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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
R05 EXALL FORTE G Chlorpheniramine maleate - 2.5mg, Guaifenesin - 100mg, Acetaminophen - 100mg, Diprophylline - 25mg Syrup 501,701 L.L
R05 COQUELUSEDAL ENFANT G Grindelia extract - 20mg, Gelsenium extract - 10mg Suppository 598,051 L.L
R05C PULMONAL SIROP G Belladona tincture - 0.5g/5ml, Drosera tincture - 2g/5ml, Ammonium bromide - 2g/5ml, Sodium benzoate - 2g/5ml Syrup 148,463 L.L
R05C SULDEX G Caffein anyhdrous - 0.216g, Antipyrine - 0.972g, Potassium sulfaguaiacolate - 1.44g Syrup 152,302 L.L
R05CA ASPECTON COUGH SYRUP G Thyme soft extract - 6.69g/100ml Syrup 588,603 L.L
R05CA03 MUCINEX G Guaifenesin - 600mg 600mg Tablet, extended release 749,864 L.L
R05CA12 HEDERAL G Dried Ivy leaf extract (Hedera Helix) - 99mg/5ml 99mg/5ml Drops solution 384,339 L.L
R05CA12 LIBLAB COUGH SUPPOSITORIES G Dried Ivy leaf extract - 80mg 80mg Suppository 142,447 L.L
R05CA12 PROSPAN ACUTE EFFERVESCENT COUGH TABLETS B Dried Ivy leaf extract - 65mg Tablet, effervescent 479,752 L.L
R05CA12 PROSPAN COUGH LIQUID B Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Liquid 353,431 L.L
R05CA12 PROSPAN COUGH SYRUP B Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Solution 353,431 L.L
R05CA12 IVY-CALM G Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Syrup 251,299 L.L
R05CA12 IVYMUC G Dried Ivy leaf extract - 0.7g/100ml 0.7g/100ml Syrup 300,765 L.L
R05CA12 TOUCALM G Dried Ivy leaf extract - 0.7g/100ml 0.7g/100ml Syrup 300,765 L.L
R05CA12 JOS-PAN G Dried Ivy leaf extract (Hederacoside C) - 75mg/100ml Syrup 306,396 L.L
R05CA12 HEDERAL G Dried Ivy leaf extract - 37mg/5ml 37mg/5ml Syrup 309,084 L.L
R05CA12 LIBLAB COUGH SYRUP G Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Syrup 237,860 L.L
R05CA12 HEDECTON COUGH G Ivy leaf soft extract - 40mg/5ml Syrup 467,657 L.L
R05CB01 FLUIMUCIL B N-acetylcysteine - 600mg 600mg Tablet, effervescent 567,102 L.L
R05CB01 ACC LONG G N-acetylcysteine - 600mg, Vitamin C - 75mg 600mg Tablet, effervescent 286,238 L.L
R05CB01 EXOMUC B N-acetylcysteine - 200mg 200mg Granules for solution 529,474 L.L
R05CB01 TREBON N G Acetylcysteine - 600mg 600mg Granules for suspension 596,666 L.L
R05CB01 FLUIMUCIL MUCOLYTIC B N-acetylcysteine - 2% 2% Syrup 595,322 L.L
R05CB02 BROMHEXINE G Bromhexine - 4mg/5ml 4mg/5ml Elixir 176,619 L.L
R05CB03 MUCOTAL PEDIATRIQUE G Carbocysteine - 100mg/5ml 100mg/5ml Syrup 298,205 L.L
R05CB03 MUCOTAL ADULTE G Carbocysteine - 250mg/5ml 250mg/5ml Syrup 308,444 L.L
R05CB06 API-MUCOL G Ambroxol HCl - 15mg/5ml 15mg/5ml Syrup 326,554 L.L
R05CB06 FLUIBRON G Ambroxol - 15mg/5ml 15mg/5ml Syrup 459,594 L.L
R05CB06 MUCUM G Ambroxol HCl - 15mg/5ml 15mg/5ml Syrup, sugar free, alcohol free 98,101 L.L
R05CB06 MUCOSOLVAN B Ambroxol HCl - 30mg/5ml 30mg/5ml Syrup 380,307 L.L
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