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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
A06AX01 SUPPOSITOIRE GLYCERINE ENFANT G Glycerol Stearate USP - Suppository 179,179 L.L
C09BB04 PRESORYL PLUS G Perindopril arginine - 5mg, Amlodipine (besylate) - 5mg Tablet 557,695 L.L
J05AR18 GENVOYA B Emtricitabine - 200mg, Tenofovir alafenamide - 10mg, Elvitegravir - 150mg, Cobicistat - 150mg Tablet, film coated 77,789,650 L.L
R05X CODOPALM EXPECTORANT G Ipeca Tincture - 3mg, Promethazine HCl - 100mg, Potassium guaiacosulfonate - 0.9g Syrup 153,582 L.L
A06AX01 SUPPOSITOIRE GLYCERINE ADULTE G Glycerol Stearate USP - Suppository 179,179 L.L
C09BB04 COVERAM B Perindopril arginine - 10mg, Amlodipine - 5mg Tablet 1,116,733 L.L
J05AR20 BIKTARVY B Bictegravir - 50mg, Emtricitabine - 200mg, Tenofovir alafenamide - 25mg Tablet, film coated 76,569,138 L.L
R05X CODOPALM EXPECTORANT G Ipeca Tincture - 3mg, Promethazine HCl - 100mg, Potassium guaiacosulfonate - 0.9g Syrup 291,806 L.L
C09BB04 PRESORYL PLUS G Perindopril arginine - 10mg, Amlodipine (besylate) - 5mg Tablet 770,022 L.L
J05AR24 DELSTRIGO B Lamivudine - 300mg, Tenofovir disoproxil - 300mg, Doravirine - 100mg Tablet, film coated 48,879,793 L.L
R05X ACTISOUFRE B Sulfure de Sodium - 13mg, Saccharomyces Cerevisiae - 500mg Solution 740,457 L.L
C09BB04 COVERAM B Perindopril arginine - 10mg, Amlodipine - 10mg Tablet 1,116,733 L.L
J01CR02 AMOXICLAV-ORBUCELL G Amoxicillin - 1g, Clavulanic Acid (potassium) - 0.2g Injectable powder for solution 7,433,691 L.L
J05AR27 DOLUTEGRAVIR/LAMIVUDINE/TENOFOVIR DISOPROXIL FUMARATE G Lamivudine - 300mg, Tenofovir disoproxil fumarate - 300mg, Dolutegravir - 50mg Tablet 54,836,160 L.L
R05X FERVEX CHILDREN SUGAR FREE B Paracetamol - 280mg, Ascorbic acid - 100mg, Pheniramine maleate - 10mg Granules for solution 425,998 L.L
C09BB04 PRESORYL PLUS G Perindopril arginine - 10mg, Amlodipine (besylate) - 10mg Tablet 770,022 L.L
R05X FERVEX ADULTS SUGAR FREE B Paracetamol - 500mg, Ascorbic acid - 200mg, Pheniramine maleate - 25mg Granules for solution 425,998 L.L
C09BB06 ENEAS G Enalapril maleate - 10mg, Nitrendipine - 20mg Tablet 2,009,045 L.L
J01CR02 VAAMOX IV G Amoxicillin - 1g, Clavulanic Acid - 200mg Injectable powder 225,766 L.L
R05X FERVEX ADULTS RASPBERRY B Paracetamol - 500mg, Ascorbic acid - 200mg, Pheniramine maleate - 25mg Granules for solution 425,998 L.L
A02BC DANLOX QUICK G Omeprazole - 20mg, Sodium bicarbonate - 1680mg Powder 1,323,685 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 2.5mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
J01CR02 VAAMOX IV G Amoxicillin - 1g, Clavulanic Acid - 200mg Injectable powder 2,150,148 L.L
R05X FERVEX ADULTS B Paracetamol - 500mg, Ascorbic acid - 200mg, Pheniramine maleate - 25mg Granules for solution 425,998 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 5mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
R05X COLDIN-H G Paracetamol - 300mg, Mepyramine maleate - 15mg, Noscapine - 10mg Capsule 386,515 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 10mg, Amlodipine - 5mg Capsule, hard 1,358,625 L.L
C09BB07 RAMIPRIL/AMLODIPINE GENERICON G Ramipril - 10mg, Amlodipine - 10mg Capsule, hard 1,358,625 L.L
R06AA52 AMYDRAMINE G Diphenhydramine HCl - 13.5mg/5ml, Sodium citrate - 57mg/5ml, Ammonium chloride - 131.5mg/5ml, Menthol - 1mg/5ml Syrup, sugar free 133,040 L.L
C02LA51 ADELPHAN ESIDREX B Reserpine - 0.1mg, Hydrochlorothiazide - 10mg, Dihydralazine - 10mg Tablet 371,157 L.L
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