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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
J01CR05 PIPERACILINA/TAZOBACTAM SALA G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 913,813 L.L
J01CR05 PIPERACILLIN/TAZOBACTAM PANPHARMA G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 7,461,939 L.L
J01CR05 PIPERACILLIN/TAZOBACTAM SANDOZ G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 913,813 L.L
J01CR05 PIPERACILLIN/TAZOBACTAM STRAGEN G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 897,687 L.L
J01CR05 PIPERACILLIN/TAZOBACTAM STRAGEN G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 7,820,986 L.L
J01CR05 PIPERACILLINE/ TAZOBACTAM ARROW G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 500mg Injectable powder for solution 7,378,682 L.L
J01CR05 PIPTAZ-ORBUCELL G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 1,087,873 L.L
J01CR05 PRIZMA G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 913,813 L.L
J01EE01 PAEDIATRIC CO-TRIMOXAZOLE MIXTURE G Trimethoprim - 40mg/5ml, Sulfamethoxazole - 200mg/5ml Suspension 190,698 L.L
J01MA12 PILOQ G Levofloxacin - 500mg/100ml 500mg/100ml Injectable solution 980,365 L.L
J01XD02 PROTOGYN G Tinidazole - 500mg 500mg Tablet, film coated 223,078 L.L
J02AC01 PANZIMOL G Fluconazole - 100mg 100mg Capsule, hard 2,015,764 L.L
J02AC01 PANZIMOL G Fluconazole - 150mg 150mg Capsule, hard 428,686 L.L
J05AG06 PIFELTRO B Doravirine - 100mg 100mg Tablet, film coated 27,819,434 L.L
J05AX18 PREVYMIS B Letermovir - 240mg 240mg Tablet, film coated 460,943,945 L.L
J05AX18 PREVYMIS B Letermovir - 480mg 480mg Tablet, film coated 961,233,292 L.L
J05AX18 PREVYMIS B Letermovir - 240mg/12ml 240mg/12ml Injectable concentrate for solution 23,599,640 L.L
J06BA02 PRIVIGEN BioHuman Immunoglobulin human - 5g/50ml 10% Injectable solution 44,463,925 L.L
J07AL01 PNEUMOVAX 23 B Polysaccharides from each of 23 capsular types of Streptococcus pneumoniae - 25mcgx23serotypes/0.5ml Injectable solution 2,378,601 L.L
J07AL02 PREVENAR 13 B Polysaccharide for serotypes 1, 3, 4, 5 , 6A, 7F, 9V,14, 18C, 19A, 19F, 23F (2.2mcg)Polysaccharide for serotypes 6B (4.4mcg)Conjugated to CRM197 carrier protein and adsorbed on aluminium phosphate (0.125mg aluminium) - Injectable suspension 6,352,343 L.L
J07AL02 PNEUMOSIL (10-VALENT) G Pneumococcal polysaccharide conjugate vaccine (adsorbed) - Injectable suspension 3,386,483 L.L
J07AL02 PREVENAR 20 B Pneumococcal polysaccharide for serotypes 1, 3, 4, 5 , 6A, 7F,8, 9V,10A, 11A, 12F, 14, 15B, 18C, 19A, 19F,22F, 23F, 33F (2.2mcg) Pneumococcal polysaccharide for serotypes 6B (4.4mcg)Conjugated to CRM197 carrier protein (approximately 51mcg) adsorbed on aluminium phosphate (0.125mg aluminium) - Injectable suspension 7,415,107 L.L
J07BD52 PRIORIX B Rubella virus live attenuated - ?10³ CCID50, Mumps virus live attenuated - ?103.7 CCID50, Measles virus live attenuated - ?10³ CCID50 Injectable lyophilised powder for solution+diluent 1,142,266 L.L
J07BF03 POLIOMYELITIS VACCINE INACTIVATED B Poliomyelitis virus type 1 inactivated - 40D.U, Poliomyelitis virus type 2 inactivated - 8D.U, Poliomyelitis virus type 3 inactivated - 32D.U Injectable suspension 1,206,771 L.L
J07CA06 PENTAXIM B Poliomyelitis virus type 3 inactivated(Prefilled syringe) - 32D.U., Poliomyelitis virus type 2 inactivated(Prefilled syringe) - 8D.U., Poliomyelitis virus type 1 inactivated(Prefilled syringe) - 40D.U., Bordetella pertussis antigen (Prefilled syringe) - toxoid 25mcg+filamentous haemaglutinin 25mcg, Tetanus toxoid (Prefilled syringe) - ?40IU, Diphtheria toxoid (Prefilled syringe) - ?30IU, H. Influenza type b polysaccharide(Vial) - 10mcg Injectable dry powder+suspension 2,558,676 L.L
L01BA04 PEMETREXED NEAPOLIS G Pemetrexed (disodium) - 500mg Injectable powder L.L
L01BA04 PEMETREXED ACCORD G Pemetrexed (disodium) - 500mg 500mg Injectable powder for concentrate for solution 20,000,292 L.L
L01BA04 PEMETREXED EVER PHARMA G Pemetrexed (disodium) - 500mg/20ml 500mg/20ml Injectable concentrate for solution 38,618,714 L.L
L01BA04 PEMETREXED GP PHARM G Pemetrexed (disodium) - 500mg 500mg Injectable lyophilised powder 46,641,484 L.L
L01BA04 PEMETREXED NEAPOLIS G Pemetrexed (disodium) - 500mg Injectable powder 41,289,202 L.L
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