Medicine shortages, missed targets delay tuberculosis healthcare delivery

The Philippines has faced ongoing tuberculosis challenges, ranking third globally in TB burden as of 2024, with procurement failures leading to medicine shortages affecting around 700,000 patients. Failed and canceled bids for TB medicines from 2023 to 2025 resulted in over P2 billion in costs, with significant shortages reported in pediatric and drug-resistant TB treatments, raising concerns about increasing drug resistance. This is AI-generated. Read the article for full context. Report any errors. Second of two partsPart 1 | IN NUMBERS: Decades of tuberculosis in the Philippines Despite being highly curable, tuberculosis (TB) has persisted in the Philippines for over two decades, with the country ranking third globally in terms of TB burden in 2024. As case counts continue to climb, experts point to medicine procurement failures in 2023-2024 that caused supply shortages and disrupted treatment for about 700,000 people with TB. Bid notices for TB medicine under the main office of the Department of Health (DOH) showed two failed and four canceled biddings from 2023 to 2025. The first failed bid, in October 2023, targeted medicine worth P966 million. It was rescheduled to January 2024, but was canceled. The office issued another P966-million bid in August 2024, which also failed. The order for pediatrics medicine for TB and bedaquiline, a medicine for drug-resistant TB (DR-TB) patients — with approved budgets of P117 million and P112 million, respectively — did not push through at all, according to the Philippine Government Electronic Procurement System (PhilGEPS). PhilGEPS is a centralized platform for government agencies to post public bidding opportunities, award notices, and procurement activities for registered suppliers. No bidding happened because of either a failure of bids or a cancellation altogether. According to documents cited by PhilGEPS, a failure of bids is declared when there are no bid submissions, the prospective bidders are ineligible, they did not comply with the bid requirements, or there was no award of contract. Meanwhile, an agency’s Bids and Awards Committee can cancel a bid if the project becomes unfeasible or unnecessary, if funding is cut or withheld, or if a calamity or quarantine is declared. In the case of the TB medicines, no specific reasons were cited for the bid failures or the cancellations. All failed and canceled procurements, despite rebiddings, cost over P2 billion. Dr. Jan Llevado, DOH Disease Control and Prevention Bureau director, pointed out that suppliers find it challenging to procure the DOH’s bulk orders as they mostly rely on manufacturers’ supplies. “So the question is how the DOH can do a more reliable [multi-year] forecast so that the industry is also informed,” Llevado said in a mix of English and Filipino. She also confirmed that there are drug-susceptible TB (DS-TB) medicine shortages across multiple regions, raising the risk factor for increasing drug-resistant TB (DR-TB) cases. Drug-susceptible TB treatment requires consistent, six-month medication regimens of two to four drugs. Those with drug resistance may require up to 18 months, depending on their condition, with more medicines to take. Straying from the regimen for just a few days could complicate the disease. Those with drug-susceptible TB could potentially develop drug resistance, too. While the treatment is free in government-run health facilities, patients facing low supply may resort to buying their own. A six-month regimen for a DS-TB patient could cost more than P2,000, while a DR-TB patient may spend up to P400,000. Reported shortages in 2026 The TB Health Education and Livelihood Support Community, Inc. (TB HEALS), a non-profit organization, said that they received 30 reports of medicine shortages or stockouts in various regions from 2025 to August 2026. Their data comes from TB HEALS’ KomuKonek, a community feedback platform for reporting local health center TB service concerns. Their data currently show 20 DS-TB medicine stockout cases for the four-drug fixed-dose combinations (FDC), followed by the two-drug regimen. Four in total complained of DR-TB drug stockouts, while one said they’re short on TB preventive treatment (TPT). Eight complaints came from Western Visayas, then seven from Calabarzon. Florita Dalida, TB HEALS president, stressed that shortages threaten not just the patient, but also the people around them. “For a disease like TB, shouldn’t it be treated as an emergency? Because if you don’t get treated, you can infect up to 15 people within a year,” Dalida said. PH’s status of TB service delivery Besides shortages, experts also monitor how the Philippines, through its national TB control program, accomplishes yearly targets. Following the first phase’s unmet goals during the pandemic, the DOH is implementing its Philippine Strategic TB Elimination Plan Phase 2, or PhilSTEP 2 (2025–2030), to address the nation’s enduring TB crisis. PhilSTEP 2 is a roadmap that envisions reducing the country’s TB mortality rate, incidence rate, and catastrophic costs by 2030, by following set objectives. The four objectives follow the cascade of care framework for TB — screening, testing, treatment, and prevention. A presumptive patient is screened via chest X-ray (CXR) or artificial intelligence computer-aided detection (CAD) software for signs of TB. If positive, they will be tested further and diagnosed. This process determines whether the patient has DS-TB, which responds to first-line medication, or DR-TB. The confirmed TB patient is registered in the system and placed under Directly Observed Treatment, Short-course, or DOTS. Healthcare providers will determine which drugs to take and how much. To prevent transmission, contact tracing is conducted. Those with higher risk, asymptomatic patients, or people exposed to active cases are given preventive treatment. How is the Philippines faring in achieving these goals? Turn to the next page to view tuberculosis screening status per region. Although the country reached a national screening rate of 98% in 2025, regional progress remains uneven. BARMM has the lowest rate at 8%, with Bicol coming up next at 15%. Six regions have not reached the 50-percent mark. Another six regions have reached more than a 100% screening rate, pulling up the national average. The DOH, along with the World Health Organization (WHO), has set a target of 12 million Filipinos screened for TB by 2026, as part of the commitment to prevent the disease. As of August 2026, the screening rate has reached only a quarter of the annual target, with the same regions lagging as last year. Even then, not everyone screened for TB underwent testing. The annual presumptive testing target for 2025 of 1.8 million people was 75% accomplished. Testing for 2026 is at 26% as of August. Llevado noted that cartridge procurement issues for GenExpert machines — used to diagnose TB and detect drug resistance — drove down 2026 testing rates compared to the same period in 2025. Based on notification rates, the DOH recorded the following treatment success rates for new and relapse DS-TB and DR-TB cases. Drug-susceptible TB treatment had an average success rate of 91.3% from 2018 to 2025, while drug-resistant TB stood at 70.8%. The success rate for the latter dropped by 10% from 2024 to 2025, which mirrors the gaps the WHO mentioned in treating drug-resistant and multidrug-resistant cases. The Philippines also has gaps in preventive treatment, which Llevado considers a low-hanging fruit. As an airborne disease, it is important to treat TB before it even becomes an active case to prevent transmission, she stressed. She added that for the DOH, strengthening programs is crucial. “We should find TB earlier, we should test accurately, we should initiate treatment immediately,” Llevado said, adding that the DOH should ensure the continuity and completion of treatment. The health department is currently evaluating bids from September 3 to 10 and promised that TB medicine supplies will be delivered by October or November this year. – Rappler.com