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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
C07AB07 CONCOR B Bisoprolol fumarate - 5mg 5mg Tablet, film coated 870,164 L.L
C07AB05 KERLONE B Betaxolol HCl - 20mg 20mg Tablet, film coated, scored 575,165 L.L
C07AB04 ACEBUTOLOL BIOGARAN G Acebutolol HCl - 200mg 200mg Tablet, coated 464,970 L.L
C07AB04 ACEBUTOLOL BIOGARAN G Acebutolol HCl - 400mg 400mg Tablet, coated 615,480 L.L
C07AB03 BLOKIUM 100MG G Atenolol - 100mg 100mg Tablet 377,620 L.L
C07AB03 ATONIUM G Atenolol - 100mg 100mg Tablet 461,207 L.L
C07AB03 TENORMIN B Atenolol - 100mg 100mg Tablet, film coated 279,519 L.L
C07AB03 BLOKIUM 50MG G Atenolol - 50mg 50mg Tablet 186,794 L.L
C07AB03 ATONIUM G Atenolol - 50mg 50mg Tablet 239,588 L.L
C07AB03 ATENOLOL BIOGARAN G Atenolol - 50mg 50mg Tablet, scored 295,645 L.L
C07AB03 APO-ATENOL G Atenolol - 50mg 50mg Tablet 327,898 L.L
C07AB03 TENORMIN B Atenolol - 50mg 50mg Tablet, film coated 393,746 L.L
C07AB02 B-BLOK SDK G Metoprolol succinate - 25mg 25mg Tablet, controlled release 282,207 L.L
C07AB02 BETALOC ZOK B Metoprolol succinate - 25mg 25mg Tablet, controlled release 219,046 L.L
C07AB02 B-BLOK SDK G Metoprolol succinate - 50mg 50mg Tablet, controlled release 295,645 L.L
C07AB02 BETALOC ZOK B Metoprolol succinate - 50mg 50mg Tablet, controlled release 491,846 L.L
C07AA07 SOTALOL BIOGARAN G Sotalol hydrochloride - 80mg 80mg Tablet, scored 288,926 L.L
C07AA07 SOTALOL BIOGARAN G Sotalol hydrochloride - 160mg 160mg Tablet, scored 357,462 L.L
C07AA05 PROBETOL G Propranolol HCl - 40mg 40mg Tablet 159,981 L.L
C07AA05 BEDRANOL G Propranolol HCl - 40mg 40mg Tablet, film coated 247,267 L.L
C07AA05 APO-PROPRANOLOL G Propranolol HCl - 40mg 40mg Tablet, scored 356,118 L.L
C07AA05 PROBETOL G Propranolol HCl - 10mg 10mg Tablet 126,705 L.L
C07AA05 BEDRANOL G Propranolol HCl - 10mg 10mg Tablet, film coated 247,267 L.L
C07AA05 APO-PROPRANOLOL G Propranolol HCl - 10mg 10mg Tablet, scored 280,863 L.L
C05CX REPARIL B Aescine - 20mg 20mg Tablet, sugar coated 510,660 L.L
C05CX GINKGO BIOGARAN G Ginkgo biloba extract - 40mg 40mg Tablet, coated 985,037 L.L
C05CX GINKGO BIOGARAN G Ginkgo biloba extract - 40mg 40mg Tablet, coated 345,368 L.L
C05CX TANAKAN B Ginkgo biloba - 40mg 40mg Tablet, film coated 1,662,333 L.L
C05CX TANAKAN B Ginkgo biloba - 40mg 40mg Tablet, film coated 661,171 L.L
C05CA54 GINKOR FORT B Heptaminol HCl - 0.300g, Troxerutine - 0.300g, Ginkgo biloba extract - 0.014g Capsule 681,328 L.L
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