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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
L04AB01 ALTEBREL BioTech Etanercept - 50mg/1ml 50mg/1ml Injectable solution L.L
A11CC05 ALTO D 10.000 G Vitamin D3 - 10,000IU 10,000IU Capsule 895,895 L.L
A11CC05 ALTUM G Vitamin D3 - 50,000IU 50,000IU Capsule, hard 712,620 L.L
A11CC05 ALTUM-D3 G Vitamin D3 - 10,000IU 10,000IU Capsule 561,342 L.L
L01ED04 ALUNBRIG B Brigatinib - 30mg 30mg Tablet, film coated 124,685,776 L.L
L01ED04 ALUNBRIG B Brigatinib - 90mg 90mg Tablet, film coated 374,059,747 L.L
L01ED04 ALUNBRIG B Brigatinib - 180mg 180mg Tablet, film coated 493,595,998 L.L
M04AA01 ALURIC G Allopurinol - 300mg 300mg Tablet, scored 175,339 L.L
N07CA01 ALVIGO G Betahistine dihydrochloride - 16mg 16mg Tablet, scored 1,204,339 L.L
L01XG01 ALVOCADE G Bortezomib - 3.5mg 3.5mg Injectable powder for solution 14,169,600 L.L
N06DA02 ALZEPIL G Donepezil HCl - 5mg 5mg Tablet 1,406,555 L.L
N06DA02 ALZEPIL G Donepezil HCl - 10mg 10mg Tablet 1,908,256 L.L
A10BB12 AMARYL B Glimepiride - 1mg 1mg Tablet 231,141 L.L
A10BB12 AMARYL B Glimepiride - 2mg 2mg Tablet 233,829 L.L
A10BB12 AMARYL B Glimepiride - 3mg 3mg Tablet 392,402 L.L
A10BB12 AMARYL B Glimepiride - 4mg 4mg Tablet 392,402 L.L
J02AA01 AMBISOME B Liposomal Amphotericin B - 50mg 50mg Injectable powder for liposomal dispersion 13,126,040 L.L
A10BB12 AMEPRIDE G Glimepiride - 1mg 1mg Tablet 137,072 L.L
A10BB12 AMEPRIDE G Glimepiride - 2mg 2mg Tablet 139,760 L.L
A10BB12 AMEPRIDE G Glimepiride - 3mg 3mg Tablet 215,015 L.L
A10BB12 AMEPRIDE G Glimepiride - 4mg 4mg Tablet 215,015 L.L
J01GB06 AMICINE G Amikacin (sulfate) - 500mg/2ml 500mg/2ml Injectable solution 1,749,683 L.L
J01GB06 AMIKACIN SULPHATE G Amikacin (sulfate) - 500mg/2ml 500mg/2ml Injectable solution 372,244 L.L
R03DA05 AMINOPHYLLINE G Aminophylline - 100mg 100mg Tablet, scored 445,388 L.L
R03DA05 AMINOPHYLLINE ADULTS G Aminophylline - 350mg 350mg Suppository 244,451 L.L
R03DA05 AMINOPHYLLINE CHILDREN G Aminophylline - 100mg 100mg Suppository 203,496 L.L
R03DA05 AMINOPHYLLINE RENAUDIN G Aminophylline - 250mg/10ml 2.5% Injectable solution 739,113 L.L
B05BA01 AMINOPLASMAL B. BRAUN B Amino acids - 10% 10% Injectable solution 1,036,103 L.L
B05BA01 AMINOVEN 10% B Glacial Acetic Acid 99% - 5.297g/l, L-Proline - 15.0g/l, L-Alanine - 15.0g/l, Glycine - 14.0g/l, L-Histidine - 3.00g/l, L-Arginine - 12.0g/l, L-Valine - 6.20g/l, L-Tryptophan - 2.00g/l, L-Threonine - 4.40g/l, L-Phenylalanine - 5.10g/l, L-Methionine - 4.30g/l, L-Lysine (monoacetate) - 6.60g/l, L-Leucine - 7.40g/l, L-Isoleucine - 5.00g/l Injectable solution 951,440 L.L
B05BA01 AMINOVEN INFANT B L-Leucine - 13g/l, L-Isoleucine - 8g/l, L-Lysine Acetate - 12g/l, L-Methionine - 3.12g/l, L-Phenylalanine - 3.75g/l, L-Threonine - 4.40g/l, L-Tryptophan - 2.01g/l, L-Valine - 9g/l, Arginine - 7.5g/l, L-Histidine - 4.76g/l, Glycine - 4.15g/l, L-Taurine - 0.40g/l, L-Serine - 7.67g/l, L-Alanine - 9.3g/l, L-Proline - 9.71g/l, N-Acetyl-L-Tyrosine - 5.176g/l, N-Acetyl-L-Cysteine - 0.70g/l, L-Malic Acid - 2.62g/l 10% Injectable solution 880,217 L.L
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