After five years of working alongside communities, local authorities, and health workers, Médecins Sans Frontières (MSF) is concluding our dedicated tuberculosis (TB) project in Tondo district, Manila, Philippines. Launched in 2021, the project aimed to strengthen TB detection, treatment, and prevention in one of the country’s most densely populated urban communities, while developing a community-based model of care that could be sustained by local partners beyond our involvement. 

The project was successfully handed over to local partners in June 2026. To help sustain active case-finding activities and ensure continuity of a locally driven model of care, we closely coordinated with local health authorities and community-led TB patient support groups. 

Working closely with the Manila Health Department, MSF implemented a comprehensive ‘search, treat, prevent’ approach that brought TB services directly into communities. The TB project was implemented initially in Tondo’s first and second districts, then from the beginning of 2025, moved to cover the six highest-burden health centre catchment areas in District 1. Since 2022, the project has screened more than 51,000 individuals in Tondo, where the TB positivity rate remains around 3.9 per cent, which is almost four times higher than the national average, reflecting persistent active transmission in the community.  

Through mobile x-ray screening, computer-aided detection (CAD) technology, GeneXpert testing,¹ contact investigation, and preventive treatment, MSF identified 2,493 new TB cases, or 21% share of Tondo TB diagnoses, including more than 78 people with drug-resistant tuberculosis (DR-TB) across 43 barangays [villages]. The project initiated treatment for 62% of people diagnosed with TB and started 85% of eligible contacts on TB preventive therapy. People diagnosed with TB were referred to health centres run by the Manila Health Department to start treatment and follow-up. 

The project also generated evidence to improve TB care for the TACTiC study which assessed uptake and feasibility of a shorter four-month TB treatment regimen for Filipino children.² The TACTiC project, or Test, Avoid, Cure Tuberculosis in Children, is a global initiative launched by MSF to improve diagnosis and treatment of TB among children. 
 

TB committees: A community-led TB model of care 

A lasting legacy of the project is the TB committee model, a structured community engagement approach established in partnership with local barangays and health centres to strengthen TB prevention, detection, and care in Tondo. The committees brought together barangay health workers, health centre staff, TB survivors, community leaders, and volunteers to support local health services and address persistent gaps in early case detection, linkage to care, and treatment adherence. 

Through training on TB fundamentals, logistics, contact investigation, and TB preventive treatment, 171 barangay representatives and 16 health centre staff were equipped to take on a more active role in the local TB response across 43 barangays.  

As community ownership grew, the committees led health promotion activities, encouraged residents to participate in screening, supported patient follow-up, and gradually assumed responsibility for community-led active case finding activities. Between November 2025 and May 2026, TB committee-led initiatives conducted 29 active case finding activities, screening 2,340 people with only minimal support from MSF. Their success demonstrates how community-led approaches can build trust, improve participation in TB services, and help ensure the sustainability of care beyond the project's transition to local partners. 

“The Tondo project has demonstrated that combining community engagement, innovative diagnostics, and strong partnerships can bring lifesaving TB services closer to the people who need them most,” says Dr Muhammad Shoaib, MSF’s head of mission in Philippines. “Sustaining these gains will depend on continued investment in diagnosis, treatment and prevention.” 

The project also highlighted persistent challenges facing TB care in the Philippines. While innovative diagnostic tools such as mobile x-ray screening, CAD technology, and GeneXpert testing helped uncover cases that would otherwise remain undetected, diagnosis alone is not enough. 

Recurrent shortages of TB medicines³ and diagnostic supplies disrupted treatment initiation and threatened community confidence in health services. To help prevent interruptions in care, we supplied TB medicines to health centres so that people diagnosed through active case-finding activities could start treatment, particularly during periods when facilities experienced shortages of essential TB drugs. This highlighted how expanding access to diagnosis must go hand in hand with ensuring a reliable supply of treatment. 

The project also found a high proportion of asymptomatic TB cases, underscoring the importance of proactive community-based screening in high-burden settings, like Tondo. Continued investment in diagnostics, treatment availability, and community outreach will be critical in the fight against TB. 

As part of the transition process, we donated our mobile x-ray truck to the Manila City Government to help ensure the continuation of community-based TB screening and early detection efforts. Manila Mayor Francisco “Isko” Moreno Domagoso, via a social media post⁴, personally thanked MSF for our invaluable contribution and continued partnership in the city’s fight against tuberculosis. 

Looking ahead, our work in Tondo will continue under a new project opening in late 2026, which will aim to reduce climate and environmental related health risks. We will focus on case management of respiratory diseases, including TB, surveillance of climate sensitive diseases or conditions,  support on resilience for extreme weather events, especially heat, and research on environmental and climate change related issues. 

Building on the lessons and partnerships developed over the past five years, we will continue working alongside communities and local authorities to address evolving public health needs while keeping patients at the centre of care.