Civil Society and Patient Groups Call on DOH to Address Recurring TB Drug Stock-Outs, Offer Solutions

TB patient groups and civil society organizations are calling for stronger government action and closer coordination to ensure Filipinos undergoing tuberculosis treatment have reliable access to essential medicines.

• Urgent Medicine Access: TB patient groups and civil society organizations are urging the Department of Health to address recurring TB drug stock-outs, warning that treatment interruptions can worsen illness, contribute to drug resistance and create substantial financial burdens for affected Filipino families.
• Economic Consequences: A modelling study presented during the discussion estimated that a one-month stock-out of first-line medicines affecting 2,663 patients with drug-sensitive TB could result in approximately US$21 million in economic impact, with households carrying most of the burden.
• Bayanihan Approach: Advocates are proposing stronger collaboration among the DOH, local governments, healthcare providers, civil society, patient communities, technical partners and the private sector, alongside improved forecasting, procurement, distribution, stock monitoring and community reporting.

Recurring shortages of tuberculosis medicines are prompting TB patient groups and civil society organizations in the Philippines to call for urgent action from the Department of Health, as advocates warn that disruptions in treatment can have consequences extending well beyond individual patients.

The call was raised during a roundtable discussion on strengthening reliable and sustainable access to TB medicines held on August 25 at the Bayview Hotel in Manila. The gathering brought together TB-affected communities, civil society organizations, health professionals, local government representatives, technical partners and other stakeholders.

"No to TB drug stock-outs!" advocates declared during the event, underscoring their call for sustained efforts to make sure people undergoing TB treatment can continuously access the medicines they need.

A Recurring Challenge for TB Patients

According to Florita Dalida, TB nurse, founder of civil society group TB HEALS and secretary of the Philippine Alliance to Stop TB or PASTB network, medicine supply interruptions have remained a persistent concern.

"TB drug stock-outs have been recurring in the Philippines for a decade and have steadily worsened over time," Dalida said.

She noted that partner organizations and community groups in different parts of the Philippines have repeatedly reported delayed medicine deliveries and shortages of free first-line TB medicines at health facilities.

Dalida called on new Health Secretary Edwin Mercado to make the issue a priority, particularly because interruptions can affect both patients' health and their families' finances.

"It is critical for new Health Secretary Edwin Mercado to prioritize this issue. Interruptions in TB treatment can have serious consequences for patients and place significant financial strain on their families," she said.

Treatment interruptions can contribute to worsening illness, treatment failure, drug resistance and continued transmission. At the household level, disruptions can also result in additional transportation and healthcare expenses, lost income and higher caregiving costs.

The Economic Cost of Stock-Outs

The financial implications of medicine shortages were also discussed during the roundtable.

David Collins, Professor of Global Health at Boston University School of Public Health, presented findings from a 2020 modelling study examining the economic consequences of TB medicine stock-outs and loss to follow-up in the Philippines.

According to the study, the economic impact of a one-month stock-out of first-line medicines affecting 2,663 patients with drug-sensitive TB could reach approximately US$21 million. This works out to around US$7,900 per affected patient, with households bearing the majority of the estimated economic burden.

Collins noted that these figures were likely to underestimate the full impact. He argued that the benefits of investing in a reliable medicine supply would substantially outweigh the associated costs.

The figures help illustrate why drug availability is not simply a logistical concern. When medicines become unavailable, the consequences can spread across healthcare, household finances and the broader effort to control TB.

During the discussion, Louie Zepeda-Teng, President of TB People Philippines, emphasized the need for collaboration in addressing TB drug stock-outs, urging different sectors to work together with the government in the spirit of bayanihan. (Credit: Marcus Teng/TB People)

A Bayanihan Approach to TB

Patient groups are also emphasizing that addressing recurring stock-outs should involve cooperation between government and other sectors.

Louie Zepeda-Teng, President of TBPeople, TB survivor and advocate, said patient communities, civil society and private organizations are prepared to work alongside government.

"We stand ready to collaborate with government because resolving TB drug stock-outs requires a whole-of-society approach," Zepeda-Teng said. "TBPeople is already working closely with patient groups, local government units, private organizations, and foundations. The DOH can harness the spirit of bayanihan (collective effort) and mobilize all stakeholders to help address this challenge."

Representatives of PASTB and TBPeople formally presented petitions addressed to the DOH during the event, calling for action on recurring medicine shortages and uninterrupted access to TB treatment.

Fixing the Supply Chain

Participants identified multiple points in the medicines supply chain where challenges can emerge, including forecasting, procurement, distribution, stock monitoring and eventual availability at healthcare facilities.

Dr. Richard Castro, head of the Manila Health Department TB Control and Prevention program, highlighted the important role of the national government in procurement.

"It is the national government that has the capacity and responsibility to purchase TB drugs at scale. Local governments can only make emergency purchases of up to 10% of supply needs," Castro said.

Meanwhile, Dr. Marizel Wong of the Quezon City Health Department discussed Quezon City's experience in maintaining first-line TB medicine supplies, including the investments and local systems needed to support availability. During the discussion, Quezon City was presented as an example of an LGU that has experienced minimal interruptions in first-line TB medicine availability.

Community Reporting as Part of the Solution

Technology, data gathering and community reporting could also contribute to detecting medicine shortages before they become more disruptive.

Claire Waterhouse of Doctors Without Borders / Médecins Sans Frontières shared lessons from South Africa's Stop Stockouts Project. The civil society-led initiative used community reporting and verification of medicine shortages to generate evidence that could be used in engagement with health authorities.

Participants discussed whether elements of this model could be adapted to the Philippine setting and incorporated into the existing activities of local civil society and patient organizations. They agreed on the need for a similar community-led initiative that could build upon the networks and activities of existing local CSOs.

Such an approach could give communities a more active role in identifying shortages while helping stakeholders gather evidence about where and when medicine supply problems occur.

Stronger Coordination Moving Forward

One of the central messages from the roundtable was the need for stronger coordination among the national government, LGUs, healthcare providers, patient groups, civil society organizations, technical partners and other stakeholders.

Participants also discussed how civil society organizations could work more collectively by combining their community networks, evidence and advocacy efforts. This cooperation could extend beyond medicine availability to other parts of the TB care cascade, including prevention, screening, diagnosis, treatment and follow-up.

The roundtable was organized by Doctors Without Borders and PASTB as a starting point for further engagement with the DOH and other partners on practical and sustainable ways of strengthening access to TB medicines.

Other participants included the Philippine Coalition Against Tuberculosis or PhilCAT, Philippine Tuberculosis Society Inc. or PTSI, World Health Organization, local government units, TB-affected communities, technical partners and health professionals.

For patients who depend on uninterrupted treatment, reliable access to medicines is ultimately more than a supply-chain concern. The discussion highlighted how stronger procurement, monitoring, community participation and coordination could work together toward one essential objective: making sure TB patients can continue their treatment when they need it.