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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
D10BA01 CURACNE G Isotretinoin - 5mg 5mg Capsule, soft 856,028 L.L
C07AB07 CONCOR B Bisoprolol fumarate - 5mg 5mg Tablet, film coated 870,164 L.L
C07AB07 CARDIOSAFE 5 G Bisoprolol fumarate - 5mg 5mg Tablet, coated 330,585 L.L
C09AA04 COVERSYL ARGININE B Perindopril arginine - 5mg 5mg Tablet, film coated 452,875 L.L
H01AC01 CINNATROPIN BioTech Somatropin recombinant - 5mg/1.5ml 5mg/1.5ml Injectable solution 4,699,417 L.L
R06AE07 CETIMED G Cetirizine (dihydrochloride) - 5mg/5ml 5mg/5ml Solution 415,951 L.L
R06AX13 CLARITINE B Loratadine (micronised) - 5mg/5ml 5mg/5ml Syrup 430,030 L.L
R06AX13 CLARA G Loratadine (micronised) - 5mg/5ml 5mg/5ml Syrup 215,015 L.L
C07AG02 CARVEDILOL ARROW G Carvedilol - 6.25mg 6.25mg Tablet, film coated, scored 364,181 L.L
A12AA04 CALTRATE 600 B Calcium (carbonate) - 600mg 600mg Tablet 618,168 L.L
J01FF01 CLINDAMYCIN VIANEX BA FREE G Clindamycin (phosphate) - 600mg/4ml 600mg/4ml Injectable solution 201,576 L.L
L01EX07 CABOMETYX B Cabozantinib - 60mg 60mg Tablet, film coated 440,893,501 L.L
M01AH05 CONSORT G Etoricoxib - 60mg 60mg Tablet, film coated 338,648 L.L
M01AH05 COXIFLAM G Etoricoxib - 60mg 60mg Tablet, film coated 1,109,630 L.L
H05BX01 CINACALCET ARROW BioTech Cinacalcet - 60mg 60mg Tablet, coated, scored 16,494,074 L.L
J01CR02 CURAM G Amoxicillin (trihydrate) - 500mg, Clavulanic Acid (potassium) - 125mg 625mg Tablet, film coated 402,189 L.L
C01EB10 CARDESINE G Adenosine - 6mg/2ml 6mg/2ml Injectable solution 563,070 L.L
B05XA01 CHLORURE DE POTASSIUM RENAUDIN G Potassium chloride - 7.46g/100ml 7.46% Injectable solution 385,683 L.L
J02AX04 CANCIDAS B Caspofungin (acetate) - 70mg 70mg Injectable concentrated powder for solution 31,611,335 L.L
J02AX04 CANDIGARD G Caspofungin (acetate) - 70mg 70mg Injectable powder for concentrate for solution 22,127,179 L.L
J02AX04 CASPOFUNGINE STRAGEN G Caspofungin (acetate) - 70mg 70mg Injectable concentrated powder for solution 22,928,852 L.L
J01DC02 CEFUMAX G Cefuroxime (sodium) - 750mg 750mg Injectable dry powder 159,917 L.L
J01DC02 CEFUROXIME – PANPHARMAPOUDRE POUR SOLUTION INJ. IM/IV G Cefuroxime (sodium) - 750mg 750mg Injectable dry powder 3,922,676 L.L
J01DC02 CEFUROXIME – PANPHARMAPOUDRE POUR SOLUTION INJ. IM/IV G Cefuroxime (sodium) - 750mg 750mg Injectable powder for solution 1,651,582 L.L
J01DC02 CEFUZIME G Cefuroxime (sodium) - 750mg 750mg Injectable dry powder 147,823 L.L
J01DC04 CECLOR MR B Cefaclor (monohydrate) - 750mg 750mg Tablet, film coated, modified release 1,555,018 L.L
G03AC09 CERAZETTE B Desogestrel - 75mcg 75mcg Tablet, film coated 407,184 L.L
B01AC04 CERUVIN G Clopidogrel (Bisulfate) - 75mg 75mg Tablet 240,548 L.L
B01AC04 CLODOR G Clopidogrel (Bisulfate) - 75mg 75mg Tablet 1,148,025 L.L
N07CA02 CINARIN G Cinnarizine - 75mg 75mg Capsule 490,183 L.L
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