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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
J01EE01 CO-TRIMOXAZOLE G Trimethoprim - 160mg, Sulfamethoxazole - 800mg Tablet 7,529,090 L.L
L04AX07 MAROVAREX G Dimethyl Fumarate - 240mg Capsule, hard, gastro-resistant 60,848,734 L.L
S02CA06 AURICULARUM G Dexamethasone (sodium phosphate) - 10mg, Nystatin - 1,000,000IU, Oxytetracycline HCl - 90,000IU, Polymyxin B sulfate - 100,000IU Powder for suspension + solvent 755,239 L.L
A06AA01 HUILE DE PARAFFINE G Liquid paraffin - Liquid 207,336 L.L
A10BD19 GLYXAMBI B Linagliptin - 5mg, Empagliflozin - 10mg Tablet, film coated 4,482,387 L.L
J01EE01 CO-TRIMOXAZOLE G Trimethoprim - 160mg, Sulfamethoxazole - 800mg Tablet 183,019 L.L
L01XK52 AKEEGA B Niraparib - 100mg, Abiraterone acetate - 500mg Tablet, film coated 519,366,124 L.L
S02CA07 PAROTICIN G Fludrocortisone acetate - 1mg/ml, Polymyxin B (sulfate) - 10.000IU/ml, Lidocaine - 50mg/ml Drops solution 319,835 L.L
A10BD19 EMPAGLINE G Empagliflozin - 10mg, Linagliptin - 5mg Tablet, film coated 2,237,050 L.L
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R05CB10 DILAMUC G Dried Ivy leaf extract - 170mg/100ml, Glycyrrhizic acid (Glycyrrhiza Glabra, Liquorice root) - 164mg/100ml, Thyme - 760mg/100ml Syrup 456,906 L.L
A10BD19 GLYXAMBI B Linagliptin - 5mg, Empagliflozin - 25mg Tablet, film coated 4,482,387 L.L
S02DA01 OTIPAX B Lidocaine HCl - 1g/100g, Phenazone - 4g/100g Drops 236,516 L.L
A10BD19 GLYXAMBI B Linagliptin - 5mg, Empagliflozin - 25mg Tablet, film coated 4,482,387 L.L
D06BB53 ACTI-VIR H G Aciclovir - 5%, Hydrocortisone acetate - 1% Cream 833,182 L.L
R05D 123 COLD AND FLU B Phenylephrine HCl - 5mg, Carbinoxamine HCl - 3mg, Caffeine anhydrous - 30mg, Codeine phosphate - 8mg, Acetaminophen - 325mg Tablet 409,552 L.L
A06AB05 HUILE DE RICIN G Castor oil - Liquid 163,821 L.L
A10BD19 EMPAGLINE G Empagliflozin - 25mg, Linagliptin - 5mg Tablet, film coated 2,237,050 L.L
R05D DULSANA WITH CODEINE B Menthol - 0.25mg/5ml, Ammonium chloride - 100mg/5ml, Codeine phosphate - 10mg/5ml, Ephedrine HCl - 4mg/5ml, Carbinoxamine maleate - 2mg/5ml Syrup 273,888 L.L
A06AB07 COLON-X G Frangula Purshiana - 62.5mg, Plantago Afra - 100mg, Foeniculum Vulgare - 50mg, Zingiber Officinale - 50mg, Aniseed powder - 20mg, Glycyrrhiza Glabra - 12.5mg, Senna Alexandrina - 25mg Tablet, film coated 833,182 L.L
S03AA30 SULFACHLOR G Sulfacetamide sodium - 110mg/ml, Chloramphenicol - 5mg/ml Drops solution 202,216 L.L
A06AB58 PICOPREP B Magnesium oxide - 3.5g, Citric acid - 12g, Sodium picosulfate - 10mg Powder 694,767 L.L
C01EX CARDIOVITEX G Coenzyme Q10 - 300mg, Magnesium oxide - 100mg Tablet 2,822,069 L.L
C09BA01 CAPTACE PLUS G Hydrochlorothiazide - 25mg, Captopril - 50mg Tablet, scored 1,028,487 L.L
G03GA30 PERGOVERIS BioHuman Follitropin alfa - 150IU, Lutropin Alfa - 75IU Injectable powder for solution+diluent 6,523,011 L.L
R05DA20 ALGOMIEL COUGH SYRUP G Dextromethorphan HBr - 5mg, Carbinoxamine maleate - 2mg Syrup 639,925 L.L
S03CA04 MYCICORT G Hydrocortisone acetate - 5mg, Neomycin sulfate - 5mg Drops suspension 166,381 L.L
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