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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
D07AD01 DERMASONE G Clobetasol (propionate) - 0.05% 0.05% Cream 119,026 L.L
D07AD01 DERMOVATE B Clobetasol (propionate) - 0.5mg/g 0.05% w/w Ointment 290,270 L.L
D07AD01 DECLOBAN G Clobetasol (propionate) - 0.05% 0.05% Ointment 302,045 L.L
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D06AX DERMOTRACIN G Neomycin sulfate - 165.000IU/150ml, Bacitracin - 15.500IU/150ml Powder 737,770 L.L
D05AX52 DAIVOBET B Calcipotriol - 50mcg/g, Betamethasone - 0.5mg/g Gel 2,100,426 L.L
D04AX01 DOXIDERM G Doxepin (HCl) - 5% 5% Cream 1,037,958 L.L
D04AA32 DERMAMINE ITCH STOPPING G Diphenhydramine HCl - 1%, Zinc acetete - 0.1% Cream 560,382 L.L
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C07AG02 DILATREND B Carvedilol - 6.25mg 6.25mg Tablet, scored 364,181 L.L
C07AG02 DILATREND B Carvedilol - 25mg 25mg Tablet, scored 598,010 L.L
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C05CA03 DIOVENOR 600 B Diosmin - 600mg 600mg Tablet 544,256 L.L
C05CA03 DIOSMINE BIOGARAN CONSEIL G Diosmin - 600mg 600mg Tablet, coated 761,959 L.L
C05BX51 DOXIPROCT B Calcium dobesilate - 4%, Lidocaine HCl - 2% Ointment 610,104 L.L
C05BX51 DOXIPROCT PLUS B Calcium dobesilate - 4%, Dexamethasone acetate - 0.0025%, Lidocaine HCl - 2% Ointment 489,159 L.L
C05BX01 DOXIUM B Calcium dobesilate - 500mg 500mg Capsule 2,151,492 L.L
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C05AE03 DILTIGEL G Diltiazem HCl - 2% 2% Gel 632,950 L.L
C03CA01 DIURESAL G Furosemide - 40mg 40mg Tablet, scored 118,258 L.L
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C01CA04 DOPAMINE FRESENIUS G Dopamine HCl - 200mg/5ml 200mg/5ml Injectable concentrated solution 713,580 L.L
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