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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
B01AC04 CLOPIDOGREL ARROW G Clopidogrel besylate - 75mg 75mg Tablet, film coated 658,483 L.L
B01AC04 CLOPIKEY G Clopidogrel (Bisulfate) - 75mg 75mg Tablet 748,520 L.L
B01AC04 CLOTRIX 75 G Clopidogrel (hydrogenosulfate) - 75mg 75mg Tablet, film coated 1,109,630 L.L
B01AC04 CLOTRIX 75 G Clopidogrel (hydrogenosulfate) - 75mg 75mg Tablet, film coated 1,035,399 L.L
B01AC04 GREPID G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 1,297,770 L.L
B01AC04 NORMIGORE G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 1,184,117 L.L
B01AC04 PEDOVEX G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 808,993 L.L
B01AC04 PIDOGREL MEDIS G Clopidogrel - 75mg 75mg Tablet, film coated 810,337 L.L
N02BF02 LYRICA B Pregabalin - 75mg 75mg Capsule 598,010 L.L
B01AC04 THROMBO G Clopidogrel - 75mg 75mg Tablet, film coated 764,646 L.L
N02BF02 LYRICA B Pregabalin - 75mg 75mg Capsule 2,131,334 L.L
B01AC04 TROKEN G Clopidogrel (Bisulfate) - 75mg 75mg Tablet, film coated 1,148,985 L.L
N02BF02 LYRICA B Pregabalin - 75mg 75mg Capsule 598,010 L.L
B01AC06 NU-SEALS G Acetylsalicylic acid - 75mg 75mg Tablet, enteric coated 403,153 L.L
N02BF02 GABRIKA 75 G Pregabalin - 75mg 75mg Capsule 793,507 L.L
N02BF02 GALICA 75 G Pregabalin - 75mg 75mg Capsule 338,648 L.L
N02BF02 NERVAX G Pregabalin - 75mg 75mg Capsule 513,348 L.L
N02BF02 NEUREXAL G Pregabalin - 75mg 75mg Capsule 335,577 L.L
N02BF02 NEUREXAL G Pregabalin - 75mg 75mg Capsule 637,365 L.L
N02BF02 PLENICA G Pregabalin - 75mg 75mg Capsule 697,454 L.L
N02BF02 PMS-PREGABALIN G Pregabalin - 75mg 75mg Capsule 1,776,560 L.L
N02BF02 PREGABADOR G Pregabalin - 75mg 75mg Capsule, hard 364,181 L.L
N02BF02 PREGAFORTE 75 G Pregabalin - 75mg 75mg Capsule 793,507 L.L
N02BF02 PREGASTAR G Pregabalin - 75mg 75mg Capsule, hard 653,370 L.L
B01AE07 DAXATRAN G Dabigatran etexilate (mesilate) - 75mg 75mg Capsule, hard 2,576,338 L.L
N07CA02 CINARIN G Cinnarizine - 75mg 75mg Capsule 490,183 L.L
N07CA02 CINNARIZINE G Cinnarizine - 75mg 75mg Capsule 386,515 L.L
R05CB06 MUCOSOLVAN LA B Ambroxol HCl - 75mg 75mg Capsule 345,368 L.L
R05CB06 SOLVAMUC SR G Ambroxol - 75mg 75mg Capsule 276,448 L.L
J05AH02 TAMIFLU B Oseltamivir (phosphate) - 75mg 75mg Capsule 1,464,788 L.L
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