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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
B01AD11 METALYSE BioTech Tenecteplase - 10,000IU 10,000IU Injectable powder for solution+diluent 77,815,572 L.L
G03GA02 MENO-CLAIR HP-HMG BioHuman Human Menopausal Gonadotrophin, Highly purified - 75IU 75IU Injectable powder for solution + solution 1,045,509 L.L
G03GA02 MENOPUR BioHuman Menotropin - 75IU 75IU Injectable concentrated powder for solution+diluent 16,864,077 L.L
G03GA02 MERIONAL HG BioHuman Menotropin - 75IU 75IU Injectable powder + solvent 24,771,315 L.L
G03GA02 MENOPUR BioHuman Menotropin - 1,200IU 1,200IU Injectable powder for solution+diluent 27,815,659 L.L
G03GA02 MENOPUR BioHuman Menotropin - 600IU 600IU Injectable powder for solution+diluent 13,907,829 L.L
G03GA02 MENO-CLAIR HP-HMG BioHuman Human Menopausal Gonadotrophin, Highly purified - 150IU 150IU Injectable powder for solution + solution 2,005,013 L.L
G03GA02 MERIONAL HG BioHuman Menotropin - 150IU 150IU Injectable powder + solvent 41,777,992 L.L
G03GA02 MERIONAL HG BioHuman Menotropin - 900IU 900IU Injectable powder + solvent 25,830,983 L.L
A02AF02 MAALOX PLUS B Dimethicone - 25mg, Aluminium hydroxide - 200mg, Magnesium hydroxide - 200mg Tablet, chewable 166,636 L.L
A06AD65 MOVICOL B Potassium chloride - 0.0466g, Sodium chloride - 0.3507g, Sodium bicarbonate - 0.1785g, Macrogol 3350 - 13.125g Powder for solution 853,340 L.L
A06AD65 MOVICOL PEDIATRIC PLAIN B Potassium chloride - 23.3mg, Sodium chloride - 175.4mg, Sodium bicarbonate - 89.3mg, Macrogol 3350 - 6.563g Powder for solution 624,887 L.L
G04BD06 MICTONORM B Propiverine HCl - 15mg 15mg Tablet, coated 1,261,868 L.L
A02AF02 MAALOX PLUS B Simethicone - 25mg/5ml, Aluminium hydroxide - 175mg/5ml, Magnesium hydroxide - 200mg/5ml Suspension 438,093 L.L
G04BD06 MICTONORM XL B Propiverine HCl - 30mg 30mg Capsule, modified release 1,648,895 L.L
G04BD06 MICTONORM XL B Propiverine HCl - 45mg 45mg Capsule, modified release 1,877,348 L.L
G04BD06 MICTONORM B Propiverine HCl - 5mg 5mg Tablet, coated 1,917,663 L.L
N06AA21 MEFIDIOMIL B Maprotiline - 25mg 25mg Tablet, sugar coated 909,973 L.L
N02AA01 MST CONTINUS B Morphine sulfate - 10mg 10mg Tablet, film coated, prolonged release 972,942 L.L
N06AA21 MEFIDIOMIL B Maprotiline - 75mg 75mg Tablet, sugar coated 958,608 L.L
N02AA01 MST CONTINUS B Morphine sulfate - 30mg 30mg Tablet, film coated, prolonged release 2,289,908 L.L
N02AA01 MST CONTINUS B Morphine sulfate - 60mg 60mg Tablet, film coated, prolonged release 3,839,358 L.L
A10BX16 MOUNJARO KWIKPEN B Tirzepatide - 2.5mg/dose 2.5mg/dose Injectable solution 39,601,065 L.L
A10BX16 MOUNJARO KWIKPEN B Tirzepatide - 5mg/dose 5mg/dose Injectable solution 39,601,065 L.L
J07AH08 MENACTRA MENINGOCOCCAL POLYSACCHARIDE DIPHTERIA TOXOID CONJUGATE VACCINE B Meningococcal Polysaccharides (serogroups A, C, Y and W-135) - 4mcg/0.5ml each, Diphteria Toxoid Protein - 48mcg/0.5ml Injectable solution 6,144,048 L.L
A10BX16 MOUNJARO KWIKPEN B Tirzepatide - 7.5mg/dose 7.5mg/dose Injectable solution 39,601,065 L.L
A10BX16 MOUNJARO KWIKPEN B Tirzepatide - 10mg/dose 10mg/dose Injectable solution 39,601,065 L.L
A10BX16 MOUNJARO KWIKPEN B Tirzepatide - 12.5mg/dose 12.5mg/dose Injectable solution 39,601,065 L.L
A10BX16 MOUNJARO KWIKPEN B Tirzepatide - 15mg/dose 15mg/dose Injectable solution 39,601,065 L.L
C03EA01 MODURETIC B Hydrochlorothiazide - 50mg, Amiloride HCl - 5mg Tablet 798,398 L.L
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