Evaluating Tuberculosis Surveillance Using Global Standards and Benchmarks in the Philippines: Mixed Methods Study.

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Surveillance

Background:

• The Philippines faces a significant global tuberculosis (TB) burden, with 741,000 estimated cases and 40,000 deaths in 2022.
• An estimated 350,000 new TB diagnoses go unreported annually in the country.
• Addressing the TB epidemic requires robust and accurate national surveillance systems.

Purpose of the Study:

• To assess the accuracy, completeness, and timeliness of the national TB surveillance system in the Philippines.
• To evaluate the system against global TB surveillance standards and benchmarks.
• To identify areas for improvement in TB case reporting and management.

Main Methods:

• A mixed-methods approach involving field visits to 9 purposively selected health facilities across 4 regions.
• Review of health records and interviews with key informants to evaluate TB surveillance activities.
• Assessment against 16 globally accepted TB surveillance performance standards.

Main Results:

• Only 25% of performance standards were fully met, with 56.3% partially met and 18.8% not met, an improvement since 2019.
• Significant local variations exist in electronic reporting adoption and quality assurance practices.
• Over 50% of reported TB cases lacked bacteriological confirmation, and underreporting/underdiagnosis was prevalent.
• Delayed reporting was common, particularly in areas with limited connectivity or medication access.

Conclusions:

• Data quality assurance, case verification gaps, and reporting timeliness pose threats to surveillance integrity.
• Enhanced monitoring, evaluation, and targeted studies (e.g., national TB inventory) are crucial.
• These interventions can quantify underreporting, guide funding, and track progress toward TB elimination targets.