BACKGROUND: The Philippines has, mandatory service policies to address the insufficiency and maldistribution of human resources particularly for health services. Despite being perceived as an appropriate intervention to bridge the aforementioned HRH gaps, the past and present implementations of such programs in the country have never been formally studied.

OBJECTIVE: This paper aimed to present the history of mandatory service programs in the Philippines, look at their natures, and see how their different implementations relate to each other.

METHODOLOGY: Using a qualitative document analysis method, administrative issuances and reports relevant to past and current implementations of mandatory service policies in the Philippines were obtained and reviewed.

RESULTS: Mandatory service programs have been implemented in the country by institutions from both the private and public sectors as early as 1968. The focus of such has been mostly for government positions and specialized professions including physicians and scientists. While extensive efforts have been made through the years, the policies demonstrated fragmentation and recurring gaps in implementation. Such gaps include the lack of enabling policy mechanisms, formal monitoring and evaluation, and program institutionalization.

CONCLUSION: The historical narrative of return service programs in the country is a potential source for the development of an overarching mandatory service policy framework for human resources in the Philippines, one that is specific to the context and setting of the country. By articulating policy issues identified, this paper provided a stepping-off point for future mandatory service program policy planning, implementation, evaluation, and institutionalization in the Philippines.

Workforce ; Institutionalization ; Physicians

Background and Objectives: Tuberculosis (TB) remains a public health problem in the Philippines despite trends indicating a decline in the burden of disease. Persons who use drugs who are confined in government-retained drug abuse treatment and rehabilitation centers (DATRCs) face an increased risk for TB because of the congestion in the facility coupled with the absence of guidelines on TB management specific to DATRCs. Thus, this study was conducted to document the current case finding and case holding practices as well as TB treatment pathway in six (6) Luzon-based, government-retained DATRCs.

Methods: Key informant interviews were conducted with DATRC personnel involved in TB diagnosis and management in six selected DATRCs in Luzon, Philippines. Interviews were transcribed and coded for thematic analysis. We compared the DATRC practices with the provisions of the 2014 National TB Control Program (NTP) Manual of Procedures. Results were validated through a workshop with (a) a group of physicians and rehabilitation practitioners assigned in other DATRCs; and (b) a group of experts who have experience in managing or overseeing DATRCs in the country.

Results: Two physicians and four nurses participated in the interviews. Variations in case finding and case holding practices in six DATRCs have been found. National guidelines exist for congregate settings but are more specific to jails/prisons, which are administratively and operationally different from DATRCs.

Conclusion: Development of special guidelines for TB case finding and case holding in DATRCs as well as staff training on the latest NTP Manual of Procedures are recommended. However, gaps and inequities posed by the current set-up underscore the need to address health system-wide factors affecting the practice and performance of these facilities.

Key Words: tuberculosis, case finding, case holding, drug abuse treatment and rehabilitation centers, Philippines

Tuberculosis ; Rehabilitation Centers

Background and Objectives: Tuberculosis (TB) continues to be a public health concern in the Philippines. Vulnerable populations in congregate settings such as drug abuse treatment and rehabilitation centers (DATRCs) have higher risks of TB transmission and infection. With the Duterte administration’s intensified campaign against illegal drugs, government-retained DATRCs are filled to capacity. There is an identified need to profile drug users and dependents living in DATRCs. Furthermore, national guidelines for TB management specific to this population is absent. A study was conducted to determine the profile of admitted clients diagnosed with TB, TB prevalence, treatment outcomes and choice of TB diagnostic modalities in six (6) Luzon-based DATRCs from 2013-2015. Methods: All medical records of drug users admitted in this period were reviewed. Information on the total patient census was sought from DATRC heads and used to compute for prevalence. Results: A total of 347 records were obtained. Overall TB prevalence in the study sites was 7,216 per 100,000 population. The typical individual diagnosed with TB in a DATRC was male, with a mean age of 35 years, with at least high school education, and unemployed. Weight loss and fatigue were the most common symptoms reported. The majority (79.83%) completed TB treatment in the DATRCs. Sputum microscopy and chest x-ray were both used for TB diagnosis in 92.80% (322) of the cases. Conclusion The high burden of TB in Luzon-based, government-retained DATRCs is alarming and underscore the critical need for standards and guidelines in the National Tuberculosis Control Program addressing the unique context of these facilities.
Substance Abuse Treatment Centers ; Prevalence ; Philippines ; Tuberculosis ; Psychiatric Rehabilitation ; Behavior Therapy