Caloocan City Health Department (CHD)

VISION

Health for all citizenry of Caloocan City by the year 2001 and Health in the hands of the people by year 2020

MISSION

To provide accessible, available, affordable  and acceptable quality basic health care delivery system at all times  through advance technology and fully equipped health facilities manned  by dedicated, competent and well-compensated manpower

GOAL

Harmonious partnership with LGU, NGOs, PO’s  and GO’s towards a common goal of achieving a productive self-reliant  and healthy citizenry

8 Basic Health Services

1. Medical And Dental Services (MDS)
2. Public Health Nursing/Midwifery (PHN/M)
3. Maternal and Child Health (MCH)
4. Public Health Laboratory (PHL)
5. Environmental Sanitation (ES)
6. Control of Communicable Diseases (CCD)
7. Vital Statistics and Epidemiology (VSE)
8. Health Education (HE)

8 THRUST HEALTH PROGRAMS

1. Control of Acute Respiratory Infections
2. Control of Diarrhea Diseases
3. National Tuberculosis Control Program
4. National Leprosy Control Program
5. Nutrition Program
6. Under Five Clinic Program
7. Expanded Program on Immunization
8. Family Planning

OTHER THRUST PROGRAMS

1. National Cardiovascular Disease Prevention & Control Program
2. Philippine National Cancer Prevention & Control Program
3. Dengue Prevention & Control Program
4. National Diabetes Mellitus Control Program
5. Primary Eye Care Control Program
6. National Voluntary Blood Service & Program
7. National Rabies Control Program
8. HIV/AIDS Prevention & Control Program

Targets of the NTP

NTP STRATEGIES

To achieve its objectives, the NTP shall focus on the  following strategies and activities:

Political commitment

Advocate for political commitment at all levels of the health system including the private sector by:

1. Mobilizing additional human, financial, and technical resources for TB control;
2. Fostering local, national and international partnership;
3. Fostering communication among all health care providers,   patients and the public at large;
4. Providing opportunities for strengthening the NTP in relation to its clients; and,
5. Involving key leaders in the overall implementation of the NTP

Sputum microscopy

Provide access to quality-assured TB sputum microscopy by:

1. Providing functional microscopes
2. Conducting training programs for Microscopists on basic sputum microscopy;
3. Maintaining and sustaining a Quality Assurance System (QAS) on TB microscopy; and,
4. Organizing a network of all TB laboratories

Program management

Improve the program management capability of health  workers by:

1. Provide technical assistance to all DOTS center, includingthe TB Diagnostic Committee;
2. Providing training on service provision and TB management; and,
3. Monitoring and supervising DOTS implementation at all   levels

Data/Information System

Improve the data/information system by:

1. Implementing the standardized DOTS recording and reporting system;
2. Developing an effective and efficient information processing system;
3. Analyzing the NTP data in relation to their DOTS implementation; and,
4. Strengthening public-private referral system

Case Detection Improve TB

Case detection by:

1. Establishing an effective public-private mix DOTS (PPMD) strategy;
2. Developing and disseminating effective IEC materials for community; and,
3. Improving and expanding hospital-based NTP

Standardized chemotherapy under DOT

Provide standardized chemotherapy to all confirmed cases of TB under Directly Observe Treatment (DOT)/supervised treatment by:

1. Provide policies and guidelines for the treatment of TB cases;
2. Monitoring treatment response and progress and assessing treatment outcomes through quality-assured sputum microscopy;
3. Establishing a mechanism or a referral system for DOT;
4. Ensuring client health education at initiation and continuation of treatment; and,
5. Providing enablers and recognition of DOTS Centers and cured TB patients

Drug Supply

Ensure uninterrupted supply of quality-assured anti-TB drugs through reliable procedure and distribution system by:

1. Establishing a drug procurement and distribution system at all levels
2. Regularly monitoring the availability of anti-TB drugs:
3. Supplementing the drugs from other sources   (e.g., LGUs, Private Sectors); and,
4. developing a public-private referral system to enable clients to access NTP drugs

CASE FINDING

Objective

The general objective of case finding is the early identification and diagnosis of TB cases.

Policies

a) Direct sputum smear examination (primary diagnosis tool in NTP case finding):

1. Sputum smear examination is the preferred method  for the diagnosis of TB. All TB symptomatics identified shall be made  to undergo smear examination for diagnosis prior to initiation of  treatment, regardless of whether or not they are suspected of having  extra-pulmonary TB. The only contraindication to sputum collection is  massive hemoptysis.

It is only after a pulmonary TB symptomatic has undergone sputum examination for diagnosis with three sputum specimens  and subsequently yielded negative results that he shall be made to  undergo other diagnostic tests such as X-ray, culture and others, if  necessary.

2. All health facilities shall be encouraged to  establish and maintain a microscopy unit in their areas of  jurisdiction. In areas where this is not possible, referral to an NTP  microscopy service provider shall be encouraged.

3. Quality of sputum microscopy shall be maintained  and sustained through the regular quality assurance system at the  provincial/city level.

b) Chest X-ray:

1. Chest x-ray examination shall be the secondary  diagnostic tool for TB case finding. However, no diagnosis of pulmonary  tuberculosis shall be made based on the result of X-ray examination  alone.

2. Smear negative cases whose chest x-ray  examination result is suspected to be positive for TB lesions shall be  referred to the TB Diagnostic Committee that shall decide on the  appropriate action to take. Comparative reading of previous and current  X-rays is highly recommended for confirming diagnosis of TB in such  situations.

3. In each province/city, the creation of a TB  Diagnostic Committee (TBDC) is recommended. The TBDC shall provide  diagnostic services to TB smear negative cases whose chest x-ray  results are consistent with active TB.

c) Skin test for TB infection (PPD skin tests) should NOT be used as a basis for the diagnosis of TB in adults.

d) Passive case finding shall be implemented in all health facilities.

e) Sputum smear examination (smearing, fixing and staining of sputum  specimens, reading the smear) shall be performed only by adequately  trained medical technologist or NTP microscopist.

CASE HOLDING

Objective

The general objective of chemotherapy is to treat TB cases effectively and completely, especially pulmonary sputum smear positive cases.

Policies

a) Treatment of all TB cases shall be primarily based on reliable diagnostic technique, namely, sputum smear examination aside  from clinical findings. Chest x-ray examination is used only as a  secondary diagnostic tool. Treatment of all sputum smear negative CXR  positive cases shall be based upon the decision of the TB Diagnostic  Committee.

b) Domiciliary treatment shall be the preferred mode of care.

c) Patients recommended for hospitalization are those with the following conditions:

1. Massive hemoptysis
2. Pleural effusion obliterating more than half (1/2) of a lung field
3. Miliary TB
4. TB meningitis
5. TB pneumonia
6. Those requiring surgical intervention
7. Those with complications

d) No patient shall initiate treatment unless the  patient and health workers have agreed upon a case holding mechanism  for treatment compliance.

e) For all patients to be started on treatment, provision of the  complete drug requirement should be ensured. The complete drug  allocation of each patient shall be secured before treatment is started.

f) The DOH shall ensure the provision of FDC drugs to the health Centers, including PPMD units and other health facilities giving  priority to sputum smear positive cases. However, the health facilities  (including LGUs) shall be encouraged to procure SDF preparations (at  least 5% of the expected cases), intended for those who may develop  adverse reaction to FDCs.

g.) Quality of FDCs shall be ensured by ordering them from a source  with track record of producing FDCs according to World Health  Organization (WHO) prescribed standards.

RECORDING AND REPORTING

Objective

a) To provide program implementers with information to serve as basis for planning on how best to assist their clients and patients.

b) To provide program supervisors with information to serve as basis for planning on how best to assist TB control program implementers.

Policies

a) Recording and reporting for NTP shall be implemented at all health facilities, including PPMD units, government and private hospitals.

b) Reporting TB cases should be made mandatory to private physicians and private clinics after agreement with parties concerned shall have been made.

c) Recording and reporting shall include all cases of TB, classified according to internationally accepted case definitions.

d) Recording and reporting for NTP shall use, as much as possible, the Field Health Services Information System (FHSIS) network for routine reporting and feedback.

e) Records and reports should allow for the calculation of the main indicators for program evaluation.

f) All four quarterly reports should be sent to DOH through the CHD. PPMD reports should be disaggregated to reflect additions to total cases reported in the province/city/municipality where PPMD's are installed.

g) The DOH shall make an annual consolidation, analysis, interpretation and dissemination of information to all partners, stakeholders and general public as necessary.

Health Officer/Medical Officer/Physician (Public and Private)

a) Supervise respective health workers when applicable to ensure the  proper and quality implementation of NTP core policies such as:

• Case finding
• Case holding
• Analysis and timely submission of NTP reports
• Referral of TB cases to other services as needed
• Management of NTP logistics

b) Participating in Continuing Medical Education (CME) related  to TB-DOTS

c) Provide continuous health education to all TB patients, their  families and to the community to strengthen their participation in TB  control activities

d) Coordinate with the local chief executives (LCEs), other government agencies, locally existing TB organizations,   private sector and NGOs in the area to ensure support for the TB program

Public Health Nurse/DOTS Nurse (Public and Private)

1. Assign, educate and supervise the designated treatment partner of a TB patient
2. Supervise support staff like Midwives, to ensure the proper implementation of the DOTS strategy/NTP core policies
3. Maintain and update the NTP Case Register
4. Facilitate the timely requisition and distribution of drugs and supplies
5. Provide continuous health education to all TB patients, their families  and to the community to strengthen their participation in the TB control
6. Prepare the NTP reports and analyze data together with the Physician and other staff to improve implementation and to plan for future activities
7. Facilitate the conduct of meetings and consultations among center staff
8. Act as Treatment Partner

Midwives, Other Support Staff (ie., Field Treatment Supervisor/Field Treatment Coordinator)

Medical Technologists or NTP Microscopists

1. Do sputum smear for diagnosis and follow-up
2. Submit the results of the sputum smear examination to the requesting staff
3. Maintain and update the NTP Laboratory Register
4. Prepare and analyze the laboratory reports in coordination with the other Staff to improve/maintain quality of microscopy services and to plan for future laboratory activities
5. Submit quarterly slides to the designated sputum smear Validator for quality assurance check

Barangay Health Workers (BHWs)

BHWs are key-role players in the NTP especially since they contribute voluntary health services to the community.

1. Refer TB symptomatic to health staff for sputum collection
2. Act as Treatment Partner and undertake the Directly Observe Treatment (DOT)
3. Keep and Update the NTP ID Cards of assigned TB patients
4. Report and receive defaulters within two (2) days from time of default
5. Consult/Update the Midwife weekly while the patient is on his/her course of treatment
6. Attend the patient’s weekly consultation with the Midwife
7. Refer any patient complaint or any untoward reaction while on treatment to the health staff
8. Provide health education to the patient and family members. Participate in the health education of the community