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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 ADVAGRAF B Tacrolimus monohydrate - 5mg 5mg Capsule, prolonged release 85,485,667 L.L
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L04AX04 REVLIMID B Lenalidomide - 5mg 5mg Capsule 105,106,076 L.L
L04AX04 LENALIDOMIDE ARROW G Lenalidomide - 5mg 5mg Capsule 26,651,802 L.L
L04AX04 LENALIDOMIDE NEAPOLIS G Lenalidomide - 5mg 5mg Capsule 68,908,116 L.L
L04AX04 LENALIDOMIDE SPC G Lenalidomide - 5mg 5mg Capsule, hard 71,647,217 L.L
L04AX04 LENALIDOMIDE STRAGEN G Lenalidomide - 5mg 5mg Capsule 33,314,752 L.L
L04AX04 LENOMA G Lenalidomide - 5mg 5mg Capsule, hard 68,908,116 L.L
L04AX04 SOTIRA G Lenalidomide - 5mg 5mg Capsule 68,908,116 L.L
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C09AA03 TENSIKEY G Lisinopril - 5mg 5mg Tablet 456,906 L.L
C09AA04 COVERSYL ARGININE B Perindopril arginine - 5mg 5mg Tablet, film coated 452,875 L.L
C09AA05 TRITACE B Ramipril - 5mg 5mg Tablet 509,316 L.L
C01EB17 PROCORALAN B Ivabradin (HCl) - 5mg 5mg Tablet, film coated 1,890,786 L.L
C09AA05 ACURIL G Ramipril - 5mg 5mg Tablet 614,136 L.L
C01EB17 BRADIREM G Ivabradine (HCl) - 5mg 5mg Tablet, film coated 1,134,203 L.L
C09AA05 APO-RAMIPRIL G Ramipril - 5mg 5mg Capsule 794,211 L.L
C01EB17 BRAVIGO G Ivabradine (HCl) - 5mg 5mg Tablet, film coated 1,237,679 L.L
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C01EB17 IVABRADINE ARROW G Ivabradine (HCl) - 5mg 5mg Tablet, film coated, scored 1,323,685 L.L
C09AA05 RAMIPRIL-REMEDICA G Ramipril - 5mg 5mg Tablet 623,543 L.L
A05AA04 OCALIVA B Obeticholic acid - 5mg 5mg Tablet, film coated 224,503,943 L.L
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A06AB02 DULCOLAX B Bisacodyl - 5mg 5mg Tablet, sugar coated 219,046 L.L
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