1. Public Health

2. TB-DOTS program Government commitment Case detection by DSSM among symptomatic patients self-reporting to health services Standard short-course chemotherapy; complete drug taking through DOT supervised by DOTS facility workers during the whole course of treatment for all smear positive cases;

3. TB-DOTS program A regular, uninterrupted supply of all essential anti-tuberculosis drugs and other materials; and A standard recording and reporting system that allows assessment of case finding and treatment

4. Access to drugs In far flung areas, barangay health workers (BHWs) should be mobilized Make the BHWs as their treatment partners and they can go to the patients’ home

5. Strengthen Patient and Healthcare Workers Relationship patients perceive health care workers’ attitudes as harsh develop good rapport as they deal with patients, learn to befriend them and take the time to explain to them the importance of taking their medications regularly

6. Inform patients that improvement of their symptoms does not necessarily mean that they are totally free from infection explain that they must take the whole set of drugs and get a negative reading in the sputum smear exam before they are considered completely free of the disease

7. Partnership with Private Practitioners use of anti-TB drugs has also contributed to the development of MDR and XDR-TB all practitioners must refer all suspected and diagnosed TB patients to the DOTS program as recommended in the guidelines

8. Partnership with Private Practitioners create a referral system, which would assure that the physician who referred the patient to the nearest DOTS center would still remain the patient’s primary attending physician Private practitioners must also be trained

9. Restricting the availability of drugs problem of low quality drugs and the over availability of drugs has also resulted in the development of MDR-TB Leads to self medication Restrict over the counter selling

10. Improve quality of DOTS Personnel working in the DOTS centers need to be trained further Lack of workers in the centers causes other employees to burn out and tire easily give more incentives or more health benefits build partnerships with other organizations Research and volunteers

11. Improve compliance If family members are also not educated about the disease, then they would not be able to assist in reinforcing positive behavior like treatment compliance and lifestyle modifications. Widespread non-compliance to treatment and lack of education about tuberculosis could be major factors leading to low cure rates of the DOTS program.

12. Improve compliance providing transportation proper education of the patients and their families widespread, comprehensive, proper education program involving the whole country

13. Diagnosis and Proper Treatment Misdiagnosis of the condition or misclassification of the specific type of TB receiving inappropriate treatment lead to greater drug resistance.

14. MDR-TB resistant to both rifampicin and isoniazid Failure of completion of treatment leads to an increased incidence of MDR-TB or could even lead to the development of even more resistant strains of the bacteria, which would lead to higher rates of treatment failure.

15. Poor Case Reporting lead to inaccurate and incomplete data and statistics = lack of preparedness Strategy: increase the health seeking behavior of people Proper education