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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
R05CA12 JOS-PAN G Dried Ivy leaf extract (Hederacoside C) - 75mg/100ml Syrup 306,396 L.L
A10BD08 GALVUS MET B Metformin HCl - 850mg, Vildagliptin - 50mg Tablet, film coated 1,816,875 L.L
B05BB02 HI-SODIUM WITHOUT POTASSIUM INJECTION G Sodium dihydrogenophosphate - 0.137g/100ml, Sodium lactate (anhydre) - 0.223g/100ml, Sodium chloride - 0.175g/100ml, Dextrose monohydrate - 5g/100ml Injectable solution 166,708 L.L
A10BD08 GLUNORM M G Metformin HCl - 850mg, Vildagliptin - 50mg Tablet, film coated 1,089,856 L.L
B05BB02 HI-SODIUM INJECTION G Sodium lactate - 0.223g%, Sodium dihydrogenophosphate - 0.137g%, Potassium chloride - 0.149g%, Sodium chloride - 0.175g%, Dextrose, H2O - 5.0g% Injectable solution 176,024 L.L
A10BD08 VILDIAB M 50/850 G Metformin HCl - 850mg, Vildagliptin - 50mg Tablet, film coated 1,029,383 L.L
B05BB02 HI-SODIUM INJECTION WITH POTASSIUM G Potassium chloride - 0.149g/100ml, Sodium dihydrogenophosphate - 0.137g/100ml, Sodium lactate (anhydre) - 0.223g/100ml, Sodium chloride - 0.175g/100ml, Dextrose monohydrate - 5g/100ml Injectable solution 165,727 L.L
G03FB01 PROGYLUTON B Norgestrel - 0.5mg (tablet 2), Estradiol valerate - 2mg (tablet 1, tablet 2) Tablet 193,513 L.L
R05CA12 HEDECTON COUGH G Ivy leaf soft extract - 40mg/5ml Syrup 467,657 L.L
A10BD08 VLUDIN MET G Metformin HCl - 850mg, Vildagliptin - 50mg Tablet, film coated 735,914 L.L
B05BB02 LO-SODIUM INJECTION G Sodium lactate - 0.223g/100ml, Sodium dihydrogenophosphate - 0.137g/100ml, Potassium chloride - 0.149g/100ml, Sodium chloride - 0.0585g/100ml, Dextrose, H2O - 5.0g/100ml Injectable solution 179,456 L.L
N07BC51 SUBOXONE G Buprenorphine HCl - 2mg, Naloxone HCl - 0.5mg Tablet, sublingual 1,473,590 L.L
A10BD09 INCRESYNC B Pioglitazone - 15mg, Alogliptin - 25mg Tablet, film coated 3,897,143 L.L
B05BB02 LO-SODIUM WITH POTASSIUM INJECTION G Potassium chloride - 0.149g/100ml, Sodium dihydrogenophosphate - 0.137g/100ml, Sodium lactate - 0.223g/100ml, Sodium chloride - 0.0585g/100ml, Dextrose monohydrate - 5g/100ml Injectable solution 165,727 L.L
N07BC51 SUBOXONE G Buprenorphine HCl - 8mg, Naloxone HCl - 2mg Tablet, sublingual 7,382,584 L.L
A10BD09 INCRESYNC B Pioglitazone - 30mg, Alogliptin - 25mg Tablet, film coated 3,897,143 L.L
B05BB02 ELECTROLYE 67 G Calcium gluconate - 0.10g/100ml, Potassium chloride - 0.075g/100ml, Sodium chloride - 0.30g/100ml, Dextrose, H2O - 5.0g/100ml Injectable solution 165,727 L.L
N07BC51 SUBOXONE G Buprenorphine HCl - 16mg, Naloxone HCl - 4mg Tablet, sublingual 14,284,125 L.L
A10BD11 JENTADUETO B Metformin - 1000mg, Linagliptin - 2.5mg Tablet, film coated 3,542,369 L.L
B05BB02 DEXTROSE 5% IN LACTATED RINGER'S G Sodium lactate - 0.31g/100ml, Calcium chloride 2H2O - 0.02g/100ml, Potassium chloride - 0.03g/100ml, Sodium chloride - 0.598g/100ml, Dextrose, H2O - 5g/100ml Injectable solution 207,404 L.L
A10BD11 INAGLIMET G Metformin - 1000mg, Linagliptin - 2.5mg Tablet, film coated 1,670,844 L.L
B05BB02 DEXTROSE 5% & SODIUM CHLORIDE 0.2% G Sodium chloride - 0.2g/100ml, Dextrose, H2O - 5g/100ml Injectable solution 194,165 L.L
A10BD11 JENTADUETO B Metformin - 850mg, Linagliptin - 2.5mg Tablet, film coated 3,542,369 L.L
B05BB02 DEXTROSE 5% & SODIUM CHLORIDE 0.2% G Sodium chloride - 0.2g/100ml, Dextrose, H2O - 5g/100ml Injectable solution 220,643 L.L
J01DH51 CELLABAXIN G Imipenem (monohydrate) - 500mg, Cilastatin (sodium) - 500mg Injectable solution 10,699,559 L.L
N02BG09 PENTHROX INHALER B Methoxyflurane - Inhalation 21,080,096 L.L
A10BD11 INAGLIMET G Metformin - 850mg, Linagliptin - 2.5mg Tablet, film coated 1,670,844 L.L
B05BB02 DEXTROSE 5% & SODIUM CHLORIDE 0.3% G Sodium chloride - 0.3g/100ml, Dextrose, H2O - 5g/100ml Injectable solution 188,772 L.L
J01DH51 CILANEM G Imipenem anhydrous - 500mg, Cilastatin (sodium) - 500mg Injectable solution 850,652 L.L
A10BD13 VIPDOMET B Metformin HCl - 500mg, Alogliptin benzoate - 12.5mg Tablet, film coated 3,112,339 L.L
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