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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
N06AX16 VENLAX XR 75 G Venlafaxine HCl - 75mg 75mg Capsule, extended release 895,895 L.L
J01XA01 VANCOTEN G Vancomycin (HCl) - 500mg 500mg Injectable powder for solution 537,537 L.L
N06AX16 VENLAX XR 75 G Venlafaxine HCl - 75mg 75mg Capsule, extended release 1,343,843 L.L
A11GA01 VITAMIN C S.A.L.F. G Ascorbic acid (vit C) - 500mg/5ml 500mg/5ml Injectable solution 498,566 L.L
J01XA01 VOXIN G Vancomycin (HCl) - 500mg 500mg Injectable powder for solution 546,944 L.L
J01XA01 VANCO MEDIS G Vancomycin - 1g 1g Injectable lyophilisate for solution 1,276,650 L.L
N06AX16 VENLAFAXINE ARROW GENERIQUES LP G Venlafaxine - 150mg 150mg Tablet, prolonged release 987,724 L.L
N06AX16 VENLAX XR 150 G Venlafaxine HCl - 150mg 150mg Capsule, extended release 944,529 L.L
N06AX16 VENLAX XR 150 G Venlafaxine HCl - 150mg 150mg Capsule, extended release 1,416,794 L.L
N06AX16 VENLAFAXINE BIOGARAN LP G Venlafaxine HCl - 37.5mg 37.5mg Capsule, prolonged release 538,881 L.L
N06AX16 VENLAX XR 37.5 G Venlafaxine - 37.5mg 37.5mg Capsule, extended release 383,955 L.L
N06AX16 VENLAX XR 37.5 G Venlafaxine - 37.5mg 37.5mg Capsule, extended release 575,933 L.L
A12AX VITAQPLUS G Vitamin K2 - 0.05mg, Colecalciferol - 400IU, Calcium - 300mg Tablet 2,500,891 L.L
S01AE07 VIGAMOX G Moxifloxacin (HCl) - 5mg/ml 5mg/ml Drops solution 670,577 L.L
J01DD04 VERACOL G Ceftriaxone (sodium) - 1g 1g Injectable lyophilised powder for solution+diluent 454,219 L.L
M02AA15 VOLDIC G Diclofenac sodium (diethylamine) - 10mg/g 1% Emulgel 172,012 L.L
N05AH03 VAINCOR G Olanzapine - 5mg 5mg Tablet, coated, scored 806,306 L.L
C09DB01 VIOSTAN AM 160/5 G Amlodipine besylate - 5mg, Valsartan - 160mg Tablet, film coated 1,177,206 L.L
A03FA01 VOMICARE INJECTION BP IM/IV G Metoclopramide - 10mg/2ml 10mg/2ml Injectable solution 247,267 L.L
C09DB01 VIOSTAN AM 160/10 G Amlodipine besylate - 10mg, Valsartan - 160mg Tablet, film coated 1,177,206 L.L
N05AH03 VAINCOR G Olanzapine - 10mg 10mg Tablet, coated, scored 1,209,458 L.L
D02AC VASELINE PURE G Vaseline pure - 20g 20g Ointment 103,668 L.L
D02AC VASIDEX G Vaseline pure - 15g 15g Ointment 78,071 L.L
D02AF VERRUFILM G Lactic acid - 16.7%, Salicylic acid - 16.7% Solution 861,403 L.L
J02AC03 VORICONAZOLE STRAGEN G Voriconazole - 50mg 50mg Tablet, coated 15,808,184 L.L
J02AC03 VIROZOLE 200 G Voriconazole - 200mg 200mg Tablet, film coated 47,909,207 L.L
J02AC03 VORICONAZOLE STRAGEN G Voriconazole - 200mg 200mg Tablet, coated 41,794,841 L.L
J02AC03 VORICONAZOLE STRAGEN G Voriconazole - 200mg 200mg Injectable powder for solution 5,841,683 L.L
G03CA03 VAGIFEM G Estradiol (hemihydrate) - 10mcg 10mcg Tablet 2,254,968 L.L
C09DX01 VIOSTAN AM PLUS 160/5/25 G Valsartan - 160mg, Amlodipine - 5mg, Hydrochlorothiazide - 25mg Tablet, film coated 1,196,020 L.L
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