P10.6-billion funding gap: Government must increase allocation for TB care

As we watch how the COVID-19 pandemic has reached every corner of the Philippines, there is another pandemic that has been with us for the longest time. Tuberculosis has put the Philippines on top in the whole of Asia, with the highest incidence rate of 554 cases per 100,000 people.

TB is curable. Yet four of five Filipinos who experience signs and symptoms of TB do not immediately go for proper check-up. They either self-medicate or simply do nothing. When asked why, they would talk about how trivial the symptoms were, or how costly it was to seek care and get treatment.

TB treatment is free in public hospitals, clinics, and health centers. Yet, about 60 percent of Filipinos with TB go to private doctors for comfort and anonymity. They spend for consultation, diagnostic tests, and medicines. Experts have reported that 35 percent of Filipinos with TB experience catastrophic costs or “out-of-pocket” expenses beyond their means.

How much does it cost for the Philippine government to find and treat one person with TB? Excluding expenses for transportation, an initial TB screening at a government health facility will cost P300 for a chest X-ray and P7,000 for a rapid confirmatory diagnostic test. For drug-susceptible TB (DSTB), or the type of TB that can be treated by first-line drugs, treatment for an adult may cost P2,300 for six months. For the more potent type called drug-resistant TB (DRTB), the treatment cost ranges from P35,000 to P600,000, depending on the treatment regimen. The estimated costs are significantly higher if a person with TB chooses to pay for the treatment regimen from his or her own pocket.

Our goals are to reduce the TB incidence rate from 554 to 448 cases per 100,000 people in 2023, and to eliminate out-of-pocket expenses for TB care. To reach these, we have to find and treat as many TB cases as possible to prevent the further spread of the infection. Our plan has been to find and treat 2.5 million Filipinos with TB from 2017 to 2022. As of June 2020, we have diagnosed and started on treatment for 1.2 million persons with TB. This means we still need to find and treat 1.3 million more, including 43,000 people with DRTB.

This requires us to allot at least P6 billion in the next three years for anti-TB drugs alone. Add to this the cost of human resources and other diagnostic commodities and logistical items to make sure that the drugs reach every hospital, clinic, or health center. Based on our analysis, we require about P50 billion to meet our goal by the end of 2023.

In 2021, we need about P15 billion to implement the National TB Program. We estimate that we could raise P4.4 billion from national and local government budgets and other donor funding sources. This leaves us with a huge funding gap of about P10.6 billion.

Although we allocated an estimated P500 million for the national TB program for 2021, extensive efforts on the political and programmatic levels should be done, so the government can increase the National TB Program’s budget allocation to at least P2 billion every year to contribute significantly to ending TB in the country. At the local levels, we ask mayors and governors to review and increase their local allocations for TB services. We enjoin the private sector and civil society groups to support the government in finding and treating more Filipinos with TB.

We have all the means and the will to end the burden of TB in the Philippines. But we need to fill in the funding gap to make this happen. Our failure to address this gap will prove to be very costly to the health of all Filipinos.

Rep. Angelina Tan
Chair, Committee on Health
House of Representatives