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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
A03DB04 PANADOL WOMAN B Paracetamol - 500mg, Hyoscine butylbromide - 10mg Tablet, coated 436,749 L.L
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N02BE51 PANADOL NIGHT B Paracetamol - 500mg, Diphenhydramine HCl - 25mg 500mg Caplet 315,803 L.L
N02BE51 PANADOL SINUS B Paracetamol - 500mg, Pseudoephedrine HCl - 30mg Caplet 228,453 L.L
N02BE51 PANADOL COLD & FLU DAY B Paracetamol - 500mg, Caffeine - 25mg, Phenylephrine HCl - 5mg Caplet 284,895 L.L
N02BE51 PANADOL COLD & FLU ALL IN ONE B Paracetamol - 250mg, Guaifenesin - 100mg, Phenylephrine HCl - 5mg Tablet, film coated 342,680 L.L
N02BE51 PANADOL COLD & FLU VAPOUR RELEASE + DECONGESTANT B Paracetamol - 600mg, Phenylephrine HCl - 10mg Powder for solution 524,099 L.L
N02BE51 PANADOL EXTRA WITH OPTIZORB B Paracetamol - 500mg, Caffeine - 65mg Tablet, film coated 524,099 L.L
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L04AD02 PROGRAF 1MG B Tacrolimus - 1mg 1mg Capsule 25,241,922 L.L
L04AD02 PROGRAF 1MG B Tacrolimus - 1mg 1mg Capsule 25,241,922 L.L
L04AD02 PROGRAF 5MG B Tacrolimus - 5mg 5mg Capsule 94,286,686 L.L
L04AD02 PROGRAF 5MG B Tacrolimus - 5mg 5mg Capsule 94,286,686 L.L
N02BE51 PANADOL MIGRAINE B Paracetamol - 250mg, Acetylsalicylic acid - 250mg, Caffeine - 65mg Caplet 604,729 L.L
B01AC04 PLAVIX B Clopidogrel (hydrogenosulfate) - 75mg 75mg Tablet, film coated 1,350,562 L.L
L04AD02 PROGRAF 0.5 MG B Tacrolimus - 0.5mg 0.5mg Capsule 13,942,481 L.L
B01AC04 PLAVIX B Clopidogrel (hydrogenosulfate) - 75mg 75mg Tablet, film coated 1,350,562 L.L
G03BB01 PROVIRON B Mesterolone - 25mg 25mg Tablet 391,058 L.L
L04AD02 PROGRAF 0.5 MG B Tacrolimus - 0.5mg 0.5mg Capsule 13,942,481 L.L
N02BE51 PANADOL COLD AND FLU B Paracetamol - 500mg, Pseudoephedrine HCl - 30mg, Chlorpheniramine maleate - 2mg Tablet 278,175 L.L
G03DA03 PROLUTON DEPOT B Hydroxyprogesterone caproate - 250mg/ml 250mg/ml Injectable solution 270,112 L.L
G03DA04 PROGESTOGEL B Progesterone - 1% 1% Gel 542,912 L.L
G03DA04 PROGESTOGEL B Progesterone - 1% 1% Gel 542,912 L.L
S01GX09 PATANOL B Olopatadine (HCl) - 0.1% 0.1% Drops solution 873,498 L.L
R05CA12 PROSPAN ACUTE EFFERVESCENT COUGH TABLETS B Dried Ivy leaf extract - 65mg Tablet, effervescent 479,752 L.L
R05CA12 PROSPAN COUGH LIQUID B Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Liquid 353,431 L.L
R05CA12 PROSPAN COUGH SYRUP B Dried Ivy leaf extract - 35mg/5ml 35mg/5ml Solution 353,431 L.L
G03DA04 PROLUTEX B Progesterone - 25mg 25mg Injectable solution 5,570,227 L.L
G03DC02 PRIMOLUT NOR B Norethisterone acetate - 5mg 5mg Tablet 296,989 L.L
G03FB01 PROGYLUTON B Norgestrel - 0.5mg (tablet 2), Estradiol valerate - 2mg (tablet 1, tablet 2) Tablet 193,513 L.L
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