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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
J01CR02 AMOKLAVIN ES G Amoxicillin (trihydrate) - 600mg/5ml, Clavulanic Acid (potassium) - 42.9mg/5ml Powder for suspension 507,972 L.L
R06AA59 CARIBAN B Pyridoxine HCl - 10mg, Doxylamine succinate - 10mg Capsule, hard, modified release 1,701,305 L.L
D07CA01 MYCICORT G Neomycin sulfate - 5mg/g, Hydrocortisone acetate - 10mg/g Ointment 485,063 L.L
J01CR02 BETAMOX ES G Amoxicillin - 600mg/5ml, Clavulanic Acid - 42.9mg/5ml Powder for suspension 592,635 L.L
D07CB01 PANDERM G Triamcinolone acetonide - 1mg/g, Gramicidin - 0.25mg/g, Neomycin (sulfate) - 2.5mg/g, Nystatin - 100.000IU/g Cream 180,075 L.L
R06AB52 HISTAMED-F G Dexchlorpheniramine - 2mg/5ml, Dexamethasone - 0.25mg/5ml Syrup 712,876 L.L
D07CB01 POSITON G Triamcinolone acetonide - 100mg, Neomycin (sulfate) - 250mg, Nystatin - Cream 1,064,323 L.L
L02BB06 NUBEQA B Darolutamide - 300mg Tablet, film coated 470,558,010 L.L
R06AB52 HISTAMED-F G Dexchlorpheniramine maleate - 2mg, Dexamethasone - 0.25mg, Fluphenazine HCl - 0.25mg Tablet, coated 579,772 L.L
D07CC01 FUCICORT B Fusidic acid - 20mg/g, Betamethasone (valerate) - 1mg/g Cream 376,276 L.L
R06AB54 ALERGICAL EXPECTORANT B Chlorpheniramine maleate - 50mg/100ml, Guaifenesin - 2000mg/100ml, Dihydroxypropyltheophylline - 500mg/100ml, Paracetamol - 2000mg/100ml Syrup 485,127 L.L
D07CC01 FUCICORT B Fusidic acid - 20mg/g, Betamethasone (valerate) - 1mg/g Cream 501,253 L.L
R06AB54 DRAUDEX G Chlorphenamine maleate - 4mg, Phenylephrine - 5mg Tablet, sugar coated 166,381 L.L
D07CC01 BETAFUCIN G Fusidic acid - 20mg/g, Betamethasone valerate - 1mg/1g Cream 210,983 L.L
D07CC01 TOPIZONE G Fusidic acid - 20mg/g, Betamethasone (valerate) - 1mg/g Cream 216,359 L.L
D07CC01 ZETA-CORT G Fusidic acid - 20mg/g, Betamethasone (valerate) - 1mg/g Cream 244,579 L.L
V06DD KETOSTERIL B Calcium - 0.05g, Total nitrogen - 36mg, L-Tyrosine - 30mg, L-Histidine - 38mg, L-Tryptophan - 23mg, L-Threonine - 53mg, L-Lysine Monoacetate - 105mg, Alpha Hydroxyanalogue-DL-Methionine, Calcium Salt - 59mg, Alpha Ketoanalogue-Valine,Calcium Salt - 86mg, Alpha Ketoanalogue-Phenylalanine,Calcium Salt - 68mg, Alpha-Ketoanalogue- Leucine,Calcium Salt - 101mg, Alpha-Ketoanalogue-DL-isoleucine,Calcium Salt - 67mg Tablet, film coated 3,950,897 L.L
D07CC01 BETASONE-N G Neomycin (sulfate) - 3.5mg/g, Betamethasone (valerate) - 1mg/g Cream 398,033 L.L
M01AB55 DIFEN FLEX G Diclofenac sodium - 50mg, Pridinol mesylate - 4mg Tablet, film coated 575,165 L.L
V07AB01 ARWAN WFI G Water for injection - Water for injection, irrigation 399,915 L.L
D07CC02 GENTACORT-FC G Fluocinolone acetonide - 0.01%, Clotrimazole - 1%, Gentamicin (sulfate) - 0.1% Cream 302,365 L.L
M01AB55 DIFEN FLEX G Diclofenac sodium - 75mg, Pridinol mesylate - 2.2mg Injectable solution 1,131,515 L.L
V07AB01 EAU POUR PREPARATION INJ. G Water for injection - Water for injection, irrigation 3,385,139 L.L
D07XA01 DAKTACORT B Hydrocortisone - 10mg/g, Miconazole nitrate - 20mg/g Cream 208,296 L.L
M01AB55 DIFEN PLUS G Diclofenac potassium - 50mg, Betamethasone - 0.3mg Tablet, coated 503,941 L.L
V07AB01 EAU POUR PREPARATION INJECTABLE PROAMP G Water for injection - Water for injection, irrigation 1,240,367 L.L
D07XB05 ECOZONE G Dexamethazone sodium phosphate - 0.1%, Econazole nitrate - 1% Cream 364,757 L.L
M01AB55 DIFEN B12 G Diclofenac potassium - 50mg, Betamethasone - 0.3mg, Cyanocobalamin - 5mg Tablet 503,941 L.L
P03AX01 SPIDOGALE G Benzyl benzoate - 10g/100ml, Sulfur colloïdal - 5g/100ml Lotion 207,336 L.L
V07AB01 EAU POUR PREPARATION INJECTABLE PROAMP G Water for injection - Water for injection, irrigation 1,034,759 L.L
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