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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
J02AC03 VIROZOLE 200 G Voriconazole - 200mg 200mg Tablet, film coated 47,909,207 L.L
G03DB08 VISANNE B Dienogest - 2mg 2mg Tablet 4,980,280 L.L
A11CC05 VIT-X-FORTE G Vitamin D3 - 10,000IU 10,000IU Capsule 895,895 L.L
B03AD VITA-FERIN C G Ferrous fumarate - 300mg, Folic acid - 0.5mg, Vitamin C - 200mg, Vitamin B6 - 0.002g, Vitamin B2 - 0.002g, Vitamin B1 - 0.01g Capsule 1,217,521 L.L
A11AA VITA-GERIN G Ginseng extract - 40mg, Vitamin A, palmitate - 2667IU, Vitamin D3 - 200IU, ?-Tocopheryl acetate - 10mg, Thiamine mononitrate - 1.4mg, Riboflavine - 1.6mg, Pyridoxine HCl - 2mg, Cyanocobalamin - 1mcg, Biotin - 150mcg, Nicotinamide - 18mg, Ascorbic acid - 60mg, Folic acid - 100mcg, Calcium phosphate - 100mg, Lecithin - 100mg, Magnesium sulfate - 10mg, Iron sulphate - 10mg, Copper sulfate - 2mg, Sodium selenite anhydrous - 50mcg, Zinc sulfate - 1mg Capsule 1,724,150 L.L
A11BA VITALIPID N INFANT B Vitamin A - 230IU/ml, Vitamin D2 - 40IU/ml, Vitamin E - 0.7IU/ml, Vitamin K1 - 20mcg/ml Injectable concentrate for solution 2,448,481 L.L
A11GA01 VITAMIN C S.A.L.F. G Ascorbic acid (vit C) - 500mg/5ml 500mg/5ml Injectable solution 498,566 L.L
A11DB VITANOR G Vitamin B1 - 250mg, Vitamin B6 - 250mg, Vitamin B12 - 500mcg Tablet, film coated 946,065 L.L
A12AX VITAQPLUS G Vitamin K2 - 0.05mg, Colecalciferol - 400IU, Calcium - 300mg Tablet 2,500,891 L.L
A11CC05 VITEX D3 G Vitamin D3 - 10,000IU 10,000IU Capsule 447,500 L.L
B03AD VITEXFER G Folic acid - 1mg, Ascorbic acid - 200mg, Iron ferrous fumarate - 100mg Tablet, film coated 791,523 L.L
J05AR06 VITRICOMB G Emtricitabine - 200mg, Tenofovir disoproxil fumarate - 300mg, Efavirenz - 600mg Tablet, film coated 22,191,783 L.L
G04BE08 VIVIDA 20 G Tadalafil - 20mg 20mg Tablet, film coated 1,721,398 L.L
G04BE08 VIVIDA 20 G Tadalafil - 20mg 20mg Tablet, film coated 624,567 L.L
G04BE08 VIVIDA 5 G Tadalafil - 5mg 5mg Tablet, film coated 2,559,700 L.L
J01MA12 VLOFINOX G Levofloxacin (hemihydrate) - 500mg/100ml 500mg/100ml Injectable solution 814,369 L.L
A10BH02 VLUDIN G Vildagliptin - 50mg 50mg Tablet 767,910 L.L
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A10BD08 VLUDIN MET G Metformin HCl - 1000mg, Vildagliptin - 50mg Tablet, film coated 735,914 L.L
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C09DB02 VOCADO B Olmesartan medoxomil - 40mg, Amlodipine besylate - 5mg Tablet, film coated 1,103,295 L.L
C09DB02 VOCADO B Olmesartan medoxomil - 40mg, Amlodipine besylate - 10mg Tablet, film coated 1,186,613 L.L
C09DX03 VOCADO HCT B Olmesartan medoxomil - 40mg, Amlodipine - 10mg, Hydrochlorothiazide - 25mg Tablet, film coated 1,523,917 L.L
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C09DX03 VOCADO HCT B Olmesartan medoxomil - 40mg, Amlodipine - 5mg, Hydrochlorothiazide - 25mg Tablet, film coated 1,523,917 L.L
C09DX03 VOCADO HCT B Olmesartan medoxomil - 40mg, Amlodipine - 5mg, Hydrochlorothiazide - 12.5mg Tablet, film coated 1,523,917 L.L
N03AX12 VOLAR G Gabapentin - 300mg 300mg Capsule 1,100,607 L.L
J01MA12 VOLCIDIN G Levofloxacin (hemihydrate) - 500mg 500mg Tablet 849,820 L.L
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