1. Randa Hamadeh MPC, CMC
Head, PHC department
Immunization and Essential Drugs Program Manager
Ministry of Public Health
Lebanon
September 2012
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2.  Country Profile
 What is Peculiar about Lebanon?
 Response to NCD burden
 PHC network: Distribution and Accreditation
Standards
 Successful Examples: Chronic Drugs Program
 Challenges : Drugs Distribution Mechanism
 Health Card for the Chronic Drugs
 Achievements
 Next steps
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3.  Capital: Beyrouth
 Surface: 10452 Km2
 Population: 3.962 millions (2010)
 Total GDP : 52650 Billion Leb. Pds
 Allocated to MoPH from total gov.
Budget:2.5 %
 Annual Budget of MoPH: 486.7 billion L.p
 Annual budget of MoPH per capita:
 $US 82
 National Health expenditure as %GDP:
83%
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4.  Vast involvement of NGO
 The public sector is expanding through strengthening partnership with the
private and non-profit, non-governmental sector, especially for primary
health care services.
 Lebanon has a wide net of dispensaries, more than 800, belonging mainly to
the MoPH, Ministry of social affairs, municipalities, Non-Governmental
Organizations (NGOs), Civil Society Organizations, and religious and political
organizations.
 Among those, around 160 are fully regulated and supported by the ministry,
and are mandated to offer primary health care services, including NCD
services.
 Lebanon has six different schemes for Public Health insurance, however, an
important share of the MoPH budget is devoted to subsidize treatment and
medicines for people with common and preventable NCDs such as coronary
heart disease, and Cancer patients.
 Non-communicable diseases, namely cardiovascular diseases (CVD), chronic
respiratory diseases, cancers and diabetes, are major cause of mortality and
morbidity in Lebanon.
 Those conditions are estimated to account for 71% of all death, with CVD
ranking top cause of death in Lebanon and accounting for more than 60% of
death due to NCD.
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6.  The Lebanese government acknowledged the challenge of the rising
burden of NCDs since the 1970s.
 The MoPH started securing essential drugs for Cancer patients(a medical
committee was developed to evaluate patients files and status and
respond to their needs) in addition to the formulation of a Cancer
registry.
 The Lebanese Ministry of Public Health (MoPH), in partnership with
World Health Organization (WHO) and the non-governmental and civil
society organizations, achieved several initiatives and measures
formalized in a National Program for Non-Communicable Diseases in
1997.
 The program had a unique arrangement between MoPH and WHO,
where the MoPH provides financial support through a special trust fund,
while being housed at and managed by the WHO Lebanon Office.
 The PHC Network was a successful example of collaboration with
partners to implement national programs and initiatives for the
prevention and control of NCD.
 Some 160 centers belonging to NGOs, municipalities, and to the Ministry
of Social Affairs are supported financially and logistically by the MoPH, to
implement NCD-related health services ranging from clinical services to
surveillance.
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7.  170 PHC facilities are Distributed all over the
Lebanese Territories based on a well defined
catchment area(5 Km)
 Provides a standardized package of essential
healthcare services based on Lebanese
Primary Care Standards developed in
collaboration with Accreditation Canada
International.
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9. 9
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10. Standards Sections
 Building an Effective Primary Care Clinic
 Maintaining a Safe Primary Care Clinic
 Having the Right People Work Together to
Deliver Care
 Delivering and Coordinating Primary Health Care
services
 Maintaining Accessible and Efficient Health
Information Systems
 Monitoring Quality and Achieving Positive
Outcomes
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11.  Accessibility
 Appropriateness
 Continuity of care
 Effectiveness
 Efficiency
 Safety
 Continuous Improvement of Performance
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12.  Basic: Addresses basic structures and processes
linked to the foundational elements of safety and
quality improvement in primary health care service
delivery
 Advanced: Builds on the foundational elements of
quality and safety, and emphasizes key elements of
client-centred care and consistency in the delivery
of services through standardized processes
 Excellence: Demonstrates a commitment to
excellence and leading the primary health care field
in terms of quality and safety
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13.  The MoPH, in partnership with a local NGO,
established since the late 1990s affordable
clinical services and free medicines for NCDs in
the PHC network.
 Currently, medicines for chronic conditions are
distributed free of charge to some 150,000
beneficiaries of the PHC network.
 This program is an important step towards :
◦ equitable access to essential medicines for NCD
patients,
◦ Being the venue of choice to integrate NCD prevention
and control in the PHC network,
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14. 1. Available at all times
2. In appropriate amounts
3. Timely accessible
4. At an Affordable cost: at both individuals and
community levels
5. In appropriate forms
6. In appropriate dosages (OD Vs QID)
7. Managed through appropriate logistic system.
8. Efficacious – potent (POEM)
9. Effective – as proven through controlled clinical trials
and cohort studies.
10. Efficient – in terms of cost benefit
11. Safe in terms of anticipated side effects
12. Convenient in terms of form, dosages, frequency, and
need for monitoring.
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15. How to secure the said criteria???
through an appropriate Management
Information System.To efficiently
Capture, Analyse, and use health data.
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18. • Ensures a communication track between various
partners (beneficiaries ,health facility, and MoPH)
• Permits the health center to register all
operations(medications requests and deliveries)
through online Web application between the health
center, MoPH and YMCA.
• Saves Electronic files of beneficiaries in a central
database .This would allow access to all pertinent
partners.
• Organizes the operation of securing drugs to
patients in regular cases as well as in emergency
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19. The magnetic band includes the
beneficiaries number and the
serial number of the card
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20. • To organize beneficiaries registration and regular
supply of chronic drugs in PHC facility network.
• To help refer patients with chronic diseases from
PHC facilities to governmental hospitals at district
level.
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21. Information system:
• Analyzing the current database and forms used in the program
• Designing and developing a MIS that enables the user to read the
magnetic cards and identify the patient from any connected outlet.
• Converting the data stored in the current database to the new system
Centers selection and Data Collection:
• The centers were selected in the pilot phase on the basis of enrolling
at least one healthcare center from each Qadha.(30 health centers in
phase I and 50 in phase II)
• Data collection of missing data in the current system (ID, Address,
Picture)
Infrastructure:
• The main central unit was equipped by servers, HDSL Internet
connection, Cards printer, …
• The targeted health centers were equipped with Card readers, Internet
Connection and IT equipment. R. Hamadeh MPH, CMC 21

22. Training:
• TOT for some focal points at district levels.(15 Trainers)
• Training of the people-in-charge in targeted centers on Information
system and in effective communication skills as well(around 74
trainees from 34 health outlets to date)
System Implementation:
• Data entry for drugs available in Health centers as part of inventory
preparation.
• Registration of beneficiaries and plans for follow-up setting.
• Issue health cards (63000 to date)
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23.  Chronic Drugs MIS :updated and in place.
 IT equipments (servers, PCs, Card readers, …):
procured and Installed for central level and
health outlets level
 Internet connection: secured for concerned
NGOs health centers and for governmental
ones.
 Personal data for 63000 beneficiaries achieved,
the rest is in process.
 On-site training sessions for healthcare outlets
and central training sessions to follow up
(additional TOTs on-going)
 System application: on-going update and
follow-up
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24. Lebanon has succeeded in decreasing deaths from NCDs before age 60 through
securing Essential Drugs for chronic diseases in PHC facility network .This rate
is about 25% in Lebanon compared to 40% as average in EMRO region
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