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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
N06AB10 APO-ESCITALOPRAM G Escitalopram (oxalate) - 10mg 10mg Tablet 565,758 L.L
N06AB10 APO-ESCITALOPRAM G Escitalopram (oxalate) - 20mg 20mg Tablet 1,087,169 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 60mg 60mg Capsule 4,731,669 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 40mg 40mg Capsule 4,114,846 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 25mg 25mg Capsule 3,703,630 L.L
N06BA09 APO-ATOMOXETINE G Atomoxetine (HCl) - 10mg 10mg Capsule 2,981,987 L.L
N06DA02 ARICEPT B Donepezil HCl - 5mg 5mg Tablet, film coated 3,254,787 L.L
N06DA02 ALZEPIL G Donepezil HCl - 5mg 5mg Tablet 1,406,555 L.L
N06DA02 ARIPEZIL 5 G Donepezil HCl - 5mg 5mg Tablet, film coated 1,970,969 L.L
N06DA02 ARICEPT B Donepezil HCl - 10mg 10mg Tablet, film coated 3,776,197 L.L
N06DA02 ALZEPIL G Donepezil HCl - 10mg 10mg Tablet 1,908,256 L.L
N06DA02 ARIPEZIL 10 G Donepezil HCl - 10mg 10mg Tablet, film coated 2,292,595 L.L
N07BB03 ACAMPROSATE BIOGARAN G Acamprosate - 333mg 333mg Tablet, gastroresistant 3,641,813 L.L
N07CA01 ALVIGO G Betahistine dihydrochloride - 16mg 16mg Tablet, scored 1,204,339 L.L
P02CA03 ALBENDA G Albendazole - 100mg/5ml 400mg/20ml Suspension 129,009 L.L
P02CA03 ALBENDA G Albendazole - 200mg 200mg Tablet 116,914 L.L
P02CA03 ALBENDAZOLE-UBSA G Albendazole - 200mg 200mg Tablet 127,985 L.L
P02CA03 ANDAZOL G Albendazole - 200mg 6 Tablet, film coated 302,365 L.L
R01AC03 ALLERGODIL NASAL B Azelastine HCl - 0.14mg/dose 0.14mg/dose Spray, solution 657,139 L.L
R01AD09 AVOCOM G Mometasone furoate - 0.05% 0.05% Spray 419,279 L.L
R01AD12 AVAMYS B Fluticasone furoate - 27.5mcg/dose 27.5mcg/dose Suspension 722,987 L.L
R01AD12 AVAMYS B Fluticasone furoate - 27.5mcg/dose 27.5mcg/dose Suspension 722,987 L.L
R01BA53 AURIMEL B Phenylephrine HCl - 5mg/5ml, Sodium citrate - 325mg/5ml, Carbinoxamine maleate - 2mg/5ml, Dextromethorphan HBr - 5mg/5ml Syrup 319,963 L.L
R02A ALFA-AMYLASE BGR CONSEIL G Alpha-Amylase - 3,000U.CEIP 3,000U.CEIP Tablet, coated 290,270 L.L
R02A ALFA-AMYLASE BGR CONSEIL G Alpha-Amylase - 200U.CEIP/ml 200U.CEIP/ml Syrup 384,339 L.L
R02A ANGINOVAG G Lidocaine HCl - 100mg/100ml, Hydrocortisone acetate - 60mg/100ml, Tyrothricin - 400mg/100ml, Dequalinium chloride - 100mg/100ml, ?-Glycerrhetinic acid - 60mg/100ml Spray 651,764 L.L
R03AC02 ASMALAT G Salbutamol (sulfate) - 2mg/5ml 2mg/5ml Syrup 177,899 L.L
R03AC02 ASTHALIN G Salbutamol (sulfate) - 2.5mg/2.5ml 2.5mg/2.5ml Inhalation solution 325,210 L.L
R03AK13 AEROCORT-A HFA G Salbutamol - 100mcg/dose, Beclometasone - 50mcg/dose Metered dose inhaler 541,569 L.L
R03AL01 ATROVENT COMP. HFA B Fenoterol Hydrobromide - 20mcg/actuation, Ipratropium bromide - 50mcg/actuation Inhalation aerosol metered dose 544,256 L.L
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