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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
L01EA01 GLIMATINIB BENTA 400 G Imatinib (mesylate) - 400mg 400mg Tablet, film coated 38,254,090 L.L
A02BC01 GASTRIMUT G Omeprazole - 40mg 40mg Capsule, hard, gastro-resistant 503,941 L.L
A02BC01 GASTRIMUT G Omeprazole - 40mg 40mg Capsule, hard, gastro-resistant 956,816 L.L
A02BC02 GASTROPAN G Pantoprazole (sodium) - 40mg 40mg Tablet, enteric coated 1,104,639 L.L
A02BC02 GASTROPAN G Pantoprazole (sodium) - 40mg 40mg Tablet, enteric coated 581,884 L.L
C05CX GINKGO BIOGARAN G Ginkgo biloba extract - 40mg 40mg Tablet, coated 345,368 L.L
C05CX GINKGO BIOGARAN G Ginkgo biloba extract - 40mg 40mg Tablet, coated 985,037 L.L
J01GB03 GENTAMICINE PANPHARMA G Gentamicin (sulfate) - 40mg/2ml 40mg/2ml Injectable solution 643,701 L.L
J01GB03 GENTAMICINE PANPHARMA G Gentamicin (sulfate) - 40mg/2ml 40mg/2ml Injectable solution 643,701 L.L
G03GA05 GONAL-f BioHuman Follitropin alfa - 450IU/0.75ml 450IU/0.75ml Injectable solution 14,813,959 L.L
A10BB12 GLIM G Glimepiride - 4mg 4mg Tablet 628,918 L.L
A10BB12 GLUMYL 4 G Glimepiride - 4mg 4mg Tablet 317,403 L.L
A10BB12 GLYPRIDE G Glimepiride - 4mg 4mg Tablet 657,139 L.L
D06BB10 GENIMOD G Imiquimod - 5% 5% Cream 2,268,406 L.L
B05CX01 GLUCOSE INJ. G Glucose - 10g/20ml 50% Injectable solution 5,038,066 L.L
A10BA02 GLUCOPHAGE XR B Metformin HCl - 500mg 500mg Tablet, prolonged release 484,421 L.L
A10BA02 GLUFORIN XR 500 G Metformin HCl - 500mg 500mg Tablet, film coated, extended release 349,399 L.L
D01BA01 GRISEOFULVIN G Griseofulvin - 500mg 500mg Tablet, scored 575,933 L.L
A10BF01 GLUFIX G Acarbose - 50mg 50mg Tablet 1,294,120 L.L
A10BH02 GALVUS B Vildagliptin - 50mg 50mg Tablet 950,097 L.L
A10BH02 GLUNORM G Vildagliptin - 50mg 50mg Tablet 611,448 L.L
A03FA07 GANATON B Itopride Hydrochloride - 50mg 50mg Tablet 1,119,421 L.L
A03FA07 GANATON B Itopride Hydrochloride - 50mg 50mg Tablet 357,462 L.L
A03FA07 GAROPRIDE G Itopride Hydrochloride - 50mg 50mg Tablet, film coated 213,671 L.L
A04AD GRAVOL B Dimenhydrinate - 50mg 50mg Tablet 163,949 L.L
G02AX GYNOCIN G Oxytocin - 5IU/0.5ml 5IU/0.5ml Injectable concentrate for solution 313,115 L.L
A10BB01 GLIBENCLAMIDE G Glibenclamide - 5mg 5mg Tablet, scored 340,440 L.L
A10BB01 GLIBENCLAMIDE G Glibenclamide - 5mg 5mg Tablet 326,362 L.L
N03AX12 GABATREX G Gabapentin - 600mg 600mg Tablet 3,132,497 L.L
G03GA05 GONAL-f BioHuman Follitropin alfa - 900IU/1.5ml 66mcg/1.5ml Injectable solution 29,625,401 L.L
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