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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
R03AK06 FLUDALT DUO G Salmeterol (xinafoate) - 50mcg, Fluticasone propionate - 100mcg Capsule, inhalation 1,777,706 L.L
C09DA01 HYZAAR B Losartan potassium - 50mg, Hydrochlorothiazide - 12.5mg Tablet 1,523,022 L.L
J07CA11 DIPHTHERIA, TETANUS,PERTUSSIS, HEPATITIS B AND HAEMOPHILUS INFLUENZAE TYPE B CONJUGATE VACCINE B Diphteria Toxoid1 - ?25Lf (?30IU)/0.5ml, Tetanus toxoid1 - ?2.5Lf (?40IU)/0.5ml, Bordetella pertussis (Whole cell) - ?16OU (?4.0IU)/0.5ml, HBs Antigen (r DNA)1 - ?10mcg/0.5ml, H. Influenza type b, purified capsular polysaccharide2 - 10mcg/0.5ml, 1 adsorbed on aluminium phosphate, Al+++ - ?1.25mg , 2 conjugated to tetanos toxoid carrier protein - Injectable suspension 1,515,854 L.L
R03AK06 PROPIONATE DE FLUTICASONE/ SALMETEROL ARROW G Salmeterol - 50mcg/dose, Fluticasone propionate - 100mcg/dose Inhalation powder 1,593,797 L.L
C09DA01 LOSANET-H G Losartan potassium - 50mg, Hydrochlorothiazide - 12.5mg Tablet 395,474 L.L
R03AK06 SERETIDE DISKUS 250 B Salmeterol (xinafoate) - 50mcg/inhalation, Fluticasone propionate - 250mcg/inhalation Inhalation powder 2,830,132 L.L
C09DA01 LOSARTAN/HYDROCHLOROTHIAZIDE ARROW LAB G Losartan potassium - 50mg, Hydrochlorothiazide - 12.5mg Tablet, film coated 470,345 L.L
R03AK06 FLUDALT DUO G Salmeterol (xinafoate) - 50mcg, Fluticasone propionate - 250mcg Capsule, inhalation 2,487,891 L.L
C09DA01 LOSARTAN/HYDROCHLOROTHIAZIDE BGR G Losartan potassium - 50mg, Hydrochlorothiazide - 12.5mg Tablet, coated 439,436 L.L
R03AK06 PROPIONATE DE FLUTICASONE/ SALMETEROL ARROW G Salmeterol - 50mcg/dose, Fluticasone propionate - 250mcg/dose Inhalation powder 1,980,824 L.L
A11DB NEUROBION B Vitamin B12 - 1000mcg, Vitamin B6 - 100mg, Vitamin B1 - 100mg Injectable solution 545,600 L.L
C09DA01 LOSARTAN/HYDROCHLOROTHIAZIDE REMEDICA G Losartan potassium - 50mg, Hydrochlorothiazide - 12.5mg Tablet, film coated 635,638 L.L
M01AE51 ADVIL COLD & SINUS B Ibuprofen - 200mg, Pseudoephedrine HCl - 30mg Caplet, coated 288,926 L.L
R03AK06 SERETIDE DISKUS 500 B Salmeterol (xinafoate) - 50mcg/inhalation, Fluticasone propionate - 500mcg/inhalation Inhalation powder 3,199,689 L.L
A11DB NEUROBION B Vitamin B12 - 1000mcg, Vitamin B6 - 100mg, Vitamin B1 - 100mg Injectable solution 287,582 L.L
C09DA01 HYZAAR B Losartan potassium - 100mg, Hydrochlorothiazide - 12.5mg Tablet 1,740,596 L.L
M01AE51 IBUGESIC COLD AND SINUS G Ibuprofen - 200mg, Pseudoephedrine HCl - 30mg Tablet, film coated 154,542 L.L
N04BA02 SINEMET B Levodopa - 250mg, Carbidopa - 25mg Tablet, scored 1,283,690 L.L
R03AK06 FLUDALT DUO G Salmeterol (xinafoate) - 50mcg, Fluticasone propionate - 500mcg Capsule, inhalation 3,169,668 L.L
A11DB NEURORUBINE G Vitamin B12 - 1mg, Vitamin B6 - 100mg, Vitamin B1 - 100mg Injectable solution 302,365 L.L
C09DA01 LOSANET-H FORTE G Losartan potassium - 100mg, Hydrochlorothiazide - 12.5mg Tablet 395,474 L.L
M01AE51 RELI-FLU G Ibuprofen - 200mg, Pseudoephedrine HCl - 30mg Tablet, film coated 139,504 L.L
N04BA02 CARLEVO G Levodopa - 250mg, Carbidopa - 25mg Tablet 796,067 L.L
R03AK06 PROPIONATE DE FLUTICASONE/ SALMETEROL ARROW G Salmeterol - 50mcg/dose, Fluticasone propionate - 500mcg/dose Inhalation powder 2,605,711 L.L
A11DB NEUROBION B Vitamin B12 - 200mcg, Vitamin B6 - 200mg, Vitamin B1 - 100mg Tablet, coated 364,181 L.L
C09DA01 LOSARTAN/HYDROCHLOROTHIAZIDE ARROW LAB G Losartan potassium - 100mg, Hydrochlorothiazide - 12.5mg Tablet, film coated 470,345 L.L
M01AE51 PROFINAL XP G Ibuprofen - 400mg, Caffeine - 65mg Caplet, film coated 286,238 L.L
N04BA02 SINEMET B Levodopa - 100mg, Carbidopa - 25mg Tablet 2,742,335 L.L
R03AK06 SEROFLO 500 G Salmeterol (xinafoate) - 50mcg/inhalation, Fluticasone propionate - 500mcg/inhalation Inhalation suspension 2,031,890 L.L
A11DB NEUROBION B Vitamin B12 - 200mcg, Vitamin B6 - 200mg, Vitamin B1 - 100mg Tablet, coated 550,975 L.L
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