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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
D10AF05 NADIXA G Nadifloxacin - 1% 1% Cream 850,652 L.L
S01AE02 NAFLOX G Norfloxacin - 3mg/ml 3mg/ml Drops 370,901 L.L
C04AX21 NAFTILUX B Naftidrofuryl oxalate acid - 200mg 200mg Capsule 432,717 L.L
C04AX21 NAFTIPRAX B Naftidrofuryl hydrogen oxalate - 200mg 200mg Tablet, film coated 614,328 L.L
G03AA12 NAJAT G Drospirenone - 3mg, Ethinylestradiol - 0.03mg Tablet, coated 417,935 L.L
N02AF02 NALBUPHINE RENAUDIN 1% G Nalbuphine HCl - 20mg/2ml 20mg/2ml Injectable solution 1,181,238 L.L
C10AB05 NANOFIB G Fenofibrate - 145mg 145mg Tablet, film coated 1,371,615 L.L
S01GA51 NAPHCON A B Naphazoline HCl - 0.025%, Pheniramine maleate - 0.3% Drops solution 369,557 L.L
M01AE02 NAPROXENE SODIQUE ARROW G Naproxen (sodium) - 550mg 550mg Tablet, film coated, scored 255,330 L.L
R01AB06 NARIX G Xylometazoline HCl - 90mcg/actuation, Carbocisteine - 900mcg/actuation Spray 518,339 L.L
R01AD11 NASACORT AQ B Triamcinolone acetonide - 55mcg/dose 55mcg/dose Spray, suspension 1,003,850 L.L
R01AD11 NASACORT AQ B Triamcinolone acetonide - 55mcg/dose 55mcg/dose Spray, suspension 1,003,850 L.L
R01AD09 NASONEX B Mometasone furoate (monohydrate) - 50mcg/dose 0.05% Spray, suspension 529,474 L.L
A04AA01 NAUSETRON G Ondansetron (HCl dihydrate) - 8mg 8mg Tablet, scored 1,023,880 L.L
A04AA01 NAUSETRON G Ondansetron - 4mg/5ml 4mg/5ml Solution 958,608 L.L
A04AA01 NAUSETRON G Ondansetron - 4mg/5ml 4mg/5ml Solution 802,466 L.L
A03FA03 NAUZEX G Domperidone - 10mg 10mg Tablet 258,530 L.L
L01CA04 NAVELBINE B Vinorelbine (ditartrate) - 20mg 20mg Capsule, soft gelatin 4,048,997 L.L
L01CA04 NAVELBINE B Vinorelbine (ditartrate) - 30mg 30mg Capsule, soft gelatin 6,072,824 L.L
D10AF05 NAXIDERM G Nadifloxacin - 1% 1% Gel 826,783 L.L
N06AB03 NEANXETIN G Fluoxetine (HCl) - 20mg 20mg Capsule 422,351 L.L
C07AB12 NEBILET B Nebivolol HCl - 5mg 5mg Tablet, scored 694,767 L.L
C07BB12 NEBILET PLUS B Nebivolol HCl - 5mg, Hydrochlorothiazide - 12.5mg Tablet, film coated 716,268 L.L
C07BB12 NEBILET PLUS B Nebivolol HCl - 5mg, Hydrochlorothiazide - 25mg Tablet, film coated 716,268 L.L
C07AB12 NEBIVOLOL BIOGARAN G Nebivolol HCl - 5mg 5mg Tablet, scored 529,474 L.L
J01DD02 NEGACEF G Ceftazidime (pentahydrate) - 1g 1g Injectable dry powder for solution 4,421,242 L.L
D06BA05 NEO SULFA G Sulfanilamide - 12g 12g Powder 151,022 L.L
R05FA01 NEO-CODION B Codeine Camphosulfonate - 25mg, Sulfogaiacol - 100mg, Grindelia soft extract - 20mg Tablet, coated 258,018 L.L
N02BG06 NEO-PAN G Nefopam HCl - 20mg/2ml 20mg/2ml Injectable solution 483,783 L.L
L03AA02 NEOGRASTIM 30 BioTech Filgrastim - 300mcg/ml 300mcg/ml Injectable solution 1,970,969 L.L
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