In a recent correspondence, Corpuz highlighted the importance of effective tuberculosis-infection prevention and control (TB-IPC) measures in Philippine healthcare settings to curb TB transmission through effective governance, leadership and accountability at the provincial and local levels.¹ In the Philippines, the legal purpose and intention of the Universal Health Care Act turn blurry when implementation and monitoring often neglect the well-being of disadvantaged and marginalized populations. A case in point is the ‘People Deprived of Liberty’ (PDL). Borja et al. concluded that ‘pulmonary tuberculosis is a major public health problem among prisoners in the Philippines, particularly among the male inmates, as evidenced by the high prevalence of bacteriologically confirmed pulmonary tuberculosis, which is four to five times higher compared to the prevalence in the general population’.²

It is not to ‘normalize’ if one says that diseases like tuberculosis are common to develop in society as medical interventions and healthcare services vary between nations. The great problem lies in how social institutions, most specifically government and public hospitals, perceive, define, and address tuberculosis. The Philippine government is often reactive rather than proactive in initiating countermeasures for emerging and prevailing diseases, and even if it does, it follows a generalized approach while ignoring the differentiated experiences and extremely negative conditions of PDL. It is ineffective, much less incompetent, to take a large-scale resolution against tuberculosis only when it receives epidemic status or mortality rises in prisons and some isolated areas. In addition, unlike other marginalized groups (e.g., women and children, LGBTQIA+, indigenous people, and the homeless), PDL are distinct in their own identity due to the deprivation of liberty—the inability to demand and seek healthcare on the basis of legal misconduct. There is already a far greater disadvantage to PDL, who have a higher chance of developing or contracting tuberculosis than any other group in the general public.

Even more, government healthcare initiatives and PDL help-seeking behaviors are sometimes regressed by social stigma and ‘othering’. It is the unlawful records that define the attitude and belief of the public towards PDL, which hardly considers their health conditions. Prisons are invisibly a space or unit of secondary importance, which makes PDL more exposed and vulnerable to not getting the appropriate treatment. In the hope of better addressing the health problem of tuberculosis in Philippine prisons, we recommend the following:

• (i) improve the quality of the prison food system, focusing on nutrition availability in meals;

• (ii) requisition and deployment of mobile diagnostic labs for regular TB screenings and follow-up visits in provincial and district jails and prisons;

• (iii) collaborations with academic institutions and international organizations for up-to-date TB research and healthcare practices; and

• (iv) strengthen the peer support groups and family visitations in correctional facilities.

The government has the moral obligation to guarantee the fundamental needs of PDL for healthcare. It is not a luxury if people who have no liberty and are serving their sentences are to receive TB-IPC measures both for their own good and for the society on which public health is contingent.