TUBERCULOSIS

from TB in 2020 (including 214

000 people with HIV). WHO Key Facts
Worldwide, TB is the 13th In 2020, the 30 high TB burden
leading cause of death and the 01 countries accounted for 86% of new
second leading infectious killer TB cases. Eight countries account for
two thirds of the total, with India
after COVID-19 (above
HIV/AIDS). 02 leading the count, followed by China,
Indonesia, the Philippines, Pakistan,
Nigeria, Bangladesh and South Africa.
Ending the TB epidemic by 2030
is among the health targets of the
United Nations Sustainable
05 In 2020, an estimated 10 million
Globally,
DevelopmentTB incidence
Goals (SDGs). is
falling at people fell ill with tuberculosis (TB)
about 2% per year and between 201504 worldwide. 5.6 million men, 3.3 million
03 women and 1.1 million children. TB is
and 2020 the cumulative reduction was present in all countries and age
11% groups. But TB is curable and
preventable.
(over half way to the End TB Strategy milestone of
20% reduction between 2015 and 2020). https://www.who.int/news-room/fact-sheets/detail/tuberculosis
What is TB?
Tuberculosis (TB) is caused by
bacteria called Mycobacterium
tuberculosis (M.
tuberculosis).

The bacteria, or germs, usually attack

the lungs. TB germs can attack
any part of the body, such as the
kidney, spine, or brain.

https://www.cdc.gov/tb/publications/faqs/pdfs/qa.pdf
What is TB?
https://www.cdc.gov/tb/publications/faqs/pdfs/qa.pdf
 Background of the study
⮚ Tuberculosis is a, or perhaps the, major challenge to global health in
the 21st Century representing a serious impediment to Sustainable
Development Goals (SDGs) 3 that aims to “attain healthy lives and
well-being for all.
In the fight against tuberculosis, there has long been a call for a
shift toward a "human rights-based approach," in which policies
and programs are explicitly based on the norms and values set
forth in international human rights law, people with TB are treated
as rights holders in their interactions with the state and health
system, and stigma and discrimination are addressed.
 TB CASES IN THE
Program (NTP) of the PhilippinesPHILS
The 2016 prevalence study conducted by the National Tuberculosis Control
showed that 14.2% of TB positive patients
were asymptomatic, and only 6% of TB positive patients presented with a cough
that lasted less thanhigh-risk
2 weeks and
group did not
included: belong
men, elderly,tothose
a high-risk
in poverty,group
dwellers in urban slums,
smokers, previous TB patients, and diabetic individuals

In 2019, the Philippines had the highest TB incidence in Asia with 554 cases
per 100,000 people, according to a World Health Organization (WHO)
report. Approximately, 74 Filipinos die of TB every day and is among the top
10 causes of death in the country.

From January to March 2020, the National Tuberculosis Control Program

(NTP) of the DOH recorded a total of 88,662 new and relapse TB
cases, declining steeply by almost 20% between February (30,728) and
March (24,782).
Student with
PTB
STUDENT CASE SCENARIO
1
 Before the start of hospital duty, the 2nd year students
were asked to have their CXR done. The result of one
student showed possible PTB.
Further tests confirmed the findings.

The clinical coordinator met with the parents and

informed them that they could no longer accept the
student because of her health.

The parents sought legal help and charged the school as

violating the constitutional right of their child found in the
United Nations Universal declaration of Human Rights
that “everyone has the right to education”.
 Legal concern

TB-related stigma can lead to

discrimination and exclusion in
education.

The legal concern is the recognition of the

rights of people living with and vulnerable
to tuberculosis.
 Health-related Application to TB in
Human Rights
Content Legal Regime
What pertinent laws can be
used to make a decision?
International
http://www.stoptb.org/assets/documents/communities/FINAL%20Declaration
%20on%20the%20Right%20of%20People%20Affected%20by%20TB
%2013.05.2019.pdf
 Local
REPUBLIC ACT
NO. 10767
An act establishing a comprehensive philippine plan of action to eliminate tuberculosis
as a public health problem and appropriating fund therefore This Act shall be known
as the “Comprehensive Tuberculosis Elimination Plan Act”.

Declaration of Policy. – The State is mandated to adopt an integrated and

comprehensive approach to health development. Towards this end, the State
shall support and expand efforts to eliminate tuberculosis as a public health
problem by increasing investments for its prevention, treatment and control,
and adopting a multisectoral approach in responding to the disease.

https://www.officialgazette.gov.ph/2016/04/26/republic-
act-no-10767/
 The House Bill
number 8615
The Philippines has committed to end the TB epidemic by 2030 as
envisioned in the Agenda 2030 of the SDG.

The House Bill number 8615; An Act Strengthening the fight to end
tuberculosis, amending for the purpose Republict Act No. 10767 or the
“Comprehensive TB elimination Plan Act”, which was enacted in 2016 to
support and expand efforts to eliminate TB as a public health problem in the
country.
 The House Bill
number
Its committed of the following:
8615

✔ Ensure adequate social protection measures…

✔ Accelerate efforts to improve access to rapid TB diagnostic tools
✔ Ensure better health outcomes, a more responsive health system, and a
more equitable health care financing; and
✔ Forge partnerships in the areas of effective referral system development
to ensure continuum of care, prevent discrimaination…
Sec 08. Education Programs

⮚ The CHAIRPERSON of CHED in coordination with secretary of DOH

shall encourage the faculty of schools of medicine, nursing or medical
technology and allied health institutions, to intensify information and
education programs, including the development of curricula, to
significantly increase the opportunities for students and for practicing
providers to learn the principles and practices of preventing, detecting,
managing, and controlling tuberculosis.

https://www.congress.gov.ph/legisdocs/basic_18/HB00167.pdf
Sec 09. Inclusion in Basic Education

⮚ The DepEd in coordination with the Secretary of the DOH, shall work for
the inclusion of modules on the principles and practices of preventing,
detecting, managing and controlling TB in the Basic Education
Curriculum.

https://www.congress.gov.ph/legisdocs/basic_18/HB00167.pdf
Sec 16. TB Patients’ Rights and Responsibilities

Persons with TB shall have the following rights:

⮚ (1) The right to be treated with humanity and respect for the inherent
dignity of the human person including the delivery of services without
stigma, prejudice or discrimination.

⮚ (10) The right to exercise all civil, political, economic, social, and
cultural rights respecting individual qualities, abilities, and diverse
backgrounds and without any discrimination…as recognized in the
Universal Declaration of Human Rights, The International Covenant
on Civil and Political Rights, the International Covenant on
Economic, Social and Cultural Rights, and other International
Human Rights treaties to which the Philippines is a state party.
https://www.congress.gov.ph/legisdocs/basic_18/HB00167.pdf
http://chr.gov.ph/wp-content/uploads/2019/04/Position-Paper-on-the-Proposed-Amendment-of-the-
Comprehensive-Tuberculosis-Elimination-Plan-Act.pdf
 JUSTIFICATI
asks for an international, ON
⮚ The Stop TB Partnership's Global Plan to End TB 2016–2020
regional, and domestic law-based
human rights and gender-based approach to TB.

⮚ The Global Plan recognizes that successful TB programming

requires global and national programs to be grounded on
human rights and gender justice.

❖ The UN High-Level Meeting on TB on 26 Sept 2018 in New York under

the theme “United to end TB: an urgent global response to a global
epidemic” is a tremendous and unprecedented step forward by
governments and all partners engaged in the fight against TB.
 JUSTIFICATI
ON
⮚ Tuberculosis is not a newly emerging disease in the
Philippines . For a long time, the Philippines battled against it,
and became a pioneer in making state-of-the-art MDR-TB
treatment available in the world.

❖ In support of the DOH, the Health Policy Development Program (HPDP’s) primary
objective is to strengthen a supportive policy and financing environment for
family planning and maternal, newborn, and child health and nutrition (FP/MNCHN)
and tuberculosis (TB) to enable the Philippines to achieve its Millennium
Development Goals (MDGs) in health, as well as expand and sustain its
Kalusugan Pangkalahatan/Universal Health Care (KP/UHC) initiative.
 JUSTIFICATI
ON
❖ it is imperative to clearly specify the policies and guidelines
to comply with the policy and program to provide the
necessary support and protection of TB patients.
 JUSTIFICATI
ON
People with tuberculosis (TB) are still subjected to stigmatizing
language (eg, ‘TB suspects’, ‘defaulters’), lacking of privacy in
mandatory screening, testing and disease notification systems, contact
tracings that label index patients, airborne respiratory isolation that
prolongs their social isolation, directly observed treatment (DOT) that
impedes individual autonomy, and in rare but relevant cases, legal
detention and even incarceration of those who refuse or stop treatment.

❖ As long as these methods are used in biological, public-

health-oriented ways, they will continue to fuel social
exclusion of persons living with tuberculosis and reify
presumptions of conflicts between public health and patient
rights.
 JUSTIFICATI
ON
⮚ The Commission on Human Rights as the country’s national
human rights institution and mandated by the 1987
Constitution supports to protect and promote human rights of
Tuberculosis patients and to empower them to demand their
entitlements due from the duty-bearers.
…Responsibilities of the TB patients

The Commission on Human Rights recommended that the law must

define the consequences if a person refuses or fails to deliver on his/her
responsibilities as a TB patient. Moreover, these consequences should
not result in causing further harm against the person.

https://www.congress.gov.ph/legisdocs/basic_18/HB00167.pdf
http://chr.gov.ph/wp-content/uploads/2019/04/Position-Paper-on-the-Proposed-Amendment-of-the-
Comprehensive-Tuberculosis-Elimination-Plan-Act.pdf
 Relevant
0 literature or
past cases
1
CHINA
 CHINA
● In a recent study of Zhang, et.al., it was found out
that TB patients are more worried about
interruption of their studies rather than the disease.
Furthermore, it was concluded that student’s
serious lack of awareness of TB, caused by the
ignorance of school, parents and the students,
becomes the biggest obstacle to timely diagnosis
and treatment. 
 TB programs have been chastised
for their top-down disease
management style, which has been
accused of alienating affected
people.
Daftary, A., Calzavara, L., &
Padayatchi, N. (2015). The contrasting
cultures of HIV and tuberculosis care.
AIDS (London, England), 29(1), 1–4.
https://doi.org/10.1097/QAD.00000000
00000515
How the case
could have
been prevented.
 Preventive measures for
01SCHOOL the case to be prevented 03
Incorporating TB screening
02 Establish
before the practicum of
students, ensuring the staff are Empower Protocols
The adoption of an
free from TB i.e. periodic
medical clearance and ensuring ment unquestioning
mindset to
school infrastructure meets TB advocacy and support. established protocols
environmental hygiene • Increase patients’ involvement in
standards. TB treatment and other patient
related programs
Strengthening health education
Other methods – Destigmatizing TB
( ‘zero suffering’,)
“NEGATIVE descriptions to be
removed from doctors' and “patient-sensitive approaches to
researchers' vocabulary, reinforce care within TB programs
unfavorable stereotyping of
persons with tuberculosis.” • emphasize community
engagement, patient
counseling and structural
aid in adherence promotion,
“consciousness raising, a
even a murmur of palliative
form of activism that
care for those with incurable
connects disparate
disease.
experiences of
discrimination and • Cohesive and complementary
disenfranchisement, and the
approach that meets the
systems and structures that
sociomedical needs of co-
abet them, across time and
infected patients
space.”
Daftary A, Frick M, Venkatesan N, et al (2017). Fighting TB stigma: we need to apply lessons learnt from HIV activismBMJ Global Healt;2:e000515
Other sources: https://tbcindia.gov.in/WriteReadData/l892s/2581521802Strategy%20to%20End%20Stigma%20and%20Discrimination%20Associated
%20with%20TB%2018032021%20New.pdf.
 REFERENCES
● Cremers AL, de Laat MM, Kapata N, et al. (2015). Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLoS
ONE; 10(3):e0119861
● Daftary, A., Calzavara, L., & Padayatchi, N. (2015). The contrasting cultures of HIV and tuberculosis care. AIDS (London, England), 29(1),
1–4. https://doi.org/10.1097/QAD.0000000000000515
● Daftary, A., Frick, M., Venkatesan, N., & Pai, M. (2017). Fighting TB stigma: we need to apply lessons learnt from HIV activism. BMJ global
health, 2(4), e000515. https://doi.org/10.1136/bmjgh-2017-000515
● Dingake O. (2017). Human Rights, TB, Legislation, and Jurisprudence. Health and human rights, 19(1), 305–309.
● Frick, M., Henry, I., & Lessem, E. (2016). Falling Short of the Rights to Health and Scientific Progress: Inadequate TB
Drug Research and Access. Health and human rights, 18(1), 9–24.
● Kavanagh MM, Gostin LO, Stephens J (2020) Tuberculosis, human rights, and law reform: Addressing the lack of progress in the global
tuberculosis response. PLoS Med 17(10): e1003324. https://doi.org/10.1371/journal.pmed.1003324
● Panelo, C. I .A., Solon, O. J. C., Ramos, R. M., Herrin, A. N. The Challenge of Reaching the Poor with a Continuum of Care: A 25-Year
Assessment of Philippine Health Sector Performance. Quezon City, 2017.
● Sharpe L , Ginsburg G , Gordon G , et al . (2017)Trying to make the personal political: feminism and consciousness-raising - a reprint of
consciousness raising guidelines (1975). Chicago: Women’s Action Alliance, Half Letter Press.
● Siwon Lee, Lincoln Lau, Krisha Lim, Jansel Ferma, Warren Dodd, Donald Cole, "The Presence of Cough and Tuberculosis: Active Case
Finding Outcomes in the Philippines", Tuberculosis Research and Treatment, vol. 2019, Article ID 4578329, 9 pages, 2019.
https://doi.org/10.1155/2019/4578329
● Tuberculosis outbreaks in schools: experiences from the Western Pacific Region. Manila, Philippines. World Health Organization Regional
Office for the Western Pacific; 2020. Licence: CCBY-NC-SA 3.0IGO.
● WHO. (2015). The End TB Strategy. Geneva: World Health Organization.
● Zhang, S., Li, X., Zhang, T. et al. The experiences of high school students with pulmonary tuberculosis in China: a qualitative study. BMC
Infect Dis 16, 758 (2016). https://doi.org/10.1186/s12879-016-2077-y
 ●https://assets.publishing.service.gov.uk/media/57a08b3ced915d622c000bb7/TB_and_Stigma_May09.pdf

●https://doh.gov.ph/sites/default/files/publications/NTP_MOP_6th_Edition.pdf

●https://www.challengetb.org/publications/tools/ua/TB_Stigma_Measurement_Guidance.pdf

●https://www.cdc.gov/tb/publications/faqs/pdfs/qa.pdf

●http://www.congress.gov.ph/legisdocs/basic_17/HB08615.pdf

●https://www.congress.gov.ph/legisdocs/basic_18/HB00167.pdf

●https://www.hindawi.com/journals/trt/2019/4578329/

●https://www.officialgazette.gov.ph/2016/04/26/republic-act-no-10767/

●https://www.theglobalfund.org/en/blog/2021-10-05-adapting-tb-programs-to-face-the-challenge-of-covid-19-lessons-from-the-philip
pines/

●http://www.stoptb.org/assets/documents/communities/FINAL%20Declaration%20on%20the%20Right%20of%20People%20Affected
%20by%20TB%2013.05.2019.pdf

●https://www.who.int/news-room/fact-sheets/detail/tuberculosis

●file:///C:/Users/persha/Downloads/9789290619369-eng.pdf
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