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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
L01FX29 TALVEY B Talquetamab - 2mg/ml 3mg/1.5ml Injectable solution 45,594,403 L.L
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D06AA04 TETRACYCLINE OINTMENT G Tetracycline HCl - 3% 3% Ointment 107,507 L.L
G04BD07 TOREDA G Tolterodine (tartrate) - 2mg 2mg Tablet, film coated 2,311,409 L.L
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R03DA04 THEOSOL ELIXIR G Théophylline - 25mg/5ml 25mg/5ml Elixir 312,283 L.L
N03AX11 TOPAMAX 25 B Topiramate - 25mg 25mg Tablet, film coated 858,715 L.L
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L01AX03 TEMOZOLOMIDE ACCORD G Temozolomide - 250mg 250mg Capsule, hard 13,397,927 L.L
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J01AA07 TETRAN G Tetracycline HCl - 250mg 250mg Capsule 168,940 L.L
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