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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
R06AX DESLOCORT G Desloratadine - 1mg/ml, Betamethasone - 0.05mg/ml Syrup 673,201 L.L
R06AX27 DAREQ G Desloratadine - 5mg 5mg Tablet, film coated 258,018 L.L
R06AX27 DELINE G Desloratadine - 5mg 5mg Tablet 430,030 L.L
R06AX27 DELINE G Desloratadine - 5mg 5mg Tablet 149,742 L.L
R06AX27 DELINE-MED G Desloratadine - 5mg 5mg Tablet 566,974 L.L
R06AX27 DESLOR MEDIS G Desloratadine - 5mg 5mg Tablet, film coated 396,434 L.L
R06AX DELINE CORT G Desloratadine - 5mg/5ml, Betamethasone - 0.25mg/5ml Syrup 693,679 L.L
H02AB02 DEXAMETHASONE SODIUM PHOSPHATE USP - EIPICO G Dexamethasone (sodium phosphate) - 8mg/2ml 8mg/2ml Injectable solution 185,450 L.L
H02AB02 DECADRON B Dexamethasone - 0.5mg 0.5mg Tablet, scored 393,218 L.L
H02AB02 DECADRON B Dexamethasone - 0.5mg/5ml 0.5mg/5ml Elixir 449,227 L.L
H02AB02 DEXAMETHASONE G Dexamethasone - 0.5mg/5ml 0.5mg/5ml Elixir 119,026 L.L
S01CA01 DEXATOBRIN G Dexamethasone - 1mg/ml, Tobramycin - 3mg/ml Drops suspension 239,204 L.L
H02AB02 DEXAMETHASON-PANPHARMA G Dexamethasone - 5mg/1ml 5mg/1ml Injectable solution 368,213 L.L
H02AB02 DEXAMED G Dexamethasone - 8mg/2ml 8mg/2ml Injectable solution 3,547,744 L.L
H02AB02 DEXAMED G Dexamethasone - 8mg/2ml 8mg/2ml Injectable solution 486,471 L.L
S01BA01 DEXAFREE G Dexamethasone Phosphate - 1mg/ml 1mg/ml Drops solution 563,070 L.L
S01BA01 DEXAFREE G Dexamethasone Phosphate - 1mg/ml 1mg/ml Drops solution 563,070 L.L
H02AB02 DEXAMETHASONE MEDIS G Dexamethasone Phosphate - 4mg/1ml 4mg/1ml Injectable solution 1,154,361 L.L
H02AB02 DEXAMEDIS FORT G Dexamethasone Phosphate - 8mg/2ml 8mg/2ml Injectable solution 43,003 L.L
H02AB02 DEXASINA G Dexamethasone Phosphate - 8mg/2ml 8mg/2ml Injectable solution 3,471,145 L.L
M01AE17 DEXKEVITAE G Dexketoprofen (trometamol) - 25mg 25mg Tablet, film coated 486,471 L.L
M01AE17 DEXON G Dexketoprofen - 25mg 25mg Tablet, film coated 239,204 L.L
M01AE17 DEXIREN G Dexketoprofen - 50mg/2ml 50mg/2ml Injectable solution 467,657 L.L
A02BC06 DEXILANT B Dexlansoprazole - 30mg 30mg Capsule, delayed release 1,595,141 L.L
A02BC06 DEXILANT B Dexlansoprazole - 60mg 60mg Capsule, delayed release 2,375,914 L.L
N05CM18 DEXMEDETOMIDINE EVER PHARMA G Dexmedetomidine HCl - 200mcg/2ml 200mcg/2ml Injectable concentrate for solution 9,340,433 L.L
N05CM18 DEXMEDETOMIDINE EVER PHARMA G Dexmedetomidine HCl - 400mcg/4ml 400mcg/4ml Injectable concentrate for solution 15,543,897 L.L
A02BC07 DEXPURE B Dexrabeprazole sodium - 10mg 10mg Tablet, enteric coated 517,379 L.L
R05DA09 DIACOL G Dextromethorphan HBr - 27mg/15ml 27mg/15ml Syrup 517,379 L.L
B05CX01 DEXTROSE G Dextrose, H2O - 10g/100ml 10g/100ml Injectable solution 170,630 L.L
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