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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
G04CB01 STERIFINE 5 G Finasteride - 5mg 5mg Tablet, film coated 733,354 L.L
C07AB07 BISOCOR 5 G Bisoprolol fumarate - 5mg 5mg Tablet, film coated 345,560 L.L
C07AB07 BISOCOR 5 G Bisoprolol fumarate - 5mg 5mg Tablet, film coated 345,560 L.L
C07AB07 BISOPROLOL NORMON G Bisoprolol hemifumarate - 5mg 5mg Tablet, film coated 321,178 L.L
C07AB07 BISOPROLOL QUIVER LAB G Bisoprolol fumarate - 5mg 5mg Tablet, film coated, scored 264,737 L.L
C07AB07 BISOPROLOL REF G Bisoprolol hemifumarate - 5mg 5mg Tablet, coated, scored 272,800 L.L
C07AB07 CARDIOSAFE 5 G Bisoprolol fumarate - 5mg 5mg Tablet, coated 330,585 L.L
C07AB07 PRESCOR 5 G Bisoprolol - 5mg 5mg Tablet, film coated 345,560 L.L
C07AB07 ZIOPROL G Bisoprolol - 5mg 5mg Tablet, film coated 409,552 L.L
L01AX03 TEMOZOLOMIDE ACCORD G Temozolomide - 5mg 5mg Capsule, hard 1,153,017 L.L
L01AX03 TEMOZOLOMIDE GP PHARM G Temozolomide - 5mg 5mg Capsule, hard 1,153,017 L.L
N05AB02 FLUPHENAZINE HCl G Fluphenazine (HCl) - 5mg 5mg Tablet, scored 624,567 L.L
N05AD01 HALDOL B Haloperidol - 5mg 5mg Tablet 231,141 L.L
N05AD01 HALOPERIDOL G Haloperidol - 5mg 5mg Tablet 276,448 L.L
N06AX26 BRINTELLIX B Vortioxetine - 5mg 5mg Tablet, film coated 2,592,272 L.L
N06AX26 LYTIOX G Vortioxetine - 5mg 5mg Tablet, film coated 1,270,379 L.L
C07AB12 NEBILET B Nebivolol HCl - 5mg 5mg Tablet, scored 694,767 L.L
C07AB12 NEBIVOLOL BIOGARAN G Nebivolol HCl - 5mg 5mg Tablet, scored 529,474 L.L
C07AB12 NEVILOC G Nebivolol HCl - 5mg 5mg Tablet 476,104 L.L
C07AB12 NIVOL G Nebivolol HCl - 5mg 5mg Tablet 590,011 L.L
L04AD02 PROGRAF 5MG B Tacrolimus - 5mg 5mg Capsule L.L
N05AH03 ZYPREXA B Olanzapine - 5mg 5mg Tablet 1,197,364 L.L
N05AH03 ZYPREXA B Olanzapine - 5mg 5mg Tablet 1,197,364 L.L
N05AH03 OLANZAMED G Olanzapine - 5mg 5mg Tablet 665,522 L.L
N05AH03 OLANZAPINE ARROW G Olanzapine - 5mg 5mg Tablet 670,577 L.L
N05AH03 PREXAL 5 G Olanzapine - 5mg 5mg Caplet, film coated 718,956 L.L
A10BB01 GLIBENCLAMIDE G Glibenclamide - 5mg 5mg Tablet, scored 340,440 L.L
N05AH03 ZYPREXA VELOTAB B Olanzapine - 5mg 5mg Tablet, dispersible 2,607,054 L.L
A10BB01 GLIBENCLAMIDE G Glibenclamide - 5mg 5mg Tablet 326,362 L.L
N05AH03 ZYPREXA VELOTAB B Olanzapine - 5mg 5mg Tablet, dispersible 2,607,054 L.L
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