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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
B05CX01 DEXTROSE INJECTION 5% G Dextrose, H2O - 5g/100ml Injectable solution 212,797 L.L
J01CR05 YANOVEN G Piperacillin (sodium) - 4g, Tazobactam (sodium) - 0.5g Injectable powder for solution 10,860,623 L.L
R02AA05 GOLASEPTINE-LIDOCAINE G Chlorhexidine HCl - 5mg, Lidocaine HCl - 1mg Tablet, chewable 736,426 L.L
J01CR05 PIPERACILLINE/ TAZOBACTAM ARROW Piperacillin (sodium) - 4g, Tazobactam (sodium) - 500mg 7,378,682 L.L
R02AA20 ANGINOVA G Lidocaine HCl - 1mg, Dequalinium HCl - 0.25mg Lozenge 349,399 L.L
C03EA01 MODURETIC B Hydrochlorothiazide - 50mg, Amiloride HCl - 5mg Tablet 798,398 L.L
J01CR05 TAZOBACT Piperacillin sodium - 4g, Tazobactam (sodium) - 500mg 783,460 L.L
A11A BEBE-VIT G Vitamin A - 1500IU/ml, Vitamin D3 - 400IU/ml, Vitamin E - 5mg/ml, Vitamin C - 40mg/ml, Vitamin B1 - 0.5mg/ml, Vitamin B2 - 0.6mg/ml, Vitamin B6 - 0.6mg/ml, Nicotinamide - 8mg/ml Drops 287,582 L.L
B02BD06 HAEMATE P BioHuman Von Willebrand Factor - 1200IU, Blood Coagulation Factor VIII - 500IU Injectable lyophilised powder for solution+diluent 35,032,787 L.L
D10AD01 RETACNYL - 0.05 % G Tretinoin - 0.05% Cream 584,571 L.L
J01CR50 FLUMOX G Flucloxacillin (monohydrate) - 250mg, Amoxicillin (trihydrate) - 250mg Capsule 348,055 L.L
A11AA PHARMATON KIDDI B Vitamin E - 15mg/15ml, Phosphorous - 200mg/15ml, Calcium - 130mg/15ml, Vitamin D3 - 600IU/15ml, D Panthenol - 10mg/15ml, Nicotinamide - 20mg/15ml Syrup 417,935 L.L
B02BD06 WILATE 500 BioHuman Von Willebrand Factor - 500IU, Blood Coagulation Factor VIII - 500IU Injectable powder for solution+diluent 32,399,164 L.L
A11AA PANTOGAR B P-aminobenzoic acid - 20mg, Keratine - 20mg, Medical yeast - 100mg, Thiamine mononitrate - 60mg, L-Cystine - 20mg, Calcium D-pantothenate - 60mg Capsule 2,005,013 L.L
A11AA CAL-VIT G Riboflavine - 9mg/100ml, Cyanocobalamine - 570mcg/100ml, Pyridoxine HCl - 35mg/100ml, Thiamine HCl - 190mg/100ml, Inositol - 150mg/100ml, Nicotinamide - 120mg/100ml, Calcium Pantothenate - 27mg/100ml, Sodium hypophosphite - 70mg/100ml Syrup 163,821 L.L
C05A ANTROLIN B Nifedipine - 0.3%, Lidocaine - 1.5% Cream 1,333,092 L.L
J07BD52 PRIORIX B Rubella virus live attenuated - ?10³ CCID50, Mumps virus live attenuated - ?103.7 CCID50, Measles virus live attenuated - ?10³ CCID50 Injectable lyophilised powder for solution+diluent 1,142,266 L.L
A11AA COMPLEVIT G Ascorbic acid - 1.32g, Riboflavine - 0.018g, Nicotinamide - 0.264g, Cyanocobalamine - 0.9g, Pyridoxine HCl - 0.132g, Thiamine mononitrate - 0.288g, Iron Ammonium Citrate - 3.6g Syrup 218,854 L.L
C05AA01 SEDIPROCT G Hydrocortisone - 500mg, Cinchocaine HCl - 500mg Cream 290,270 L.L
J07BD52 M-M-R II (MEASLES, MUMPS AND RUBELLA VIRUS VACCINE LIVE) B Rubella virus live attenuated - , Mumps virus live attenuated - , Measles virus live attenuated - Injectable solution+diluent 12,924,401 L.L
A11AA VITA-FERIN C G Manganese sulfate - 0.77mg, Copper sulfate - 0.72mg, Iron fumarate - 0.022g, Vitamin C - 0.15g, Vitamin B5 - 0.01g, Vitamin B3 - 0.022g, Vitamin B6 - 0.002g, Vitamin B2 - 0.002g, Vitamin B1 - 0.01g Capsule 1,217,521 L.L
C05AA01 SEDIPROCT G Hydrocortisone - 5mg, Cinchocaine HCl - 5mg, Framycetin sulfate - 10mg, Esculoside - 10mg Suppository 237,860 L.L
J07BD52 MEASLES, MUMPS AND RUBELLA VACCINE LIVE ATTENUATED (FREEZE-DRIED) MMR G Rubella virus live attenuated - ?1000CCID50 /0.5ml, Mumps virus live attenuated - ?5000CCID50 /0.5ml, Measles virus live attenuated - ?1000CCID50 /0.5ml Injectable freeze dried powder + diluent 739,113 L.L
N02BA51 ASPIRINE C EFFERVESCENT B Acetylsalicylic acid - 400mg, Vitamin C - 240mg Tablet, effervescent 162,605 L.L
A11AB CYPRO-VITA B Vitamin C - 20mg, Vitamin B3 - 5mg, Vitamin B12 - 2.5mg, Vitamin B6 - 0.6mg, Vitamin B2 - 0.75mg, Vitamin B1 - 0.6mg, Vitamin D3 - 167IU, Vitamin A - 1670IU, Cyproheptadine HCl - 4mg Tablet, film coated 409,552 L.L
C05AA01 SINAHEAL-H G Hydrocortisone acetate - 5mg, Lidocaine - 60mg, Zinc oxide - 400mg, Aluminium Subacetate - 50mg Suppository 501,253 L.L
J07BF03 POLIOMYELITIS VACCINE INACTIVATED B Poliomyelitis virus type 1 inactivated - 40D.U, Poliomyelitis virus type 2 inactivated - 8D.U, Poliomyelitis virus type 3 inactivated - 32D.U Injectable suspension 1,206,771 L.L
N02BA51 ASPRIVIT G Acetylsalicylic acid - 500mg, Caffeine - 50mg, Vitamin B1 - 2mg Tablet 186,794 L.L
L01FD01 TRASTUREL BioTech Trastuzumab - 440mg L.L
A11BA VITALIPID N INFANT B Vitamin A - 230IU/ml, Vitamin D2 - 40IU/ml, Vitamin E - 0.7IU/ml, Vitamin K1 - 20mcg/ml Injectable concentrate for solution 2,448,481 L.L
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