September 2024, Olongapo City — “Huwag kang hihinga doon (Don’t ever breathe the air there)!”
Dian May Pecson cites the worst way people would talk about the community of Barretto, where she has been serving as a registered nurse at the health center for 10 years. All because of the high number of cases of tuberculosis being treated at the TB clinic of the Barretto Health Center.
“We have heard of stories of how outsiders would hold their breath when passing by not just our clinic but the whole village as well,” shares Dian. She shakes her head at the absurdity of such a reputation.
Barangay Barretto is one of 17 villages in Olongapo City, an urbanized city adjacent to the former United States naval base called Subic. With a population of about 21,000, Barretto had 165 new and relapse TB cases in 2023. In the first four months of 2024, 38 new cases of TB are already recorded in the TB registry and are currently undergoing free TB treatment.
One of them is 54-year-old Dencio (not his real name), who is on his second month of treatment. Dencio collects scraps for a living. In March, he started coughing and losing weight. When he went to the Barretto Health Center, a chest X-ray scan and a sputum specimen test confirmed he has TB.
“I can’t read nor write,” admits Dencio. He is very thankful that nurse Dian and the other health workers at the Barretto Health Center are “very considerate” of him. He gets his TB medicines every two weeks and swears that he takes his medicines daily in the mornings. He leaves his thumbprint on the clinic’s record log to signify that he already received his free TB drugs.
Poor treatment compliance
Dian says that despite the clinic’s limited resources, she and other health workers try their best to encourage treatment compliance and completion from their clients. In 2023, the treatment success rate at Barretto Health Center was only 68%. Forty-three of 170 patients from the previous year dropped out of treatment. The treatment outcome is recorded in the registry as “lost to follow up.”
One main reason for this outcome is that a fourth of the cases in Barretto Health Center are described as “persons who are deprived of liberty” or those who were diagnosed of TB while incarcerated at the Olongapo City Jail, located about 500 meters from the TB clinic.
“Many of the TB cases from the city jail would be lost to follow up if they get released and serve their sentences,” explains Dian. The patients from the city jail would return to their original residences, more likely outside Olongapo City. Tracking them for completion of TB treatment has been difficult.
To address this, the Olongapo City Health Office recently signed an agreement with the Olongapo City Jail to secure clearance and ensure proper referral for TB patients who would be released from jail while still undergoing TB treatment.
DOH-certified TB clinic
The agreement was a significant step toward improving the clinic’s program performance. The Department of Health (DOH) recognized this and approved the application of Barretto Health Center as a certified TB clinic.
The certification process is a vital exercise in improving the quality of TB care and services. If a TB clinic gets this DOH certification, it can proceed to the next step of applying for accreditation at the Philippine Health Insurance Corporation (PhilHealth), the government’s health insurance coverage agency. A PhilHealth accreditation would mean that a TB clinic could file for medical reimbursement and receive a facility benefits package of PhP 4,000 (US$ 68) per cured TB patient.
Dian makes a mental computation of additional program funding that the clinic could secure if the Barretto Health Center could qualify for this PhilHealth benefits package. For example, if 90 patients complete their TB treatment, the clinic could receive approximately a benefits package of PhP 360,000 (US$ 6,000).
“We can get our ceiling fixed for that amount,” quips Dian, pointing to a portion of the clinic with a ceiling falling apart.
In the meantime, Dian and the rest of Barretto Health Center’s TB clinic staff are appreciative of the technical support provided by the Center for Health Solutions and Innovations Philippines, Inc. (CHSI), a non-government organization (NGO) that received a grant from the United States Centers for Disease Control and Prevention (US CDC) to support local TB programs in high TB-burden communities.
In the United States, Philippine-born migrants rank second among non-US born citizens with the highest number of TB cases. This prompted US CDC to support local TB programs in “source communities.” In the Philippines, Olongapo City is one of the top locations with the highest number of migrant applicants found to be positive of TB upon medical check-up for US visa. CHSI forged an agreement with the Olongapo City to support its local TB programming from 2023 to 2027.
CHSI recently turned over a supply package of an electric fan and office file organizers to the Barretto Health Center after the latter successfully passed its certification. There are now seven health centers in Olongapo City with DOH certification. CHSI is supporting data quality check activities in Olongapo City by participating in monitoring visits and reviewing TB registry records. A robust recording and monitoring system is a requirement for PhilHealth accreditation.
Having been certified by DOH as a TB clinic with quality services and complete record-keeping is already something that Dian and the Barretto Health Center are proud of. Dian looks forward to a time when Barretto will be known not for having many TB cases but for having excellent TB care and services. (END)
