There are occasions where a person with TB disease is either non-compliant with treatment or fails to act in a way that minimises the potential for transmission to others. Where the person has pulmonary TB and is assessed as being infectious the risk to the public must be considered. It is essential that individualised, ongoing education and support is provided to all persons with TB to improve compliance with diagnosis, treatment and screening. A Public Health Order is only issued after other strategies to establish and maintain compliance with care or treatment are exhausted and it is assessed that there is a risk to the health of the public.
A Public Health Order must require the person to whom it applies to do any one or more of the following:. Where the circumstances justify continuing the order past 28 days, then an application may be made to the District Court to extend the order for up to a further six months. Legal preparedness and key regulations are central in ensuring the success of public health efforts to control the spread of TB [ 13 ].
One of the epidemiological indicators for national TB control programs is the case detection rate for all forms of TB [ 2 , 16 ]. However, TB has not been included on the list of legally notifiable diseases in the Philippines since when Department Circular No. This has limited the ability of the Department of Health DOH to ensure notification from non-national TB providers in the public and private sectors to monitor the disease incidence effectively in the country [ 9 , 15 , 18 ].
This is a major concern, as the incidence of TB cases cannot be estimated accurately due to the inadequate reporting of TB cases from non-NTP providers in the public and private sectors. This study aimed to review and describe TB regulations in the Philippines to assist public health practitioners and policy makers to assess and improve regulations, as a tool to control TB.
Regulating TB as a notifiable disease improves the detection and surveillance of the disease [ 3 ]. This study also aimed to provide options for introducing TB notification regulations. The current communicable disease-related laws and regulations in the Philippines and those of other countries were compared to determine the comparable status of TB laws in the Philippines, and to show where the current TB regulations in the Philippines need to change to reflect global practice.
Laws regulating TB are defined as comprising health legislation e. To review the current TB-related laws in the Philippines, relevant acts, executive orders, presidential decrees, administrative orders, and memorandums were reviewed. Comparable health policies and legislations of countries in the Western Pacific region, in particular, as well as those of a range of other countries were reviewed. The WHO have categorized the Philippines as one of the countries in the Western Pacific region; therefore, most countries within the region were selected for comparison, with developed countries such as the United Kingdom and Canada also selected for review.
It was considered that the range of countries selected was sufficiently representative of TB regulations internationally to be informative of best policy and practice. Data on the cases reported in the Philippines were obtained from health authorities, and health legislation data of foreign countries were collected from public law databases or from the webpages of each government Table 1 that were publicly accessible.
A content analysis of the legal provisions was performed to propose future directions of TB control law in the Philippines. The Philippines has a population of 99 million and has a high burden of TB, with an estimated , new TB cases each year [ 17 ].
The estimated incidence of newly diagnosed TB annually was per , persons in [ 22 ], and TB-related mortality was 33 per , persons in [ 15 ]. TB continues to be the sixth leading cause of death despite the long-standing public health prevention efforts made by various units of the Philippine government.
Services covered are not comprehensive, co-payment is high, and the reimbursement procedure is complex. The TB prevention program is operated by health centers and provincial hospital outpatient clinics in the public sector.
Outpatient TB-DOTS is included in the benefits package, but outpatient consultation and ongoing requirements for medication are not yet included [ 23 ].
Cost may be among the barriers in accessing TB services, although the national TB budget was million US dollars in [ 21 ]. Cases diagnosed and treated in health facilities outside the NTP network of providers, including private clinics and hospitals, are not included; therefore, the surveillance system underreports the total number of TB cases in the Philippines [ 18 ].
In , the Law on Reporting of Communicable Diseases was enacted, which required all individuals and health facilities to report notifiable diseases to local and national health authorities. In addition, the Act reorganized the TB Unit in the Department of Health to specify that the TB Unit have the functions of pooling all information on TB and exchanging such information with other countries.
The Law on Reporting of Communicable Diseases Republic Act still requires all individuals and health facilities to report notifiable diseases to local and national health authorities. In , the Department of Health circular No. In that circular, TB is listed as a reportable disease along with the case definitions of TB, meningitis, respiratory illnesses, and other types of communicable diseases.
The revised list of notifiable diseases is the same as that of the document. However, the revised list of notifiable or reportable diseases included diseases and syndromes that had been selected because they were epidemic-prone diseases, targeted for eradication or elimination, and subject to international health regulations. TB was no longer included the list of reportable or notifiable diseases.
A recent update on the administrative Order no. However, TB is not included in either of these categories. The Code of Sanitation of the Philippines notes that the Philippines recognized the [ 19 ] and that some of the provisions in the IHR may be considered part of this code. The reporting of TB as a notifiable disease is intended to control TB through ensuring that healthcare professionals have an official obligation to inform the government concerning TB to enable it to control the disease and authorize health officials to act as necessary.
However, this practice is not mandatory in the Philippines. Nine of 17 countries selected have legislation declaring TB as a notifiable disease. The other 8 countries have notification regulations in their domestic laws, but which do not specify the diseases, including TB.
Because the sample countries are mainly drawn from the Western Pacific region, our study findings are primarily applicable to countries within this region. However, given that TB is a notifiable disease in other countries such as the United Kingdom and Canada, the results of the study provide useful information in understanding international practice more broadly. The goals of TB control are to reduce mortality, morbidity, and disease transmission until it no longer poses a threat to public health.
One of the target goals of TB control is case detection. In the US, TB control laws have established reporting requirements even at the sub-national jurisdiction level in at least 25 different jurisdictions, based on legal research, review, and feedback provided by legal and TB practitioners [ 4 ].
Health care providers, laboratories, or others are legally required to report suspected or confirmed cases of TB, MDR-TB, or XDR-TB infection, and public health officials in state or non-state agencies are legally required to further report such information to any other entity at the appropriate local, state, or tribal levels.
Since , TB has been a notifiable disease in India, which means that all cases of TB diagnosed by any means must be reported to the public health authorities following a specified format [ 1 ].
This initiative was implemented to estimate the number of TB cases in the community with greater accuracy [ 14 ]. Added 'Tuberculosis in England: national quarterly reports'. Added 'National quarterly report of tuberculosis in England: Quarter 4, provisional data' report.
Added new page 'Tuberculosis in England: quarterly reports'. Added TB annual report for and the slide set. Added resource for tackling tuberculosis in under-served populations. Added guidance for the unlicensed BCG vaccine, in response to a vaccine shortage: training material for healthcare professionals; guide for parents and carers.
Added existing latent TB testing guidance and patient leaflet in multiple languages to the collection. Added treatment and management advice documents from the National Knowledge Service. Publishing annual report and statistics covering up to The Tuberculosis in Kent, Surrey and Sussex: annual report has been published. The Tuberculosis: notifying cases guidance has been added. Updated to include 'Bovine tuberculosis: public health management' guidance. Bovine tuberculosis is rare, but can be acquired from ingestion of unpasteurised milk or air-borne spread.
Incubation period: 4 weeks to many years. Infectious period: As long as live bacteria are in sputum. Effective treatment usually eliminates infectious risk within 2 — 4 weeks. Case exclusion: exclude until Medical Certificate of Recovery is obtained.
Contact exclusion: Do not exclude.
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