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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
L01BA04 ALIMTA B Pemetrexed (disodium) - 100mg 100mg Injectable concentrated powder for solution 16,854,009 L.L
S01GX07 ALLERGODIL B Azelastine HCl - 0.5mg/ml 0.5mg/ml Drops solution 709,549 L.L
R01AC03 ALLERGODIL NASAL B Azelastine HCl - 0.14mg/dose 0.14mg/dose Spray, solution 657,139 L.L
M04AA01 ALLOPURINOL BIOGARAN G Allopurinol - 100mg 100mg Tablet 107,507 L.L
M04AA01 ALLOPURINOL BIOGARAN G Allopurinol - 300mg 300mg Tablet 212,327 L.L
M04AA01 ALLOPURINOL BIOGARAN G Allopurinol - 200mg 200mg Tablet 169,324 L.L
D11AX18 ALMIRAL G Diclofenac sodium - 1% w/w 1% w/w Gel 396,434 L.L
M01AB05 ALMIRAL G Diclofenac sodium - 75mg/3ml 75mg/3ml Injectable solution 415,247 L.L
N02CC05 ALMOVITAE G Almotriptan - 12.5mg 12.5mg Tablet, film coated 1,148,985 L.L
D11AX01 ALOPEXY G Minoxidil - 20mg/ml 2% Solution 532,162 L.L
D11AX01 ALOPEXY G Minoxidil - 2% 2% Solution 532,162 L.L
D11AX01 ALOPEXY G Minoxidil - 50mg/ml 5% Solution 896,343 L.L
D11AX01 ALOPEXY G Minoxidil - 5% 5% Solution 896,343 L.L
A04AA05 ALOXI B Palonosetron HCl - 0.25mg/5ml 0.25mg/5ml Injectable solution 3,656,595 L.L
B03XA01 ALPEEN BioTech Erythropoietin recombinant human (Epoetin alfa) - 10,000IU 10000IU Injectable solution 4,036,903 L.L
B03XA01 ALPEEN BioTech Erythropoietin recombinant human (Epoetin alfa) - 10,000IU 10,000IU Injectable solution 10,661,285 L.L
B03XA01 ALPEEN BioTech Erythropoietin recombinant human (Epoetin alfa) - 4000IU 4000IU Injectable solution 8,728,144 L.L
B03XA01 ALPEEN BioTech Erythropoietin recombinant human (Epoetin alfa) - 4000IU 4000IU Injectable solution 1,127,036 L.L
B03XA01 ALPEEN BioTech Erythropoietin recombinant human (Epoetin alfa) - 4000IU 4000IU Injectable solution 4,748,244 L.L
B03XA01 ALPEEN BioTech Erythropoietin recombinant human (Epoetin alfa) - 40,000IU 40,000IU Injectable solution 11,210,836 L.L
S01EA05 ALPHAGAN P B Brimonidine tartrate - 1.5mg/ml 0.15% Drops solution 999,819 L.L
S01EA05 ALPHAGAN P B Brimonidine tartrate - 1.5mg/ml 0.15% Drops solution 999,819 L.L
S01EA05 ALPHAGAN P B Brimonidine tartrate - 0.1% 0.15% Drops solution 999,819 L.L
S01EA05 ALPHANOVA G Brimonidine tartrate - 0.15% 0.15% Drops solution 599,354 L.L
N05BA12 ALPRAZOLAM BIOGARAN G Alprazolam - 0.5mg 0.5mg Tablet, scored 169,324 L.L
N05BA12 ALPRAZOLAM BIOGARAN G Alprazolam - 0.25mg 0.25mg Tablet, scored 115,570 L.L
N05BA12 ALPROX G Alprazolam - 0.5mg 0.5mg Tablet 383,955 L.L
N05BA12 ALPROX G Alprazolam - 1mg 1mg Tablet 895,895 L.L
L04AB01 ALTEBREL BioTech Etanercept - 50mg/1ml 50mg/1ml Injectable solution 14,833,767 L.L
L04AB01 ALTEBREL BioTech Etanercept - 25mg/0.5ml 25mg/0.5ml Injectable solution 27,383,989 L.L
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