ORDINANCE NO: 2009-286 (Sponsor: Committee on Ecology, Health and Social Services) "AN ORDINANCE ADOPTING THE MANUAL OPERATION OF THE TB-DOTS STRATEGY OF THE NATIONAL TUBERCULOSIS PROGRAM IN THE CITY OF PAGADIAN AND APPROPRIATING FUNDS THEREFOR" Be it ordained by the Sangguniang Panlungsod of Pagadian City, in session assembled that: SECTION 1. TITLE. - This ordinance shall also be known as "The Pagadian City NTP-TB-DOTS PPMD Program." SECTION 2. DECLARATION OF PRINCIPLES. - It shall be the declared policy of the City Government of Pagadian to: 2.1. Institute an effective program for Tuberculosis control and eradication in the City of Pagadian through the National Tuberculosis-Control Program (NTP) utilizing as the main basis or reference the Direction Observed Treatment Short-course (DOTS) strategy in accordance with Executive Order No. 187 dated 21 March 2003 including, but not limited to, the following components, to wit: 2.1.1. Direct Sputum Smear examination shall be the initial diagnostic tool in case finding. 2.1.2. Standardized chemotherapy in accordance with NTP. 2.1.3. Recording and Reporting of cases shall be on the standardized NTP forms to be implemented in the health center. 2.1.4. Directly Observed Treatment (DOT) shall be used as the strategy to insure patient compliance. 2.1.5. Political commitment to ensure a sustained and comprehensive implementation of the NTP activities. 2.2. Establish its Mission/Vision, Goal and Target as measures or indicators for the evaluation of the NTP-DOTS-PPMD program of the City. 2.2.1. Mission/Vision Statement: "A competent and committed public and private health care providers supported by other stakeholders working together with an empowered healthy citizenry towards achieving a TB-FREE, progressive and God-loving community in the City of Pagadian." 2.2.2. Goal: To reduce the prevalence, morbidity and mortality of TB cases in Pagadian City by 50% in 2012 and complete control or eradication of TB in 2015. 2.2.3. Impact Target: To make Pagadian City a TB-FREE community in the year 2016. SECTION 3. DEFINITION OF TERMS. - As used in this Ordinance, the following terms are hereby defined to mean: 3.1. CHO - City Heath Office of Pagadian City. 3.2. DOTS - Directly Observed Treatment Short-course. 3.3. DSSM - Direct Sputum Smear Microscopy. 3.4. NTP - National Tuberculosis-Control Program. 3.5. PhilCAT - Philippine Coalition Against Tuberculosis. 3.6. PPMD - Public-Private Mix DOTS. 3.8. PPMD Unit-Philhealth Accredited Facility - PPMD Unit of the City of Pagadian. 3.9. PPMD Unit-TB DOTS Center - Pagadian City Government Facility. 3.10. QA - Quality Assurance. 3.11. PHM - Public Health Midwives. 3.12. TB - Tuberculosis. 3.13. TBDC - TB Diagnostic Committee. SECTION 4. NTP-DOTS-PPMD: OPERATION, MANAGEMENT AND PROTOCOL. - The establishment of the NTP-DOTS-PPMD shall be guided by the herein declared rules, policies and guidelines, to wit: The City Government of Pagadian through the City Health Office in coordination with the Department of Health through its Region IX Office and Philhealth shall stipulate the following rules for the PPMD Unit-TB DOTS Center. 4.1. Ownership. The facility is owned and operated by the City Government of Pagadian. 4.2. Service Capability. This City Health Facility shall provide detection, diagnosis, management and treatment, recording and monitoring of active TB patients in the City of Pagadian. 4.3. Functions and Responsibilities of the TB DOTS Facility and staff: 4.3.1. to identify and establish the roles and responsibilities of the partners in the organization and delivery of NTP care per NTP guidelines; 4.3.2. to coordinate with the different sectors involved in the NTP implementation and ensure that the NTP policies and DOTS strategy is implemented thereby ensuring a case detection rate of at least 70% and a cure rate of at least 85%. 4.3.3. to ensure that efforts and resources are generated and geared towards achieving the goal of having a community where TB is no longer a public health problem; and 4.3.4. to follow a Manual of Operation from WHO that shall be used for the NTP implementation in the City, following the standards used for the management and operation of the PPMD-TB DOTS Center/Facility. 4.4. Command Responsibility. The City Health Officer shall have command responsibility role on the operation of the facility. The project-in-charge is, however, equally responsible in providing constant and all updates. 4.5. Personnel Benefits. 4.5.1. The staff of the PPMD-TB DOTS is entitled to a continuing Medical Education updates and conferences depending on the availability of training funds. 4.5.2. The PPMD staff who attends to the needs of TB clients is exposed to the bacteria and shall, therefore, receive the appropriate hazard pay and other benefits as provided by the Magna Carta Law. 4.6 Specific Functions of Health Workers. 4.6.1 The City Health Officer, being the City Medical Coordinator, shall be tasked with the following responsibilities under the program: 4.6.1.1. Organize the planning, budgeting and evaluation activities of the City NTP-TB DOTS-PPMD. 4.6.1.2. Implement advocacy activities to generate leadership commitment and community awareness. 4.6.1.3. Coordinate all NTP activities within the City. 4.6.1.4. Ensure availability and adequacy of NTP supplies. Manage drug and laboratory supply system. 4.6.1.5. Monitor, supervise and evaluate the implementation of NTP and QA, and execute corrective or remedial measures. 4.6.1.6. Implement QA for quality laboratory work at the DOTS facility. 4.6.1.7. Mobilize resources for TBDC and serve as Chairperson of the TBDC. 4.6.1.8. Asses and refer chronic TB client/cases to higher level of care. 4.6.1.9. Attend all diagnosed TB cases for clinical assessment, prescription of appropriate treatment regimen and management of adverse drug reactions, if any. 4.6.1.10. Provide continuous health education to all TB patients. 4.6.1.11. Coordinate with the Local Chief Executive to ensure funds and personnel for program implementation. 4.6.1.12. Supervise health staff to ensure proper implementation of NTP policies: 4.6.1.12.1. Identification, examination and classification of TB cases. 4.6.1.12.2. Implementation of case holding mechanism such as DOTS. 4.6.1.12.3. Ensure proper procedure in the collection and transport of sputum specimen to microscopy center. 4.6.2. NTP-PPMD Nurse shall be the City Health Nurse who will take the following charges: 4.6.2.1. Open the NTP treatment card. 4.6.2.2. Assign and supervise a treatment partner for patients who will undergo DOTS. 4.6.2.3. Supervise the PHMs to ensure proper implementation of DOTS. 4.6.2.4. Maintain and update the TB register. 4.6.2.5. Facilitate requisition and distribution of drugs and NTP supplies. 4.6.2.6. Provide continuous health education to all TB patients placed under treatment and encourage family and community participation in TB control. 4.6.2.7. Conduct training of health workers in coordination with the NTP medical and nurse coordinator. 4.6.2.8. Prepare, analyze and submit the quarterly report to CHO, PhilCAT and copy furnish IPHO. 4.6.2.9. Coordinate and consolidate all NTP activities within the City. 4.6.2.10. Collate and analyze quarterly reports from PHMs covering the 54 component barangays of the City. 4.6.2.11. Assist in the monitoring, supervision of and evaluation of the implementation of NTP. 4.6.3. Public Health Midwives are the City Heath Office PHMs assigned in the different barangays of the City. Their roles are: 4.6.3.1. Together with the other health staff, implement case finding activities. 4.6.3.1.1. Refer all diagnosed TB cases to a physician or nurse for clinical evaluation and initiation of treatment. 4.6.3.1.2. Identify TB symptomatic and collect sputum specimen for microscopy. (Active care finding is required for midwives of at least 1 to 5 cases amount, computed based on the barangay population: population x 0.00133); and 4.6.3.1.3. Maintain and update NTP treatment cards. (Use of TB symptomatics Master list) 4.6.3.2. Implement DOTS with treatment partners: 4.6.3.2.1. Provide continuous health education to all TB patients placed under treatment and encourages family and community participation in TB control activities; 4.6.3.2.2. Conduct regular consultation meetings with the assistance of the City TB-DOTS/PPMD physician or nurse during the course of treatment; 4.6.3.2.3. Collect sputum specimen for follow-up examination on the scheduled dates during the treatment course. They shall retrieve and report defaulters within two (2) days; 4.6.3.2.4. Refer patients with adverse drug reactions to the TB DOTS/PPMD physicians for further evaluation and management; and 4.6.3.2.5. Supervise and instruct community health volunteers (HV) who would be the treatment partners to ensure proper implementation of DOTS. 4.6.4. Medical Technologists shall be the Medical Technologists who are employed at the City Health Office. They shall perform the following tasks: 4.6.4.1. Do DSSM for diagnosis and follow-up. 4.6.4.2. Inform the physician, nurse or midwife of the DSSM result. 4.6.4.3. Maintain and update the NTP Laboratory Register. 4.6.4.5. Prepare quarterly report on the laboratory activities and submit this to the NTP physician or nurse. 4.6.4.6. Prepare and submit quarterly laboratory supply requirements to the NTP physician. 4.6.4.7. Store sputum smears to allow sampling by the City-NTP Coordinator for the External Quality Assurance. 4.6.5. Barangay Health Workers (BHW) and Community Health Volunteers (CHV) of all the 54 component barangays of the City shall have the following roles: 4.6.5.1. Identify TB symptomatics and collect sputum specimen for DSSM to DOTS facility. 4.6.5.2. Assist the Health personnel in the implementation of DOTS. 4.6.5.3. Help keep and update the NTP ID card. 4.6.5.4. Help retrieve and report defaulters in their respective area of jurisdiction within two (2) days. 4.6.5.5. Attend regular consultation meeting with the City Health Personnel, together with the patient and treatment partner. 4.6.5.6. Refer patient with observed adverse reaction, if any, to the PPMD-TB DOTS Center of the City. 4.6.5.7. Facilitate health education to patient, family members and community. 4.6.5.8. Attend trainings or seminars on health matters. SECTION 5. ADMINISTRATIVE PROVISIONS. - To ascertain strict compliance and enforcement of the NTP, these administrative provisions are hereby defined. 5.1 Regular application of sanitizers/disinfectants within and outside the premises of the TB-DOTS center. 5.2 Strict compliance on the confidentiality and privacy of patient's record. 5.3 All TB suspects be immediately attended to for consultation, diagnosis and counseling with personalized and client-friendly manner. 5.4 TB advocacy program shall be conducted regularly to all stakeholders of both government and non-government sectors especially during Lung Month and World TB Day celebrations. SECTION 6. OTHER PROVISIONS. - 6.1 Creation of a Community-Based TB Task Force. The composition of this Task force shall be studied and defined later in the Implementing Rules and Regulations of this Ordinance. It is important that this body shall be created so as to enhance and augment the anti-TB advocacy thereby attaining the program's targets and goal. It shall take charge of counseling and giving moral support to the TB clients submitting for and /or undergoing the treatment. In coordination with the City Government, the NTP-TB DOTS-PPMD staff shall be responsible in the creation, orientation and sustainability of the Task Force. 6.2. For Philhealth Members 6.2.1. Eligibility Rules 6.2.1.1. All members and their qualified dependents of the National Health Insurance Program (NHIP), who satisfy the criteria of the eligibility and are not disqualified by the exclusion criteria may avail of the TB-DOTS Package. 6.2.1.2. An individually paying and Employment Member must have at least 3 months contributions paid within the immediate 6 months prior to the enrollment at the TB-DOTS Philhealth accredited center. 6.2.1.3. New cases-a patient who has never had treatment for TB, extra-pulmonary TB and TB disease of the children can avail of this Philhealth TB-DOTS Package. 6.2.1.4. New cases of smear positive/negative Pulmonary TB, extra-pulmonary TB and TB disease of the children can avail of this Philhealth TB-DOTS Package. SECTION 9. IMPLEMENTING RULES AND REGULATIONS. - The rules and Regulations to guide the implementation of the provision of this ordinance shall be formulated by the City Health Office in consultation with City Legal Office and the Local Chief Executive. SECTION 10. PENAL PROVISIONS. - 11.1. Health Workers: Specific functions of the health workers are defined in this ordinance, as well as appropriate incentives are clearly provided. In the event that a health worker fails to do his/her job relative to these NTP-TB DOTS activities, his/her incentive commensurate to failure shall be forfeited. 11.2. Barangay Officials and City Government Officials. The Barangay and City LGU Officials shall strongly push for the enforcement of this NTP and the attainment of the goal. Unsupportive officials shall be subjected to administrative sanctions, and a fine of not more than Three Hundred (P300.00) pesos. 11.3 Private Medical Practitioner (Physician). It shall be the duty of the Private Physicians to immediately refer to the PPMD unit those patients who come to them and are diagnosed by them as TB positive and who, by evaluation cannot pursue complete treatment for reasons of financial constraints, more particularly the indigents. 11.4 Such erring physicians shall be subjected to the provisions of the Code of Ethics by their Local Medical Society, and to the City Government a fine of not more than Three Thousand (P3,000.00) pesos. SECTION 11. REPEALING CLAUSE. - All ordinances or laws of local applications and effect inconsistent hereto are hereby modified, superseded and/or repealed accordingly. SECTION 12. SEPARABILITY CLAUSE. - If, for any reason or reasons, any part or provision hereof shall be held unconstitutional or invalid, the remaining parts of the provision which are not affected shall continue to be in full force and effect. SECTION 13. SUPPLEMENTARY CLAUSE. - On matters not provided in this ordinance, any existing applicable laws and their corresponding implementing rules and regulations, executive orders and other relevant issuances issued thereof, shall be applied in a supplementary manner. SECTION 14. EFFECTIVITY CLAUSE. - This Ordinance shall take effect immediately upon approval. ENACTED AND APPROVED by the 9th City Council of Pagadian City during its 91st Regular Session held on July 28, 2009 at the Sangguniang Panlungsod Session Hall.