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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
R05CB06 MUCOSOLVAN B Ambroxol HCl - 30mg/5ml 30mg/5ml Syrup 380,307 L.L
R05CB06 MUCOVIC FORTE G Ambroxol HCl - 30mg/5ml 30mg/5ml Solution, sugar free 293,086 L.L
R05CB06 MUCOVIC FORTE G Ambroxol HCl - 30mg/5ml 30mg/5ml Solution, sugar free 440,268 L.L
R05CB06 MUKORAL G Ambroxol HCl - 30mg/5ml 30mg/5ml Syrup 341,336 L.L
J01CR02 MOXICLAV FORTE G Amoxicillin (trihydrate) - 250mg/5ml, Clavulanic Acid (potassium) - 62.5mg/5ml 312.5mg/5ml Powder for suspension 298,333 L.L
M05BA07 MADRONATE G Risedronate sodium - 35mg 35mg Tablet, film coated 724,907 L.L
L04AA06 MYFORTIC B Mycophenolic acid (sodium) - 360mg 360mg Tablet, gastroresistant 20,324,991 L.L
L04AA06 MYFORTIC B Mycophenolic acid (sodium) - 360mg 360mg Tablet, gastroresistant L.L
J01XX01 MONUROL B Fosfomycine (trométamol) - 3g 3g Granules for solution 571,133 L.L
D10AF02 MED-ERYTHROMYCIN 4% G Erythromycin - 40mg/ml 4% Solution 235,492 L.L
L01FX02 MYLOTARG BioTech Gemtuzumab Ozogamicin - 4.5mg 4.5mg Injectable powder 748,160,090 L.L
L01FX02 MYLOTARG BioTech Gemtuzumab Ozogamicin - 4.5mg 4.5mg Injectable powder L.L
J01DD08 MAGNACEF 400 G Cefixime - 400mg 400mg Capsule 1,307,559 L.L
J01DD08 MUREX G Cefixime - 400mg 400mg Capsule 679,984 L.L
N05AN01 MANICARB SR-400 G Lithium carbonate - 400mg 400mg Tablet, prolonged release 1,431,192 L.L
L01FG01 MVASI BioTech Bevacizumab - 400mg/16ml 400mg/16ml Injectable concentrate for solution 58,035,926 L.L
J01MA14 MOFLOXINE G Moxifloxacin (HCl) - 400mg/250ml 400mg/250ml Injectable solution 1,638,144 L.L
C09CA07 MICARDIS B Telmisartan - 40mg 40mg Tablet 760,615 L.L
A02BC05 METAPRO G Esomeprazole - 40mg 40mg Tablet, gastroresistant 639,669 L.L
H02AB04 METHYL PREDNISOLONE VIATRIS 40MG G Methylprednisolone (hemisuccinate) - 40mg 40mg Injectable dry powder for solution 258,657 L.L
H02AB04 METHYLPREDNISOLONE ORBUCELL INJ. G Methylprednisolone sodium succinate - 40mg 40mg Injectable powder for solution 2,143,749 L.L
H02AB04 MP 40 G Methylprednisolone - 40mg 40mg Injectable powder for solution 219,046 L.L
L01FD01 MABTIN 440 BioTech Trastuzumab (r-DNA origin) - 440mg 440mg Injectable powder for solution 70,042,700 L.L
J01CR02 MEGAMOX-JPI G Amoxicillin (trihydrate) - 400mg/5ml, Clavulanic Acid (potassium) - 57mg/5ml 457mg/5ml Suspension 435,405 L.L
J01CR02 MOXICLAV BIS G Amoxicillin (trihydrate) - 400mg/5ml, Clavulanic Acid (potassium) - 57mg/5ml 457mg/5ml Powder for suspension 309,084 L.L
G04BD06 MICTONORM XL B Propiverine HCl - 45mg 45mg Capsule, modified release 1,877,348 L.L
R03DC03 MONTELUKAST ARROW LAB G Montelukast (sodium) - 4mg 4mg Tablet, chewable 851,996 L.L
R03DC03 MONTELUKAST-SANDOZ G Montelukast (sodium) - 4mg 4mg Tablet, chewable 1,184,140 L.L
C01DX12 MOLSIDOMINE BIOGARAN G Molsidomine - 4mg 4mg Tablet 344,024 L.L
D11AX01 MINOXIDIL BAILLEUL G Minoxidil - 5% 5% Solution 3,675,409 L.L
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