3 November 2017

Lebanon has been undergoing a demographic and epidemiological transition for the past two decades.  As such, Lebanon is a country with double burden of disease; there is an increase in the incidence of non-communicable diseases at a time where infectious diseases remain a public health risk¹. In order to respond to the country’s changing profile and health needs, the ministry of public health in Lebanon has adopted prevention as a strategic direction in the country’s health strategies, policies, projects and programs.

In 1991, the ministry of public health held the first national conference on primary healthcare which led to the elaboration of a national primary healthcare strategy². At the core of this strategy was the national primary healthcare network. The MOPH collaborated with NGOs, civil societies and the private sector to identify health centers and dispensaries and included them in the national network.  These primary health care centers provide services including promotive, preventive and palliative ‎care in addition to early diagnosis and treatment³ for reduced nominal fees. The MOPH supports these PHCCs though providing training, medical equipment and supplies, vaccines, essential medication, and a health information system for continuous reporting.

To date the MOPH national primary healthcare network encompasses 207 PHCCs across the country and serves around 1.4 million beneficiaries annually including both vulnerable Lebanese, and displaced Syrians⁴. The MOPH national network has made leaps in terms of prevention coverage in Lebanon as evidenced by the 95% vaccination coverage rate for children and the maintenance of Lebanon’s Polio free status despite the Syrian refugee crisis⁴. In addition to immunization services, the national primary network offers several programs. One of the most successful and pertinent programs at the MOPH national primary network is the Non communicable disease (NCD) initiative.

Non-Communicable Disease Screening in Lebanon

In line with the epidemiological transition in Lebanon, recent reports have shown that those whose ages are 65 years and over represent 10% of the population⁵. In fact, Lebanon has the highest proportion of their population aged 65+ years among countries in the Arab world⁶. With an aging population, the burden of non-communicable diseases becomes even more prominent. NCDs are the leading causes of disease and illness in Lebanon accounting for 85% of all deaths in 2014⁷.

The Lebanese government subsidizes access to tertiary and secondary care for uninsured and for those suffering from NCDs, the cost of diagnosis and treatment but primary and preventive services remain uncovered. In order to address this imbalance and encourage NCD prevention in 2012, the Primary Health Care Department in collaboration with WHO, launched a pilot initiative of Non-Communicable Diseases (NCD) in 26 Primary Health Care (PHC) centers.

By the year 2016, this initiative was developed further and was integrated as a sustainable service into the package of health care services provided by PHC centers a total of ‏189‏ PHCCs across Lebanon⁴.

This Initiative aims primarily at the early detection of (i) diabetes, (ii) hypertension, (iii) dyslipidemia and (iv) cardiovascular disease through screening beneficiaries 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. This risk is calculated using an algorithm developed jointly by WHO and the International hypertension Society (HIS). Once risk is calculated, education and referral for medical treatment as per PHC protocol is performed accordingly.

During 2016, the NCD initiative screened over 16,000 PHCC beneficiaries and referred 43% of those beneficiaries to receive further lab tests⁴. The results of the screenings demonstrated the prevalence of NCDs among screened beneficiaries as follows: hypertension (91/1000), diabetes (85/1000), dyslipidemia (81/1000) cases⁴. 

References

1.      Ammar, W, Health system and Reform in Lebanon, Ministry of Public Health, 2003.

2.      Ammar, W. Health Beyond Politics, Ministry of Public Health, 2009.

3.      Ammar W., (2016): Health Strategic Plan; Strategic Plan for the medium term (2016 to 2020) ‎‎(2017). Retrieved 2 June 2017‎

4.      Primary healthcare Department Annual Report, 2016.

5.      Central Administration of Statistics. (2012). Population and housing characteristics in Lebanon, Statistics In Focus (SIF), Beirut, Lebanon, Issue number 2.

6.      Abdulrahim, S., Ajrouch, K. J., & Antonucci, T. C. (2014). Aging in Lebanon: challenges and opportunities. The Gerontologist, 55(4), 511-518

7.      World Health Organization - Noncommunicable Diseases (NCD) Country Profiles , 2014.

Randa Hamedeh,PHD,MPH

Head ,Phc and social Health Department,MOPH

Coordinator,Universal health Coverage Project in collaboration with the World bank