ULPINDO, Vinjoe C.
BSN II-G3
A Qualitative Study on the Implementation of the Workplace TB Program in the Philippines:
Challenges and Way Forward
ABSTRACT
Tuberculosis (TB) is a chronic infectious disease that remains to be a primary health concern
globally. The Philippines is among the top TB-burdened countries. Workplace TB prevention
and control programs are essential to ensure the health and safety of workers and economic
security. There remains a knowledge gap regarding the Philippine workplace TB prevention
and control program implementation. This qualitative study involving key informant interviews
reviewed the implementation of the workplace TB program in selected companies in a high
TB burden region in Eastern Philippines. Results were presented under four themes in
accordance with the components of the workplace TB policy: preventive strategies, medical
management, data recording and reporting, and social policy. Various good practices,
opportunities, and challenges in the implementation of the workplace TB program were
identified. There is a need to strengthen the enforcement of policy across different
components. Compliance with guidelines on preventive strategies and recording and
reporting schemes needs to be intensified. Coordination across different levels and agencies
may also be enhanced to allow more efficient implementation. Increased awareness of
corporate decision makers may improve company ownership of the program leading to
improved implementation while increased awareness of employees on their rights and
entitlements may likewise enhance compliance.
Keywords: tuberculosis; workplace; occupational health; qualitative research; Philippines
INTRODUCTION
Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis,
primarily affecting the lungs but with potential extrapulmonary manifestations. It poses
significant public health and economic challenges globally, with the Philippines ranking
among the highest TB-burdened nations. Workplace TB prevention and control programs are
crucial to ensuring worker safety and economic stability. Despite existing workplace TB
policies in the Philippines, gaps in program implementation persist, necessitating a
comprehensive evaluation to identify strengths, challenges, and opportunities for
improvement.
Objective of the Study
To evaluate the implementation of the workplace TB prevention and control program in
selected companies in a high TB-burden region of Eastern Philippines, focusing on policy
enforcement, coordination, and compliance.
Statement of the Problem
The implementation of workplace TB policies in the Philippines faces challenges, including
inconsistencies in guidelines, limited interagency coordination, resource constraints, and
inadequate compliance and awareness among stakeholders.
METHODOLOGY
Research Design
The study utilized a qualitative research approach through key informant interviews (KIIs),
guided by a thematic framework derived from existing workplace TB policy provisions.
Population and Sample of the Study
The study included 18 representatives from relevant government agencies (e.g., DOH, DOLE),
local government units (LGUs), and private companies with at least 100 employees and
workplace TB programs. Participants were purposively selected to capture diverse insights on
policy implementation.
Instrumentation
Pre-tested interview guides aligned with policy components were used to explore
participants' experiences, roles, and challenges in program implementation.
Hypothesis of the Study
The workplace TB prevention and control program's success depends on the consistency of
policy enforcement, interagency collaboration, resource availability, and stakeholder
engagement.
Data Processing and Analysis
Thematic analysis was conducted using Braun and Clarke’s approach, guided by the
components of the workplace TB policy: preventive strategies, medical management, data
recording and reporting, and social policy.
Ethical Considerations
Ethical approval was obtained from the University of the Philippines Manila Research Ethics
Board. Informed consent ensured participant privacy and confidentiality.
RESULTS
Preventive Strategies
Key findings revealed gaps in the consistent application of TB guidelines and the significant
influence of company willingness on policy adherence. While some companies incorporated
TB screening in annual health checks and workplace improvements (e.g., ventilation), limited
coordination and funding constrained broader capacity-building efforts.
Medical Management
Challenges included a shortage of trained personnel, inconsistent resource availability, and
service disruptions due to the COVID-19 pandemic. High pill burdens affected treatment
adherence, highlighting the need for patient-friendly formulations.
Recording and Reporting
Issues such as incomplete data, limited jurisdiction of the Department of Health (DOH), and
non-compliance with reporting protocols hindered effective monitoring. Coordination
between DOLE and DOH was minimal, complicating data integration.
Social Policy
Stigma against TB-positive individuals and insufficient knowledge of available benefits
undermined patient compliance. However, provisions for work accommodations and
non-discrimination policies emerged as strengths in improving treatment adherence.
DISCUSSION
The study underscores the interplay between policy enforcement, stakeholder collaboration,
and resource allocation in shaping workplace TB program outcomes. Aligning
company-level guidelines with national policies, addressing logistical gaps, and enhancing
interagency collaboration are critical to program success. Lessons from COVID-19 response
measures may offer valuable insights for strengthening TB initiatives.
CONCLUSION
The workplace TB program in the Philippines demonstrates notable practices but faces
significant challenges in enforcement, resource allocation, and coordination. Addressing
these gaps requires enhanced awareness, stricter policy compliance, and integrated
approaches to data management and service delivery.
RECOMMENDATIONS
1. Policy Enforcement: Intensify monitoring and compliance through interagency
collaborations and clear penalties for non-compliance.
2. Data Integration: Develop a unified information system for TB case tracking across
DOLE, DOH, and LGUs.
3. Capacity Building: Conduct regular training and workshops at all implementation
levels to improve awareness and competency.
4. Stigma Reduction: Implement targeted awareness campaigns to normalize TB
discussions and encourage treatment adherence.
5. Resource Allocation: Prioritize funding for medications, diagnostics, and manpower,
particularly in underserved regions.
6. Engaging MSMEs: Expand workplace TB programs to micro and small enterprises
through simplified compliance mechanisms.
REFERENCES
● Roxas, E.A., et al. (2023). A Qualitative Study on the Implementation of the Workplace
TB Program in the Philippines: Challenges and Way Forward. Tropical Medicine and
Infectious Disease, 8, 93.
● World Health Organization. (2022). Global Tuberculosis Report. Geneva.
● Department of Health. (2021). National Tuberculosis Control Program: Manual of
Procedures, 6th ed. Manila.
● Department of Labor and Employment. (2005). Guidelines for the Implementation of
Policy and Program on Tuberculosis (TB) Prevention and Control in the Workplace.
Manila.
As a student nurse, this study on the workplace TB program in the Philippines resonates
deeply with the foundational principles of nursing, particularly health promotion and disease
prevention. The challenges highlighted, such as resource limitations, stigma, and inconsistent
policy implementation, shed light on the complexities of real-world public health
interventions. It is eye-opening to see how workplace health programs, which aim to protect
both employees and the greater community, can face systemic obstacles despite their
noble intentions. This study reinforces the importance of a holistic and collaborative
approach in healthcare, where all stakeholders—government agencies, employers, and
health workers—must work in unison to achieve optimal outcomes. As future healthcare
providers, we must champion policies like these, ensuring that even the most vulnerable
sectors of society, such as informal workers and employees in small enterprises, have access
to essential health services.
Relating this to the Department of Health’s National Tuberculosis Control Program (NTP), the
findings of this study emphasize the need for robust policy enforcement and the integration
of workplace initiatives into the broader TB prevention and control efforts. The NTP’s focus on
patient-centered care and community engagement aligns with the call for more
collaborative efforts highlighted in the research. This underscores our role as student nurses
not only as caregivers but also as advocates for stronger health systems and better policy
adherence. By understanding these gaps, we are better equipped to contribute
meaningfully to health promotion campaigns and address the barriers to accessing care,
ultimately striving to reduce the burden of TB in the Philippines.
The Department of Health's National Tuberculosis Control Program (NTP) is the primary
government initiative in the Philippines dedicated to addressing the prevention, diagnosis,
treatment, and management of tuberculosis (TB). Established under the Comprehensive and
Unified Policy (CUP) for TB control in the Philippines, the NTP aims to reduce TB incidence,
prevalence, and mortality by providing accessible, high-quality TB care and services to all
Filipinos. Its overarching goal aligns with the global efforts to eliminate TB as a public health
problem, as outlined by the World Health Organization's (WHO) End TB Strategy.
The program adopts a patient-centered approach, emphasizing early detection through
active case finding, rapid diagnostic tests, and community-based screening. It ensures free
access to TB medications via the Directly Observed Treatment Short-course (DOTS) strategy,
a WHO-recommended framework that ensures adherence to treatment. The NTP also
prioritizes education and advocacy to increase awareness and reduce stigma, aiming to
create an environment where individuals are encouraged to seek diagnosis and treatment
without fear of discrimination. Additionally, the NTP collaborates with various sectors,
including local government units (LGUs), private healthcare providers, and international
organizations, to integrate TB control efforts into the broader health system. Through these
measures, the program seeks to make TB diagnosis and treatment universally accessible,
especially to marginalized and high-risk populations.
