with the Philippine Daily Inquirer’s Read Along Program

TB Platforms is partnering with the Philippine Daily Inquirer through its multi-awarded corporate social responsibility arm, Read Along Program, in raising public awareness on the symptoms of tuberculosis and feature how family members, health workers and the community play an important role in TB detection, care and treatment. Through the Read Along Program, TB Platforms will share a children’s story based which is based on the true-to-life story of sisters, Whiskey, 4 years old, DR-TB survivor and Champagne, 8 years old, DS-TB survivor.

2- 3 sentences of supporting information

This partnership will use social behavior change strategy while reaching out to elementary and high school students as well as the adults in sharing how TB patients faced the challenges of stigma, financial burden

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019 50

and the daily rigors of adhering to treatment. #EndTB Ambassador and Miss Earth 2019 Janelle Lazo Tee will read the storybook about Whiskey and Champagne and share the success story of their plight against TB. Learn about the impact of public-private partnerships as it will showcase how the health facilities and even the patient-support group (TB HEALS Program) affected their health seeking behavior leading to completion of treatment. Their story will bring inspiration to other patients especially to the older ones that to surpass the challenges of TB treatment. Families of children with TB will appreciate the lessons that can be learned in this story. Health workers will learn that their passionate service and compassionate support to TB patients are not only greatly appreciated but will encourage others to do the same.

Details of who will be interviewed (names/titles or general description •• for example, three beneficiaries in the impacted town)

Ex: Family members of Whiskey and Champagne Dr. Caroline Bernardo, Rogaciano M. Mercado Memorial Hospital Ms. Leoncia Ledelisa Gener, Chief Nurse, Rogaciano M. Mercado Memorial Hospital Ms. Aquilina Cruz, TB DOTS Nurse Ms. Annie Balingit, Program Coordinator, Bulacan Provincial Health Office Representatives from TB HEALS Program Representatives from DOH Region 3

Description of anticipated photos/graphics that will accompany main article

Hospital Consultation/Visit of TB survivors Health workers at Work Snapshots of Children’s Storybook Read Along Session with #EndTB Ambassador Miss Earth 2019 Janelle Lazo Tee

1•sentence summary of story idea

Launching of Manila City Government’s Support to #EndTB Campaign: Todas ang TB, Todits:

TB Platforms provided TA to the City Government of Manila in the drafting of their local TB Ordinance. Last December, the Manila City Council passed Ordinance Number 8592 Series of 2019. To formally launch their support to the #EndTB campaign, this coming February 13, 2020, Mayor Isko Moreno and members of the City Council in partnership with the City Health Office and with support from the TB Platforms will launch “Todas ang TB, Todits!,” Manila City Government’s local campaign covered by the TB Ordinance which will engage their local leaders to implement programs and activities which promote health education about tuberculosis.

2- 3 sentences of supporting information

In this story, learn about the technical assistance of TB Platforms to local government units like the City Government of Manila in putting TB as one of the top priorities under the local chief executive’s health agenda. This story will also highlight the partnership of the CHO and the Local Council in pushing for an annual budget appropriation of Php3M for TB-related programs and the implementation of FAST in all hospitals under their jurisdiction under the TB Ordinance.

Details of who will be interviewed (names/titles or general description •• for example,

USAID | TB Platforms for Sustainable Detection, Care and Treatment Quarterly Report, October-December 2019 51

three beneficiaries in the impacted town)

Ex: Mayor Isko Moreno, Ciry Government of Manila Members of the Manila City Council Representatives from the City Health Office

Description of anticipated photos/graphics that will accompany main article

Snapshots of the Manila City Ordinance Behind-the-scene photos of the TB Council CHO staff at work

1•sentence summary of story idea

Partnership for Active Case Finding and TB in the Workplace with Central Azucarera and Garments Factory

In this story, TB Platforms will highlight its public-private partnerships for Active Case Finding and TB in the Workplace campaigns in Region IV-A specifically in Central Azucarera, Nasugbu, Batangas, a subsidiary of Roxas Holdings Inc, and and two garments factories named Jenny’s and Frankhaus International in Taytay, Rizal. Through its technical assistance, these organizations were encouraged to implement an advocacy for TB in the workplace and active case finding specifically for their subcontractors who employs the informal sector (farmers, sewers, factory workers). This story will also feature how this partnership will support TB Platforms’ activities in increasing the number of people who will seek immediate care especially if they are symptomatic of tuberculosis. Promoting health education among employees and subcontractors as well as providing healthcare services to its stakeholders will be part of this partnership.

2- 3 sentences of supporting information

This story will also highlight the partnership among TB Platforms, DOH Region IV-A, the respective City Health Offices involved and the management of Central Azucarera and the Garments Factory. Interestingly, these private organizations are willing to conduct various TB-related activities such as a medical mission, TB education, health for all campaign and even produce information materials to support the TB in the Workplace advocacy. Central Azucarera also committed to launch a TB in the Workplace campaign and active case finding in their other areas of operation like in Central Azucarera de la Carlota in Negros Occidental.

TB Platforms is also collaborating with the Department of Labor and Employment (DOLE) to reinforce TB in the Workplace and expand its coverage to enlisted subcontractors. Discussion is ongoing related to labor mechanisms and regulations for this initiative.

Details of who will be interviewed (names/titles or general description •• for example, three beneficiaries in the impacted town)

Ms. Angielyn Bondad, CSR Manager, Central Azucarera Ms. Marivic Medoza, Director, DOLE- Rizal Pronvincial Office Dra. Sara Marquez, City Health Office, Nasugbu, Batangas Dr. Roxas, City Health Office, Taytay, Rizal

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