Figure 4.

Comparison of subnational pathways in 2 provinces in the Philippines. When the patient pathway is completed at the subnational level, it can highlight important differences in care seeking and service alignment patterns of national tuberculosis programs. This visual highlights 2 regions in the Philippines with important differences in the alignment of care-seeking patterns and service coverage. The top visual shows Cagayan Valley (Region II), which has relatively uniform care seeking across the 3 levels of the public-sector healthcare system. Owing to the high coverage by diagnostic tools at levels 1 and 2, >50% of patients are likely to access diagnosis on their first visit to a health facility (column 3). The bottom visual shows the pathway for Zamboanga Peninsula (Region IX). In this region, more than half of patients initiate care seeking at level 0 public sector facilities, where coverage by tuberculosis diagnostic tools is not available. Thus, these patients are reliant on a referral system to receive a diagnosis for tuberculosis. Owing to the higher share of patients seeking care where diagnostic tools are not available, the access to diagnosis at initial care seeking metric (column 3) is much lower in Region IX. Abbreviations: DOTS, directly observed therapy, short course; DST, drug-susceptibility testing; iDOTS, integrated directly observed therapy, short course; LED-FM, light-emitting diode fluorescence microscopy; NA, not available; STC, satellite treatment center; TC, treatment center. ^aThe National Health Facility Registry does not provide reliable data on the number of health facilities in private-sector level 1 facilities.