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Integration of Non-Communicable Disease Services within Primary Health Care

 
Introduction
The Primary Health Care Department at the Ministry of Public Health in collaboration with WHO, launched an initiative for the integration of Non-Communicable Diseases (NCD) program within Primary Health Care centers in Lebanon, in 2012. This initiative aimed at integrating a two-step early detection of Diabetes Mellitus and Hypertension as well as estimating the Total Cardiovascular Risk among beneficiaries aged 40 years and above. The model adopted in this initiative was based on the WHO’s 2012 package of Essential Non-Communicable Diseases interventions for Primary Health Care.
The two-step screening model consists of administering initially a screening tool by the health care workers whether in the setting of the health center or in the community. Step 1 consists of using this tool which is in the form of a questionnaire that tackles information related to the beneficiaries. The health care worker would then calculate the total cardiovascular risk for the beneficiary (using the WHO/International Society of Hypertension –WHO/ISH- risk prediction charts) and would refer him/her to the next step (Step 2) in case the total cardiovascular risk was greater than 10% or there was a previous history of diabetes or hypertension. Step 2 involves performing a set of laboratory tests and a referral to the treating physician for calculation of the final cardiovascular risk.
 
Development of the Non-Communicable Disease Program
The program has passed through many phases, in each phase many centers were trained on implementing and using the NCD programs tools and protocols. All the centers within the Primary Healthcare network were trained on NCD within the time period 2013 to 2017. Training sessions were done on regular basis including 25 centers per session. The training included the healthcare workers, nursing staff, administrative staff and physicians.
 
Continuous Support
In order to maintain the sustainability of the program, POINT OF CARE testing machines for NCD screening were distributed to all involved Primary Health Care centers.
Furthermore, to sustain the accuracy of the data entered daily by the centers, an NCD e module was developed by the IT MoPH department on the Health Information System to aid the centers to enter all the NCD related data and perform the calculations necessary for diagnosis of cardiovascular risks.
The MoPH encourages the Primary Health Care centers in Lebanon to organize outreach activities, events and campaigns to raise the awareness on health factors associated with cardiovascular diseases (CVDs), such as obesity, lack of physical activity and smoking (tobacco-use). MoPH provides educational material to support these activities.
 
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ATC Name B/G Ingredients ↑ Dosage Form Price
A10BF01 GLUFIX G Acarbose - 50mg 50mg Tablet 1,294,120 L.L
R02AA05 GOLASEPTINE-LIDOCAINE G Chlorhexidine HCl - 5mg, Lidocaine HCl - 1mg Tablet, chewable 736,426 L.L
B01AC04 GREPID G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 1,297,770 L.L
M02AA15 GROFENAC G Diclofenac sodium - 1% Emulsion Gel 314,459 L.L
A04AD GRAVOL B Dimenhydrinate - 100mg 100mg Suppository 294,302 L.L
A04AD GRAVOL B Dimenhydrinate - 15mg/5ml 15mg/5ml Liquid 258,018 L.L
A04AD GRAVOL B Dimenhydrinate - 50mg 50mg Tablet 163,949 L.L
J01AA02 GRANUDOXY G Doxycycline (monohydrate) - 100mg 100mg Tablet, film-scored 318,491 L.L
J01AA02 GRANUDOXY G Doxycycline (monohydrate) - 100mg 100mg Tablet, film-scored 282,207 L.L
J05AR18 GENVOYA B Emtricitabine - 200mg, Tenofovir alafenamide - 10mg, Elvitegravir - 150mg, Cobicistat - 150mg Tablet, film coated 77,789,650 L.L
G03CC06 GYNOFLOR B Estriol - 0.03mg, Lactobacillus acidophillus - 10 MIU Tablet 813,025 L.L
L04AA27 GILENYA B Fingolimod - 0.5mg 0.5mg Capsule 166,452,693 L.L
D07CC02 GENTACORT-FC G Fluocinolone acetonide - 0.01%, Clotrimazole - 1%, Gentamicin (sulfate) - 0.1% Cream 302,365 L.L
B03AD03 GYNO-TARDYFERON B Folic acid - 0.35mg, Ferrous (sulfate) - 80mg Tablet, sugar coated, slow release 819,744 L.L
G03GA05 GONAL-f BioHuman Follitropin alfa - 300IU/0.5ml 300IU/0.5ml Injectable solution 10,305,698 L.L
G03GA05 GONAL-f BioHuman Follitropin alfa - 450IU/0.75ml 450IU/0.75ml Injectable solution 14,813,959 L.L
G03GA05 GONAL-f BioHuman Follitropin alfa - 900IU/1.5ml 66mcg/1.5ml Injectable solution 29,625,401 L.L
N03AX12 GABATREX G Gabapentin - 100mg 100mg Capsule 292,958 L.L
N03AX12 GABAMOX G Gabapentin - 300mg 300mg Capsule, hard 1,108,670 L.L
N03AX12 GABANET 300 G Gabapentin - 300mg 300mg Capsule 1,380,126 L.L
N03AX12 GABAPENTINE ARROW GENERIQUES G Gabapentin - 300mg 300mg Capsule 1,342,499 L.L
N03AX12 GABAPENTINE ARROW GENERIQUES G Gabapentin - 300mg 300mg Capsule 1,342,499 L.L
N03AX12 GABATREX G Gabapentin - 300mg 300mg Capsule 1,585,734 L.L
N03AX12 GABAMOX G Gabapentin - 400mg 400mg Capsule, hard 1,233,647 L.L
N03AX12 GABANET 400 G Gabapentin - 400mg 400mg Capsule 1,607,236 L.L
N03AX12 GABAPENTINE ARROW GENERIQUES G Gabapentin - 400mg 400mg Capsule 1,342,499 L.L
N03AX12 GABAPENTINE ARROW GENERIQUES G Gabapentin - 400mg 400mg Capsule 1,342,499 L.L
N03AX12 GABATREX G Gabapentin - 400mg 400mg Capsule 1,846,440 L.L
N03AX12 GABATREX G Gabapentin - 600mg 600mg Tablet 3,132,497 L.L
S01AD09 GANVIR G Ganciclovir - 0.15% 0.15% Gel 698,798 L.L
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