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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
H02AB02 DEXAMED G Dexamethasone - 8mg/2ml 8mg/2ml Injectable solution 3,547,744 L.L
H02AB02 DEXAMED G Dexamethasone - 8mg/2ml 8mg/2ml Injectable solution 486,471 L.L
H02AB02 DEXAMETHASON-PANPHARMA G Dexamethasone - 5mg/1ml 5mg/1ml Injectable solution 368,213 L.L
S01CA01 DEXATOBRIN G Dexamethasone - 1mg/ml, Tobramycin - 3mg/ml Drops suspension 239,204 L.L
H02AB02 DECADRON B Dexamethasone - 0.5mg/5ml 0.5mg/5ml Elixir 449,227 L.L
H02AB02 DEXAMETHASONE G Dexamethasone - 0.5mg/5ml 0.5mg/5ml Elixir 119,026 L.L
H02AB02 DECADRON B Dexamethasone - 0.5mg 0.5mg Tablet, scored 393,218 L.L
H02AB02 DEXAMETHASONE SODIUM PHOSPHATE USP - EIPICO G Dexamethasone (sodium phosphate) - 8mg/2ml 8mg/2ml Injectable solution 185,450 L.L
R06AX DELINE CORT G Desloratadine - 5mg/5ml, Betamethasone - 0.25mg/5ml Syrup 693,679 L.L
R06AX27 DAREQ G Desloratadine - 5mg 5mg Tablet, film coated 258,018 L.L
R06AX27 DELINE G Desloratadine - 5mg 5mg Tablet 430,030 L.L
R06AX27 DELINE G Desloratadine - 5mg 5mg Tablet 149,742 L.L
R06AX27 DELINE-MED G Desloratadine - 5mg 5mg Tablet 566,974 L.L
R06AX27 DESLOR MEDIS G Desloratadine - 5mg 5mg Tablet, film coated 396,434 L.L
R06AX DESLAMED FORTE G Desloratadine - 1mg/ml, Betamethasone - 0.05mg/ml Syrup 1,009,802 L.L
R06AX DESLAMED FORTE G Desloratadine - 1mg/ml, Betamethasone - 0.05mg/ml Syrup 673,201 L.L
R06AX DESLOCORT G Desloratadine - 1mg/ml, Betamethasone - 0.05mg/ml Syrup 1,009,802 L.L
R06AX DESLOCORT G Desloratadine - 1mg/ml, Betamethasone - 0.05mg/ml Syrup 673,201 L.L
R06AX27 DELINE G Desloratadine - 0.5mg/ml 0.5mg/ml Syrup 197,097 L.L
R06AX27 DELINE-MED G Desloratadine - 0.5mg/ml 0.5mg/ml Syrup 259,810 L.L
R06AX27 DESLAMED G Desloratadine - 0.5mg/ml 0.5mg/ml Solution 323,802 L.L
R06AX27 DESLOR CHAPHA G Desloratadine - 0.5mg/ml 0.5mg/ml Solution 323,802 L.L
R06AX27 DESLORATADINE ARROW G Desloratadine - 0.5mg/ml 0.5mg/ml Solution 256,674 L.L
N06AA01 DESIPRAMINE G Desipramine (HCl) - 50mg 50mg Tablet, scored 656,563 L.L
H02AB13 DEFAL B Deflazacort - 6mg 6mg Tablet 415,247 L.L
H02AB13 DEFAL B Deflazacort - 30mg 30mg Tablet 635,638 L.L
V03AC03 DEFERASIROX ARROW G Deferasirox - 90mg 90mg Tablet 8,846,092 L.L
V03AC03 DEFEROXAL 90 G Deferasirox - 90mg 90mg Tablet, film coated 9,279,724 L.L
V03AC03 DEFIROX G Deferasirox - 500mg 500mg Tablet, dispersible 38,502,953 L.L
V03AC03 DIFIRAX G Deferasirox - 500mg 500mg Tablet, dispersible 38,637,010 L.L
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