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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
D11AX18 LABDIC RELIEF G Diclofenac sodium - 1%w/w, Methyl salicylate - 8%w/w, Menthol - 2%w/w Gel 263,393 L.L
C07AG01 LABETALOL HYDROCHLORIDE INJECTION G Labetalol HCl - 100mg/20ml 100mg/20ml Injectable solution 2,955,110 L.L
R06AX29 LABIXTEN B Bilastine - 20mg 20mg Tablet 584,571 L.L
R06AX29 LABIXTEN B Bilastine - 2.5mg/ml 2.5mg/ml Solution 463,626 L.L
C09CA01 LACINE 50 G Losartan potassium - 50mg 50mg Tablet, film coated 671,921 L.L
N03AX18 LACOSAMIDE/GENEPHARM G Lacosamide - 50mg 50mg Tablet 614,136 L.L
N03AX18 LACOSAMIDE/GENEPHARM G Lacosamide - 100mg 100mg Tablet 4,856,647 L.L
N03AX18 LACOSAMIDE/GENEPHARM G Lacosamide - 200mg 200mg Tablet 8,284,105 L.L
B05BB01 LACTATED RINGER'S G Sodium lactate - 0.31g/100ml, Calcium chloride, 2H2O - 0.02g/100ml, Potassium chloride - 0.03g/100ml, Sodium chloride - 0.598g/100ml Injectable solution 147,095 L.L
B05BB01 LACTATED RINGER'S G Sodium lactate - 0.31g/100ml, Calcium chloride, 2H2O - 0.02g/100ml, Potassium chloride - 0.03g/100ml, Sodium chloride - 0.598g/100ml Injectable solution 218,681 L.L
B05BB01 LACTATED RINGER'S G Sodium lactate - 0.31g/100ml, Calcium chloride, 2H2O - 0.02g/100ml, Potassium chloride - 0.02g/100ml, Sodium chloride - 0.598g/100ml Injectable solution 239,275 L.L
B05BB01 LACTATED RINGER'S G Sodium lactate - 0.31g/100ml, Calcium chloride, 2H2O - 0.02g/100ml, Potassium chloride - 0.03g/100ml, Sodium chloride - 0.598g/100ml Injectable solution 234,862 L.L
B05BB01 LACTATED RINGER'S G Sodium lactate - 0.31g/100ml, Calcium chloride, 2H2O - 0.02g/100ml, Potassium chloride - 0.03g/100ml, Sodium chloride - 0.598g/100ml Injectable solution 268,908 L.L
B05BB01 LACTATED RINGER'S INJECTION USP G Sodium lactate - 0.31g/100ml, Calcium chloride, 2H2O - 0.02g/100ml, Potassium chloride - 0.03g/100ml, Sodium chloride - 0.6g/100ml Injectable solution 197,659 L.L
B05BB01 LACTATED RINGER'S INJECTION USP G Sodium lactate - 0.31g/100ml, Calcium chloride, 2H2O - 0.02g/100ml, Potassium chloride - 0.03g/100ml, Sodium chloride - 0.6g/100ml Injectable solution 209,151 L.L
B05BB01 LACTATED RINGER'S INJECTION, USP G Sodium lactate - 3.1g/l, Calcium chloride, 2H2O - 0.2g/l, Potassium chloride - 0.3g/l, Sodium chloride - 6g/l Injectable solution 158,587 L.L
B05BB01 LACTATED RINGER'S INJECTION, USP G Sodium lactate - 3.1g/l, Calcium chloride, 2H2O - 0.2g/l, Potassium chloride - 0.3g/l, Sodium chloride - 6g/l Injectable solution 216,046 L.L
B05BB01 LACTATED RINGER'S INJECTION, USP G Sodium lactate - 3.1g/l, Calcium chloride, 2H2O - 0.2g/l, Potassium chloride - 0.3g/l, Sodium chloride - 6g/l Injectable solution 232,134 L.L
J01MA02 LADININ G Ciprofloxacine (HCl) - 500mg 500mg Tablet, film coated 595,060 L.L
J01MA02 LADININ G Ciprofloxacine (lactate) - 200mg/100ml 200mg/100ml Injectable solution 892,591 L.L
N03AX09 LAMICTAL B Lamotrigine - 100mg 100mg Tablet 2,741,209 L.L
N03AX09 LAMICTAL B Lamotrigine - 25mg 25mg Tablet 1,088,270 L.L
N03AX09 LAMICTAL B Lamotrigine - 50mg 50mg Tablet 1,753,895 L.L
N03AX09 LAMICTAL LIQUI-TABS B Lamotrigine - 5mg 5mg Tablet 361,046 L.L
D01AE15 LAMIFEN G Terbinafine HCl - 1% 1% Cream 350,743 L.L
D01BA02 LAMIFEN G Terbinafine HCl - 250mg 250mg Tablet 245,923 L.L
D01AE15 LAMINOX G Terbinafine HCl - 10mg/g 10mg/g Cream 453,067 L.L
D01BA02 LAMINOX G Terbinafine HCl - 250mg 250mg Tablet 725,675 L.L
D01AE15 LAMISIL B Terbinafine HCl - 10mg/g 1% Cream 616,824 L.L
D01AE15 LAMISIL B Terbinafine HCl - 10mg/ml 1% Solution 506,629 L.L
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