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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
G04BX ROWATINEX B Olive oil - 33mg, Cineol - 3mg, Fenchone - 4mg, Anethol - 4mg, Borneol - 10mg, Camphene - 15mg, ?-Pinene - 6.2mg, ?-Pinene - 24.8mg Capsule 255,330 L.L
J01DC02 ZINNAT B Cefuroxime (axetil) - 250mg/5ml 250mg/5ml Granules for suspension 1,120,782 L.L
J07BF03 POLIOMYELITIS VACCINE INACTIVATED B Poliomyelitis virus type 1 inactivated - 40D.U, Poliomyelitis virus type 2 inactivated - 8D.U, Poliomyelitis virus type 3 inactivated - 32D.U Injectable suspension 1,206,771 L.L
N02AJ13 ZALDIAR B Paracetamol - 325mg, Tramadol - 37.5mg Tablet, film coated 404,497 L.L
R02A MAXILASE MAUX DE GORGE B Alpha-Amylase - 200U.CEIP/ml 200U.CEIP/ml Syrup 342,680 L.L
A02BC05 NEXIUM B Esomeprazole (magnesium trihydrate) - 20mg 20mg Tablet, gastroresistant 1,005,194 L.L
C05CA54 GINKOR FORT B Heptaminol HCl - 0.300g, Troxerutine - 0.300g, Ginkgo biloba extract - 0.014g Capsule 681,328 L.L
G04BX14 PRILIGY B Dapoxetine (hydrochloride) - 30mg 30mg Tablet, film coated 1,957,979 L.L
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C05CX TANAKAN B Ginkgo biloba - 40mg 40mg Tablet, film coated 661,171 L.L
J07BH01 ROTATEQ ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT B Rotavirus G1, live attenuated - ?2.2x106 IU, Rotavirus G2, live attenuated - ?2.8x106 IU, Rotavirus G3, live attenuated - ?2.2x106 IU, Rotavirus G4, live attenuated - ?2.0x106 IU, Rotavirus P1, live attenuated - ?2.3x106 IU Suspension 4,508,592 L.L
R06AX22 EBASTEL B Ebastine - 10mg 10mg Tablet, film coated 722,987 L.L
C05CX TANAKAN B Ginkgo biloba - 40mg 40mg Tablet, film coated 1,662,333 L.L
J07BH01 ROTARIX ORAL B Rota virus human RIX4414, live attenuated - ?106 CCID50 Suspension 5,167,074 L.L
L01EH01 TYKERB B Lapatinib ditosylate - 250mg 250mg Tablet, film coated 101,971,611 L.L
L03AX16 MOZOBIL B Plerixafor - 20mg/ml 20mg/ml Injectable solution 413,801,327 L.L
B03AD03 GYNO-TARDYFERON B Folic acid - 0.35mg, Ferrous (sulfate) - 80mg Tablet, sugar coated, slow release 819,744 L.L
C09CA08 OLMETEC B Olmesartan medoxomil - 10mg 10mg Tablet, film coated 710,893 L.L
L01EJ01 JAKAVI B Ruxolitinib - 5mg 5mg Tablet 172,845,338 L.L
M01AE03 PROFEMIGR B Ketoprofen - 150mg 150mg Tablet, scored 302,365 L.L
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N03AX18 VIMPAT B Lacosamide - 50mg 50mg Tablet, film coated 1,024,008 L.L
L01DB01 CAELYX B Doxorubicin HCl pegylated liposomes - 20mg/10ml 20mg/10ml Injectable concentrated solution L.L
C09CA08 VOTUM B Olmesartan medoxomil - 10mg 10mg Tablet, film coated 753,896 L.L
G04BX14 PRILIGY B Dapoxetine (hydrochloride) - 60mg 60mg Tablet, film coated 1,957,979 L.L
M01AE03 PROFENID B Ketoprofen - 100mg 100mg Tablet, film coated 469,001 L.L
N02AX02 TRAMAL B Tramadol HCl - 50mg 50mg Capsule 349,399 L.L
B03AD04 MALTOFER B Iron trivalent (hydroxide polymaltose) - 10mg/ml 50mg/5ml Syrup 589,947 L.L
C05CX REPARIL B Aescine - 20mg 20mg Tablet, sugar coated 510,660 L.L
C09CA08 VOTUM B Olmesartan medoxomil - 10mg 10mg Tablet, film coated 753,896 L.L
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