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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
L04AD02 PROGRAF 1MG B Tacrolimus - 1mg 1mg Capsule 25,241,922 L.L
N02BE51 PARACETAMOL/CAFEINE/CODEINE BIOGARAN G Paracetamol - 400mg, Caffeine - 50mg, Codeine - 20mg Capsule 548,288 L.L
L04AD02 PROGRAF 1MG B Tacrolimus - 1mg 1mg Capsule 25,241,922 L.L
L04AD02 PROGRAF 5MG B Tacrolimus - 5mg 5mg Capsule 94,286,686 L.L
M03BB53 PARAXONE-JPI G Paracetamol - 300mg, Chlorzoxazone - 250mg Capsule 334,617 L.L
L04AD02 PROGRAF 5MG B Tacrolimus - 5mg 5mg Capsule 94,286,686 L.L
L04AD02 PROGRAF 0.5 MG B Tacrolimus - 0.5mg 0.5mg Capsule 13,942,481 L.L
L04AD02 PROGRAF 0.5 MG B Tacrolimus - 0.5mg 0.5mg Capsule 13,942,481 L.L
N02BF02 PLENICA G Pregabalin - 150mg 150mg Capsule 997,131 L.L
N02BF02 PMS-PREGABALIN G Pregabalin - 150mg 150mg Capsule 2,534,487 L.L
N02BF02 PREGAFORTE 150 G Pregabalin - 150mg 150mg Capsule 1,023,880 L.L
N02BF02 PLENICA G Pregabalin - 75mg 75mg Capsule 697,454 L.L
N02BF02 PMS-PREGABALIN G Pregabalin - 75mg 75mg Capsule 1,776,560 L.L
N02BF02 PREGAFORTE 75 G Pregabalin - 75mg 75mg Capsule 793,507 L.L
N02BF02 PREGAFORTE 100 G Pregabalin - 100mg 100mg Capsule 998,283 L.L
N02BF02 PLENICA G Pregabalin - 25mg 25mg Capsule 697,454 L.L
N02BF02 PMS-PREGABALIN G Pregabalin - 25mg 25mg Capsule 770,022 L.L
N02BF02 PREGAFORTE 25 G Pregabalin - 25mg 25mg Capsule 700,078 L.L
N06AX21 PMS-DULOXETINE G Duloxetine HCl - 60mg 60mg Capsule, delayed release 976,973 L.L
N06AX21 PMS-DULOXETINE G Duloxetine HCl - 30mg 30mg Capsule, delayed release 642,357 L.L
A02BC05 PRIMAZOL 20 G Esomeprazole (magnesium dihydrate) - 20mg 20mg Capsule, gastro-resistant 511,940 L.L
A02BC05 PRIMAZOL 40 G Esomeprazole (magnesium dihydrate) - 40mg 40mg Capsule, gastro-resistant 639,925 L.L
L01EF01 PAPILLIO G Palbociclib - 75mg 75mg Capsule, hard 147,883,080 L.L
L01EF01 PAPILLIO G Palbociclib - 100mg 100mg Capsule, hard 147,883,080 L.L
L01EF01 PAPILLIO G Palbociclib - 125mg 125mg Capsule, hard 147,883,080 L.L
L01EF01 PAPILLIO G Palbociclib - 125mg 125mg Capsule, hard L.L
C10BA03 PRAVAFEN B Pravastatin sodium - 40mg, Fenofibrate - 160mg Capsule, hard 1,264,556 L.L
L01EF01 PAPILLIO G Palbociclib - 100mg 100mg Capsule, hard L.L
J02AC01 PANZIMOL G Fluconazole - 100mg 100mg Capsule, hard 2,015,764 L.L
J02AC01 PANZIMOL G Fluconazole - 150mg 150mg Capsule, hard 428,686 L.L
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