Essential Medicines Program In Lebanon

R. Hamadeh MPH, CMC 1

Essential Medicines Program In Lebanon

Randa Hamadeh MPC, CMCHead, PHC department

Immunization and Essential Drugs Program Manager

Ministry of Public HealthLebanon

September 2012


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

OUTLINES

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Country Profile

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%palestineR. Hamadeh MPH, CMC


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.

What is Peculiar about Lebanon?


Proportional Mortality(% of all death, all ages)


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.

Response to NCD Burden


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.

Just a small window on PHC network in Lebanon


9R. Hamadeh MPH, CMC


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

Lebanese Primary Care Standards(developed in cooperation with Accreditation Canada International)


Accessibility Appropriateness Continuity of care Effectiveness Efficiency Safety Continuous Improvement of Performance

Measures of Quality


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

A step by step approach to accreditation


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,

Successful examples


1. Available at all times2. In appropriate amounts3. Timely accessible 4. At an Affordable cost: at both individuals and community levels 5. In appropriate forms6. 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 benefit11. Safe in terms of anticipated side effects12. Convenient in terms of form, dosages, frequency, and need for

monitoring.

Challenges: distribution mechanism while respecting the criteria that essential chronic drugs should fulfill?


How to secure the said criteria???

through an appropriate Management Information System.To efficiently Capture, Analyse, and use health data.




System main functions

• 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 cases.


The CARD

The magnetic band includes the beneficiaries number and the

serial number of the card


Objectives

• 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.


Preparatory steps 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.


Preparatory steps(cont’d)

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)


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

Achievements

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Deaths from NCDs before age 60 in the EMR (percentage of total NCD deaths in 2008)

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

R. Hamadeh MPH, CMC


Next Steps?1- Continue linking PHC network with the NCD package that is already functional through MoPH chronic drugs program and specialist referral consultations available in the center.In the future include network of dispensaries-not housing the drug program, private general and family practice clinics.

2-To strengthen the NCD initiative with pharmacies that are a privileged healthcare encounter and are the frontline healthcare providers, especially in poor and rural areas.


Thank you

Health & Medicine

Essential Medicines Program In Lebanon