Providing TB Clients the Care They Need: Assessing the quality of tuberculosis services in the Philippines

MEASURE Evaluation conducted a Quality of TB Services Assessment in randomly selected health facilities across the country to identify where services were of high quality and where there were gaps. The QTSA includes four tools—the facility audit, the provider interview, the patient interview, and the register review.

Tuberculosis is the leading cause of death worldwide from a single infectious disease. TB incidence in the Philippines is 500 per 100,000 people—topping the range found in 27 of the other 30 high-burden countries identified by the World Health Organization.

To address this high rate of infection with improved strategies and programs, the Republic of Philippines National Tuberculosis Control Program responded with the Philippine Strategic TB Elimination Plan, running from 2017 to 2022. An important element of the plan is to enhance TB service use by improving quality to increase demand. To that end, MEASURE Evaluation, which is funded by the United States Agency for International Development, conducted a Quality of TB Services Assessment (QTSA) in randomly selected health facilities across the country to identify where services were of high quality and where there were gaps, to ensure that TB patients were receiving the care that they deserve. The QTSA includes four tools: the facility audit, the provider interview, the patient interview, and the register review.

“The tools exist in a generic format that is adaptable to any country wishing to conduct a QTSA,” said Soumya Alva, PhD, who led the assessment along with Suzanne Cloutier, MSPH, and in-country partners. “For instance, some countries may have different names for their health administrative units (e.g., district, province, ward, or woreda) or the name of their TB registers (e.g., TB patient logbook or TB confirmed cases register). They are customized to fit the country priorities and context in which they will be used.”

Using the QTSA, MEASURE Evaluation assessed three indicators of quality care at the health facilities:

  • The structure of the health facility (services available, health worker capacity, management of services, wait time)
  • The service delivery process (interaction with clients, TB awareness among clients, access to follow-up care)
  • The outcomes of service delivery (proper diagnosis, appropriate care, adherence to care)

The availability of TB services was found to be high in the Philippines, accounting for the role played by community health workers and volunteers in service delivery and onward referrals. Patient care was emphasized through preventing loss to follow-up through patient tracking for missed appointments and providing reminders to support treatment adherence.

Although the providers communicated clearly with patients, fewer than half mentioned being flexible about their patients’ needs or addressing their fears about TB. Approximately three-quarters of the providers talked to patients about their knowledge of TB; however, fewer reported discussing patients’ ability to follow the treatment plan, their resources for support, or barriers to treatment.

Outcomes were good for most clients (84%–89%). However, the remaining clients had either died, failed treatment, were lost to follow-up, or had no known outcome. 

Recommendations from the assessment highlighted two main issues: 

First, almost one-third of the patients did not know their TB diagnosis or the phase of treatment they were in, suggesting the need for better patient education and provider counseling. 

Second, considerable differences existed in the services desired by clients and the services they received, suggesting that TB support services at facilities should be reviewed and possibly expanded. 

The results of the assessment are being used to develop programs and interventions to improve TB service delivery. “Studies show that good quality of care in TB services helps patients and their families address their health needs safely and effectively,” said Cloutier. “Therefore, to enhance TB service use, there is a need to assess and improve the quality of TB services.”

Access the full report at https://www.measureevaluation.org/resources/publications/tr-19-350 

For more information on MEASURE Evaluation’s work on TB, visit https://www.measureevaluation.org/our-work/tuberculosis

To find out about our associate award, The TB Data, Impact Assessment and Communications Hub (TB DIAH), visit https://www.tbdiah.org/