Remote control

A lack of roads and transport, land conflicts, regional political violence, not to mention an acute tuberculosis problem, just a few of the challenges facing the 2009 APM International Relief and Development Project of the Year Award winner.

Some projects are delivered in testing circumstances. Some are downright dangerous.

For almost 40 years, Maguindanao in the Philippines has been the site of continuous low-intensity conflict between government forces and diverse revolutionary groups.

Set against this backdrop, the Maguindanao Tuberculosis Control Project (MTCP) aims to reduce tuberculosis (TB) stigma and mortality through increased detection and cure rates.

The four-year partnership project between Catholic Relief Services and the Integrated Provincial Health Office targeted three main areas of improvements.

First, upgrading health care facilities; second, training health workers to become more responsive and effective at managing cases of TB; third, improving awareness of TB among local communities throughout the region.

Baseline study

Before taking action a detailed baseline assessment looked at the capacity of the existing health care system and its ability to deal with a co-ordinated TB project; the populations knowledge, beliefs, and attitudes towards health workers with respect to TB control, plus an assessment of laboratory testing facilities.

As a result of the baseline studies several bottlenecks were identified. These included a lack of communication/supervision between health officials and frontline staff i.e. nurses; a lack of checklists to monitor performance, and inaccurate sampling results. But more pressing, was a lack of reliable transport.

Due to the remoteness of the region, rural services were sporadic at best, with health workers often hamstrung by a lack of regular transport. This not only impacted on the ability of staff to assess the needs of local people but also delayed analysis of samples and the release of the results.

To address these concerns, one of the first activities of the project team was to organise transport groups dubbed as Microscopy-on-Wheels or MOW. The MOW groups primarily motorcyclists provided voluntary assistance to rural health clinics by transporting samples or slides to and from central laboratories. In addition, MOW members were asked to promote awareness of TB symptoms among community residents.

At the same time TB patients undergoing treatment were encouraged to join TB Clubs. The clubs offered advice and information, as well as a means of tracing family members or close neighbours. This was seen as a key factor in improving cure rates.

In support of this, a programme of reform was introduced to train 214 new health staff; 10 registered medical technologists and two as quality assurance controllers. Dilapidated and non-functional laboratories were repaired providing good working conditions for technologists to perform laboratory examinations.

Building capacity at local and regional levels was a key part of the MTCP sustainability strategy, which also sought to engage with key stakeholders before, during and after project implementation. On a political level MTCP worked hard to reconcile differences between disparate groups and unite them in working towards a common goal. However, due to the volatile nature of the region (events in Maguindanao bear testament to this) it was also deemed necessary to utilise existing resources such as the Quick Disaster Response Team, so as to ensure continuous TB treatment should armed conflict resume in designated hot spots.

Project outcome

When the project began in 2005, the case detection rate of the province was at 69 per cent; in 2008, it registered at 84 per cent. Cure rate was 72 per cent; the latest figures show a seven per cent increase. Both sets of data now surpass the original project target.