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WHEREAS, Section 17 (b) (2) (iii) of Republic Act No. 7160, otherwise known as the Local Government Code of the 1991 provides that "health services, which include the implementation of programs and projects on primary health care, maternal and child care, and communicable and noncominunicable disease control services; access to secondary and tertiary health services: purchase of medicines, medical supplies, and equipment needed to carry out the services herein enumerated "are the duties and responsibilities of the local government units;

WHEREAS, tuberculosis remains a major public health concern in the city where the percentage of cases found Case Detection Rate of 85% is below the national standard of 90 percent and the percentage of TB patients who completed treatment and are confirmed as cured Cure Rate of 79% is below the national standard of 90 percent;

WHEREAS, the low Case Detection Rate of 85% is a result of low case finding. With only 85% percent of estimated cases detected, the remaining cases do not receive the correct treatment which may result in death. Furthermore, each active case of TB can result in the spread of infection lo as many as 10 to 20 new cases every year;

WHEREAS, the low Cure Rate of 79% is a result of low case holding or defaulters. The low Cure Rate means that patients are not completing and confirming treatment. Uncompleted treatment may result in Multi-Drug Resistant TB which is much more difficult and expensive to treat;

WHEREAS, it is important for the City to always monitor and evaluate the performance , of the health centers as well as medical personnel who provide public health services;

WHEREAS, while the National Government, through thu City Health Office, is responsible for providing drugs and other commodities that ara essential to TB control, such supply has been erratic at times. Therefore, it is essential for the City to provide buffer stock of the necessary drugs and commodities;

WHEREAS, multi-drug resistant TB (MDRTB) is a highly dyngerous form of TB that requires expensive specialized care and treatment (Programmatic Management of Drug-Resistant TB) over a period of 18-24 months. A MDRTB patient can easily pass on his/her form of TB to other people, posing a grave threat to the community;

WHEREAS, level of awareness on TB needs more attention. Thus, it is incumbent upon the City to conduct health promotion activities, including community outreach TB education,   IEC materials distribution and mass media campaigns;

WHEREAS, in order to fully implement the TB program to a wider scope and further achieve its objectives, there is a need to create a Multisectoral Alliance consisting both from the public and private sectors of the city;

WHEREAS, the success of TB treatment depends on the patient getting support and encouragement from treatment partners, who ensures that drugs are taken daily and that follow up sputum exam schedules are adhered to. It is important for treatment partners to be able to go to the patients, rather than the patients going to the treatment partner, particularly if distances are far, to ensure treatment compliance;

NOW THEREFORE, BE IT ORDAINED by the Sangguniang Panlungsod of San Juan, Metro Manila in a session duly assembled that:

Section 1.  Declaration of Policy.  The City of San Juan joins the government's efforts to institute an effective program for Tuberculosis Control through the National Tuberculosis Control Program (NTP), the Directly Observed Treatment Short Course (DOTS) strategy of the National Tuberculosis Control Program (NTP) (Executive Order No. 187, 21 March 2003) shall be the main strategy for tuberculosis control in the City.

The five (5) component of DOTS strategy includes:

	a)	Direct Sputum Smear Examination shall be the initial diagnostic tool in case finding.
	b)	Standardized Chemotherapy in accordance with the National TB Program.
	c)	Recording and reporting of cases shall be on the standardized National TB Program forms to be implemented in all health centers.
	d)	Directly Observed Treatment Short Course shall be used as the strategy to ensure patient compliance.
	e)	Political commitment to ensure sustained, comprehensive implementation of National TB Program activities.

Section 2. Ensure Annual Fund Allocation. This will serve as a vehicle for improving and sustaining the efficient and effective delivery of the City TB Control Program.

	2.1.	Ensure that the allocation for the budget requirements for the TB program of the City is sufficient.
	2.2.	Ensure that efforts and resources are geared towards achieving the goal of having a community where TB is no longer a public health problem.
	2.3.	Ensure that the NTP policies and the DOTS strategies are implemented, thereby ensuring a case detection rate of at feast 90% and a treatment success rate of at least 90%.
	2 4.	Advocate for the continuous investment for quality improvement and certification and accreditation of the LGU health facilities as DOTS centers. To strengthen and capacitate and local community health volunteers on TB DOTS program.
	2 5.	Ensure that the LGU regularly supports the monitoring, supervision, evaluation, training requirements, and NTP drug supplies.

Section 3. Creation of the City Multisectoral Aiiiance (CMSA) and the CMSA Secretariat.

Establish networks, inter-agency links and partnerships with key stakeholders. This will strengthen partnerships with different sectors involved in the program such as government agencies, NGOs, civil society private sector, donor institutions and other cooperating agencies for a more comprehensive NTP implementation. The City Mayor is hereby authorized to create a City Multi-Sectoral Alliance (CMSA) whose membership may be composed of the various public and private sectors in tho city.

As a vehicle for consolidation and unification of efforts onTB and consistent with DILG Memorandum Circular 98-155 and 2010-2016 PhilPACT, the City Government of San Juan hereby creates the CMSA and the CMSA Secretariat. The CMSA will serve as the coordinating body for public-private sector partnerships and advise the City Government in the implementation of the policies and strategies of the National TB Control Program (NTP) involving various government line agencies, civil society groups and private sector.

The NTP core team of the City Health Office (CHO) is designated as the CMSA secretariat.

Section 3.1. Composition of the City of San Juan Multi Sectoral Alliance (CMSA)

The San Juan City Multi Sectoral Alliance will be composed of the following:

Chairperson: City Mayor and/or her duly Authorized Representative
Vice-Chairperson for the public sector; City Health Officer
Vice-Chairperson for the private sector: San Juan Medical Society -

Members :

1. SP Chairperson on Committee on Health
2. San Juan Medical Center, Pulmonary Chief
3. Cardinal Santos Medical Center
4. St. Martin de Porres Charity Hospital
5. President, Liga ng mga Barangay
6. City Budget Officer
7. City Treasurer
8. City Accountant
9. City Planning Officer
10. City DILG Officer
11. City Social Welfare Department
12. Superintendent, Interim Division
13. President, Barangay Health Workers Federation
14. President, TODA

Secretariat:
NTP CORE TEAM

Section 3.2. Roles, Functions and Responsibilities

The San Juan City Multi Sectoral Alliance shall have the following roles, functions and responsibilities:

1. Identify and establish tho roles and responsibilities of the partners in the organization and delivery of TB care as per NTP guidelines.
2. Establish a secretariat for the TB Program CMSA
3. Ensure that socio-economic development policies and programs include consideration of the impact of TB Infection to the community.
4. Work for the prioritization in the allocation of resources for the TB Program.

Section 4. Coordinate the different sectors involved in the NTP implementation and ensure that the NTP policies and the DOTS strategy is implemented thereby ensuring a case detection rate of at least 90% for all forms and a treatment success rate of at least 90% for all forms.

	a.	Strengthen partnerships with other government agencies, NGOs
	b.	Private entities and international agencies for a more comprehensive NTP implementation
	c.	Support local community health volunteers and TB Diagnostic Committee (TBDC) activities to sustain private sector interest and participation in the NTP
	d.	Ensure that proper referral, recording and reporting of TB patients is systematically done using the NTP forms. That referrals from other sectors be disaggregated and reported separately in the said NTP forms.
	4.1	Ensure that efforts and resources ace generated and geared towards achieving the goaf of having a community where TB is no longer a public health problem.
		a.	Ensure that the allocation for the budget requirements for the TB program for the city are sufficient.
		b.	Ensure that the LGU regularly supports the monitoring, supervision, evaluation, training requirements, NTP drugs and supplies.
		c.	Advocate for the continuous investment for quality improvement and certification and accreditation of the LGU health facilities as DOTS centers.
	4.2	The City should provide adequate services to TB control. Additional microscopist who is responsible for the diagnosis or identification of TB cases and to confirm those under treatment as cured.

Section 5. Establish networks, inter-agency links and partnerships with key stakeholders. This will strengthen partnerships with different sectors involved in the program such as government agencies, NGOs, civil society private sector, donor institutions and other cooperiating agencies for a more comprehensive NTP implementation.

Section 6. Rules and Regulations. The City Health Office, in coordination with the Local Chief Executive, shall formulate the implementing rules and guidelines pertaining to this Ordinance.

Section 7. Funding and Disbursement. The City Government shall appropriate in the General Fund the amount of at least 3 Million Pesos (P3,000,000.00) annually, Disbursements shall be approved by the City Mayor subject to the usual accounting and auditing procedures. The said funds will be allocated as follows:

	a)	Monitoring and supervisory visit - 2% (P60,000.00)
	b)	Contingency for medicines and laboratory supplies and equipment - 30% (P900,000.00)
	c)	Programmatic Management of Drug-Resistant TB - 30% (P900,000.00);
	d)	Quality assurance for sputum microscopy - 1% (P30.000.00);
	e)	Capability building - 25% (P750,000.00)
	f)	Health Promotion Activities - 5% (P150,000.00) and;
	g)	Community organization - 7% (P210,000.00)

Section 8. The City Treasurer's Office is hereby authorized to release fund subject to accounting and auditing procedure.

Section 9. Participation of Barangays in the TB Program. All barangays of the City of San Juan are hereby directed to serve as frontliners in the promotion of the TB Program.

	a)	Create a TB Task Force in their lespective barangays
	b)	Provide necessary trainings for the TB Task Force
	c)	Create an incentive program to BHWs or my member of the TB Task Force who have identified a patient in their barangays who are TB positive and have completed the necessary program to treat the sickness. The incentives will only be applicable to BHWs, or any member of the TB Task Force whose identified patient have successfully completed the treatment program.
	d)	Pass an ordinance appropriating the necessaty funding for the incentives program.

Section 10. Participation of all private and public clinics and hospitals. All private and public clinics and hospitals in the City of San Juan are hereby mandated to include in their services the TB program being implemented by the City Health Office.

All Hospitals are required to have their own TB teams. Those involved in the team will be the one responsible to attend the orientation and they will be Ihe one responsible to cascade information to all the practitioners. Functionality of referral system must be exercised both by private and public health providers.

Section 11. BARANGAY HEALTH CENTER should disseminate communication materials through flyers or posters for adequate information on HEALTH EDUCATION. Broader Communication must be streghthen and sustain the education campaign or seminars in barangay.

a.	For violations of Section 9.
	1st Offense	:	First Notice to the Punong Barangay
	2nd Offense	:	Second Notice for compliance to the Punong Barangay
	3rd Offense	:	Final Notice for Suspension to the Punong Barangay
b.	For violation of Section 10.
	1st Offense	:	First Notice to the medicat establishment
	2nd Offense	:	Fine of P3,000.00 and Suspension of business permit
	3rd Offense	:	Fine of P5,000.00 and Cancellation of business permit

Section 13. Repealing Clause. All ordinances, resolutions or laws of local application an effect inconsistent hereto are hereby modified, superseded and repealed accordingly.

Section 14. Supplementary Clause. On matters not provided in this Ordinance, any existing applicable laws and their corresponding implementing rules and regulations, executive orders and relevant issuances therefore shall be applied in a supplemental manner.

Section 15. Effectlvity Clause. This Ordinance shall take effect 30 days upon its approval and after posting in at ieast three (3) conspicuous places in the territorial jurisdiction of this local government unil, such as but not limited to Barangay Hall, Public Market, Public Terminal and City Hall building and publication in a local newspaper for a period of 2 consecutive weeks.

(Sgd.) ALLEN CHRISTOPHER M. SILVANO City Councilor	(Sgd.) ARTHUR ALFREDO E. AQUINO City Councilor
(Sgd.) JANELLA EJERCITA ESTRADA City Councilor	(Sgd.) WILLIAM C. GO City Councilor
(Sgd.) MICHAEL CRISTOPHER R. MATHAY City Councilor	(Sgd.) MARIE O'NEAL S. MENDOZA City Councilor
(Sgd.) RICHARD F. PERALTA City Councilor	(Sgd.) FERDINAND A. VELASCO City Councilor
(Sgd.) JOSE WARREN P. VILLA City Councilor	(Sgd.) EDGARDO V. SORIANO Sergeat-at-Arms City Councilor
(Sgd.) LEONARDO G. CELLES Asst. Majority Floor Leader City Councilor	(Sgd.) ANGELO E. AGCAOILI Majority Floor Leader City Councilor
(Sgd.) ROLANDO M. BERNARDO President Pro-Tempore City Councilor
I HEREBY CERTIFY THAT THIS ORDINANCE HAS BEEN DULY APPROVED BY THE SANGGUNIANG PANLUNGSOD ON MARCH 16 , 2015.
(Sgd.) RIA P. ESTRELLA-PADILLA City Government Department Hall II Secretary, Sanggunuang Panglungsod
ATTESTED:
(Sgd.) FRANCISCO JAVIER M. ZAMORA Presiding Officer City Vice-Mayor
APPROVED:
(Sgd.) GUIA G. GOMEZ City Mayor