Tuberculosis (TB) is an airborne disease that is among one of the highest killers among all infectious diseases (Mayo Clinic, 2021). Tuberculosis is acquired when the bacteria enters a host through droplets in the air (Mayo Clinic, 2021). Tuberculosis mainly affects the lungs by causing difficulty breathing, coughing up blood, and pain with breathing (Mayo Clinic, 2021). There are many areas in the world where TB is highly prevalent, and one of the ongoing issues is finding out why is it so active in these areas when there is a cure and treatment available.

The Philippines is one of the hardest hit areas in the world with regards to active TB cases. One of the more recent estimates from the Philippines was that there are over 1 million active cases and every day around 70 people lose their lives from TB (Weiler, 2019). These are very high numbers for a disease that should not be claiming the amount of lives that it is considering there are screenings and treatments available.

As of now, the Philippines rank as the fourth highest country in new TB cases; there are over 1 million active cases of TB in the Philippines and the country has a population of 109 million, meaning that around 1 percent of the population has TB (National TB Control Program, 2020). In 2021, there have been 340,254 new cases of TB reported (National TB Control Program, 2020). Some of the major obstacles that are preventing Filipinos from receiving treatment are the high cost of treatment through both the public and private sector, the lack of transportation to get to the hospitals that are equipped to treat this disease, and the lack of help from the Department of Health (Weiler, 2019).

Other factors that affect the Philippines are that a large majority of the population that are affected by TB never seek treatment. A survey was conducted to determine the number of patients with TB that sought medical treatment and the results were that only 19 percent of the population with TB-like symptoms sought medical care, while 81 percent chose to self-medicate and avoid medical care (Querri et al., 2017).

Some of the resources that exist and are currently being implemented in the Philippines to combat tuberculosis include TB innovations, which is a program that helps to provide state of the art technology to combat TB as well as improve screening practices in local areas and promote TB symptom and management teaching (Health: Philippines, 2020). TB Platforms is another program that is being implemented. This program aims to address the TB infections that are drug-resistant and helps to provide more cost-effective and successful treatment to patients with this type of TB (Health: Philippines, 2020). A lot of TB cases in the Philippines go untreated because the patients don’t have the money to afford the treatment they need. The program CLAimHealth aims to provide cost-free care to the underserved population (Health: Philippines, 2020).

The Philippine government passed the Comprehensive TB Elimination Plan Act of 2016, which mandated notification for TB and granted funding for the Department of Health (DOH) to expand access to TB services (National TB Control Program, 2020). The goal of this plan is to eliminate TB through prompt access to affordable, effective TB services at local clinics run by community members (National TB Control Program, 2020). This law led to the creation of the 2017-2022 Philippine Strategic TB Elimination Plan: Phase 1 (PhilSTEP1) (National TB Control Program, 2020).

From 2017-2019, there were 3,351,590 presumptive TB cases were tested, which was 53% of the goal (National TB Control Program, 2020). 90% of those with drug-susceptible TB were treated successfully (National TB Control Program, 2020). Despite a 20% increase in TB notifications to the DOH, the Philippines struggles with multidrug-resistant TB (MDR-TB), minimal TB prophylaxis, and overall poor case detection (National TB Control Program, 2020).

In response to the new data, the Comprehensive TB Elimination Plan was updated to further combat TB. The Philippine government strengthened their evidence-based approach through a continuity of care framework, education for local providers, and new legislation. The 2020-2023 plan incorporates the Universal Health Care Act, which guarantees access to healthcare and protects them from exorbitant billing practices (National TB Control Program, 2020).

PhilSTEP1for 2020-2023 will require a total of 61.2 billion Philippine pesos (PhP) to be funded through the Philippine national and local governments and foreign-assisted projects such as The Global Fund to Fight AIDS, TB, and Malaria and The US Agency for International Development (National TB Control Program, 2020). Funding amounting to 49.3% of the budget is required for testing and diagnosis, while 29.7% is needed for screening, 19.2% for treatment, and 1.8% prevention (National TB Control Program, 2020). The main cost (67.5%) results from the use of diagnostic tools like chest x-rays, GeneXpert supplies, and other diagnostic costs; pharmaceuticals only make up 12.7% of the budget (National TB Control Program, 2020).

In terms of a transition plan, funding continues to be a major issue even with an expected $6.0 billion from The Global Fund (National TB Control Program, 2020). The funding gap will be $32.7 billion PhP, which amounts to 53% of the total needed (National TB Control Program, 2020). In response, two funding packages have been proposed. Some of the funding may come from the start of a national health insurance corporation called PhilHealth, which will cover the costs of chest x-rays which is $711 million PhP (National TB Control Program, 2020). Another source of money to address the funding gap may come from the Mandanas Ruling, which is supposed to increase funding for local government expenditures at a cost of around $366 million PhP (National TB Control Program, 2020).

Even if these funding packages are accepted, there will still be a deficit of $7,469 million PhP (National TB Control Program, 2020). As of November 2021, there is no report on how the Philippines plans to address the more ideal scenario, which still possess a funding gap of $7,469 million PhP (National TB Control Program, 2020). It appears they are planning on running the program on a deficit, which will make it difficult to meet their goals of lowered rates of TB transmission, increased rates of TB reporting, and more successful TB treatments.

An arm of the Research Insitute of Japan, this secular NGO's mission is to contribute to the National TB Control Program (NTP) of ensuring that quality TB services are accessible, affordable, and available for all TB patients (Querri et al., 2019). The organization is funded by Japan's Official Development Assistance, Japan International Cooperation Agency, and the Innovations for Multi-Sectorial Partnership to Control Tuberculosis in the Philippines (Querri et al., 2019). To fight tuberculosis, the organization's funding contributions were used to conduct trainings for community health volunteers, local government workers, NGO workers, and skilled health care workers in Tondo, Manila and Payatas, Quezon City (Querri et al., 2019).

The goal of the trainings was to assist in improving case detection and the treatment outcomes of the TB patients as well as people living with HIV in the urban poor sites (Querri et al., 2019). Conductors of the organization chose the areas in which they worked based on four barriers: economic, geographical, socio-cultural, and health system (Querri et al., 2019). These barriers included economic costs of treatment, distance of health facilities, stigma due to lack of awareness of TB patients, and issues in the health system both from public health facilities and non-government organizations (Querri et al., 2019). The areas chosen were in highly vulnerable urban poor populations, such cities like Tondo and Payatas (Querri et al., 2019).

The activities implemented were: engaging other health providers, capability building, establishment of the network and linkage, establishment of referral mechanisms, and development of recording forms to accelerate TB service points in the communities (Querri et al., 2019). The organization partnered with five other NGOs which were previously engaged in projects similar to implement their activities (Querri et al., 2019). The organization also sustained partnerships with the local government organizations such as the Manila Health Department.

Although the RJPI project ended in 2016, continuous updates and trainings have been provided by government agencies to the NGO partners. Since government workers were trained, this project can now be ran by nationals. The five other NGOs are still actively providing TB care from diagnosis, treatment, and management to TB patients and are still submitted reports to the Manila Health Department and the Quezon City Health Department (Querri et al., 2019).

As far as outcomes measured, access to quality TB services had been growing. Access to RJPI-sponsored continuing education for radiologists about chest radiography has facilitating learning about modern medical imaging (Querri et al., 2019). In fact, a quality control training course improved the radiography skills of technicians in terms of image contrast, quality, and sharpness (Querri et al., 2019). The TB case detection rate grew due to better, more frequent smear tests, with positive smear tests rising 8% in the city of Payatas (Querri et al., 2019). The main goal of the RJPI project was to bring quality services through engaging NGOs and sustaining a partnership with the Metro Manila Health Office, which was achieved.

World Vision is an international partnership of Christians whose mission is to follow Christ in working with the poor and oppressed to promote human transformation, seek justice, and bear witness to the good news of the Kingdom of God (World Vision Philippines, 2014). Their focus is transformational development that is community-based and sustainable, focused especially on the needs of children (World Vision Philippines, 2014).

The organization is funded by privates donation and public grants which include food and cash. During 2020, the organization received about $1233 million dollars in funds (World Vision Philippines, 2020). Of those funds, the organization spent 88% of the budget ($1063 million) in their program services, 7% ($85 million) in fundraising and the remaining 5% ($55 million) in management and general expenses (World Vision Philippines, 2020).

For the Philippines, this organization is focused on trying to identify and reduce tuberculosis cases, especially in rural and low socioeconomic areas. They created a task force where volunteers are trained to identify sign and symptom of tuberculosis. Once they find a possible TB patient, they are trained to refer them to a clinic to received medical treatment. In addition, volunteers are trained in educating the community on tuberculosis signs and symptoms, prevention, and treatment. Furthermore, the organization also donates money for people to be able to afford the treatment needed.

Between 2003 and 2013, World Vision trained 538 TB task forces across 29 cities in the Philippines (Millora, 2018). In the same ten-year period, the task forces identified over 16,000 TB patients, with around 12,000 of these directly supervised by a volunteer (Millora, 2018). The TB task forces also launched an awareness campaign, which reached over 295,000 households via house-to-house visits, and more than 18,000 people through health classes (Millora, 2018).

The resources needed for this project are minimal; it only took money to train the first set of volunteers. New volunteers were then taught through other community members to be proactive in treating and managing tuberculosis. Therefore, this project is sustainable and successful because minimum capital was needed to make a big impact. Also, the government could take over for the organization and help people be able to afford the treatment for TB. With all of this in mind, this project could be replicated around the world to be more proactive in diseases detection and treatment.

When evaluating these agencies, the research performed, and the impact achieved, it is clear that progress needs to continue. We would not make any changes to the government's efforts to eliminate tuberculosis, other than promoting more dialogue between between nations about TB elimination strategies. Through the Philippine government, RJPI, and World Vision, the tuberculosis prevalence and death rates have decreased significantly in the past 5 years, which is also in line with the passage of the Comprehensive TB Elimination Plan Act of 2016 (National TB Control Program, 2020).

This act mandated the notification of TB and funding granted to the Department of Health (National TB Control Program, 2020). Though the rates of tuberculosis in the Philippines are still the fourth highest in the world with over one million active cases, there are multiple efforts from different sources being enacted to help with this health disparity (Weiler, 2019).

Assuming our group could only choose to fund one of these programs, we would opt for the government to receive funding. The government would be the best in budgeting funds received and maximize their spending. The Philippine government was one of the first efforts to control this health crisis and to initiate the other programs brought into the Philippines such as RJPI and World Vision. They used evidence-based practice to strengthen plans that would guarantee access to healthcare and protect citizens from exorbitant billing practices.

Though these NGOs are funded through other sources such as donations, our idea is for these other associations to be funneled through the Philippine government. This would, in turn, result in a government ran and controlled program, lead by local leaders from the organizations who have the connections within the population. Routing funding through the government would have the greatest impact on the citizens of the Philippines and allow the other agencies to partner more in their community outreach as potential government ambassadors.