Many underdeveloped countries of the world, like the Philippines, experience incidence of tuberculosis at a rate that is only relative to the corresponding efforts of the government and its medical department. Although the Philippine government continues to march towards reducing TB incidence in the urban areas through easier access to care, another population lives in rural areas where healthcare is seldom spoken, if ever. The people who live there are poor and financially handicapped; they need the most help and soon. In support, country like the United States is actively making collaborative efforts and offers wide range of support to the TB identification, prevention, and treatment programs in the Philippines. Several agencies, including United States Agency for International Development (USAID), continue to have its strong presence in the TB prevention program in the Philippines.
In the past several decades, there has been a worldwide population shift from rural to urban areas. In Asia, it was estimated that by the year 2000, the urban population would have grown to 35% of the total population, compared to only 21% in 1975. From 1970 to 1990, population growth in three major cities in the Philippines, Metro Manila, Metro Cebu, and Metro Cagayan de Oro, far exceeded that of the whole country. By the last census in 1990, the aggregate population in these three metropolitan areas constituted 15.2% of the total national population and the urban poor in these areas constituted 70% of the country's total urban poor population. The rapid population expansion in urban areas has resulted in sprawling urban poor settlements where people live in desperate conditions, suffering from social inequity and problems of poverty, overcrowding, and poor hygiene and sanitation. These factors in the presence of a large reservoir of infectious agents are important determinants of disease transmission in urban poor communities. These urban poor settlements are therefore fertile grounds for diseases of poverty, of which tuberculosis is of paramount importance. The present survey was undertaken to determine the magnitude of the problem of tuberculosis in urban poor settlements (UPS) in the Philippines, and to compare the findings with those of the general urban areas included in the 1997 nationwide tuberculosis prevalence survey (NPS), which was performed concurrently.
While the magnitude of the tuberculosis problem in the urban poor settlements in the Philippines is particularly grim, the problem of tuberculosis at the national level is also very large. Vigorous implementation of the control program nationwide is therefore being pursued by the government with the phased implementation of directly observed therapy, short course strategy (DOTS). By the end of 1998, 25% of the population had access to DOTS, and by the year 2001, it is anticipated that 100% will be covered. Similarly to the situation in the urban poor settlements studied in this survey, the increase of TB cases with the emergence of HIV in the inner city of New York reached epidemic proportions, and DOTS was successfully implemented in this setting. As a large number of patients with tuberculosis consult private medical practitioners, harnessing the manpower and resources of the private sector in this endeavor will greatly enhance the implementation of DOTS. A private-public collaboration with the DOTS strategy, utilizing incentives for private practitioners, has been successfully implemented in India, and should be considered in similar developing countries with limited resources.
Tuberculosis remains a major health problem despite laudable efforts of the National TB Program after the implementation of DOTS in 1996. Since the introduction and maintenance of DOTS in the public sector, and the subsequent expansion involving the private sector, several accomplishments have been reported. In spite of the remarkable achievements, several issues...