Integration Of Non-Communicable Disease Program In Primary Health Care

I. Introduction:

In 2012, the Primary Health Care Department at the Ministry of Public Health in collaboration with WHO, launched a pilot initiative of Non-Communicable Diseases (NCD) in the 26 Primary Health Care (PHC) centers that were classified in the Accreditation Preparedness Phase. By the year 2013, this Initiative was developed further and was integrated as a sustainable service into the package of health care services provided PHC centers across Lebanon. By the year 2015, the NCD program was integrated into a total of 146 centers across Lebanon.

This Initiative aims primarily at the early detection of diabetes, hypertension, and dyslipidemia through screening visitors of designated PHC centers who are 40 years and above. It further aims at the prevention of these diseases, promotion of health awareness, management of individuals with these pre-existing diseases, and surveillance of cardiovascular diseases in the Lebanese population. The risk for the development of diabetes, hypertension, and dyslipidemia is assessed by calculating the cardiovascular risk of each individual within the screening criteria. Once risk is calculated, education and referral for medical treatment as per PHC protocol is performed accordingly.

II- Trainings:

Therefore, in order to ensure proper implementation of this program and its continuity, health care providers were trained continuously.

In 2012, the first phase of implementation included training of 91 health care providers. In 2013, additional 193 health care providers were trained and by the year 2014 training included another 230 health care providers. As a result, a total of 514 health care providers from PHC centers across Lebanon were trained over a period of 2 years. Besides these trainings, Refresher sessions were held for 135 already trained health care providers during the months of May and September of the year 2013. During this period, further work was prepared to develop educational material for the general population and develop the NCD e-module that aimed at enhancing and unifying the process of implementation and reporting.

Year	NCD Tranings	NCD Refresher Sessions
	Health Care Providers Trained	Health Care Providers included
2012	91	---
2013	193	135
2014	230	138
2015	81	84
	Total : 595	Total 357

By the year 2014, aiming at ensuring the continuity of this initiative implementation, 3 additional Refresher Sessions were held during the months of February, October, and December, including 138 previously trained health care providers from PHC centers across Lebanon. Refresher sessions include presentations and discussion of case studies that tackle the proper use of screening tools, calculation of cardiovascular risk, and referral for medical treatment based upon need. Proper completion of monthly reports, use of the NCD e-module, and integration of outreach activities are issues that are also encouraged. Furthermore, healthy lifestyle and dietary guidelines given to beneficiaries to help regulate blood pressure, blood glucose, and lipid levels are also discussed.

During the month of December 2014, 2 full day NCD Refresher sessions were held for health care providers attending from different Qaza across Lebanon. (Photos from Resfresher Session, December, 2014)

During 2015, 2 refresher sessions were held during the months of March and April for additional PHC centers within the National
PHC Network.