On September 7, 2022, the Department of Family Medicine at the American University of Beirut (AUB), the Primary Healthcare Department at the Ministry of Public Health (MoPH), and the World Diabetes Foundation (WDF) held a national stakeholder meeting to discuss the current situation of Non-Communicable Diseases (NCDs) in Lebanon and the challenges faced by NCD patients. This meeting is part of a four-year project entitled “Bridging the Gap: Advancing an Integrated NCD-humanitarian Response for Refugees and Host Communities in Lebanon 2021–2024" that aims at improving the prevention and management of NCDs in the country. This project is implemented by AUB and MoPH and funded by a generous grant from WDF with support from the Novo Nordisk Foundation.
Representatives from ministries, the World Health Organization (WHO), United Nations agencies, international and local non-governmental organizations, primary health care centers, academic institutions, scientific societies, and patients' advocacy groups attended the meeting. The participants were divided in working groups tackling different themes related to access to care, self-management, NCD prevention and health promotion, treatment guidelines, research, and digital health. NCDs, including diabetes mellitus and hypertension, are a major public health problem in Lebanon leading to high morbidity and mortality rates; moreover, NCD risk factors such as smoking, lack of physical activity, and unhealthy diet are on the rise.
The main challenges that face NCD patients currently are limited access to medications and medical care. In fact, the multifaceted crisis that Lebanon is facing including political instability, economic crisis, major devaluation of the local currency, increasing poverty level, considerable lifting of the subsidization on medications, electricity and fuel shortage, and major brain drain of doctors and nurses had its impact on NCD care. The primary health care centers were able to respond and fill a gap for NCD patients through ensuring access to affordable consultations and free chronic medications; yet, other challenges still exist. These include the lack of national NCD prevention and management guidelines, gaps in the supply chain of medications and other needed medical supplies, shortages in and high turnover of healthcare providers, lack of enough peer-to-peer support programs, difficulty in changing health providers prescribing behaviors, as well as patients' behaviors.
The participants suggested a list of recommendations that can help improve the NCD care in the country. These include strengthening the primary healthcare centers, ensuring continuous funding for chronic medications, setting unified NCD prevention guidelines that take the current situation into consideration, adapting international NCD management guidelines to local settings, task shifting from specialists to primary care physicians, capacity building of primary healthcare providers, establishing bridging programs for healthcare providers, better coordination among relevant stakeholders, better communication and access to available quality evidence-based information and resources, encouraging peer-to-peer support groups and patient-led organizations, educating patients on self-management, integrating person-centered approach in the care of NCD patients, and using digital health in provision of care, etc.
It is worth noting that the project that AUB and MoPH are working on cover many of the above-mentioned recommendations. Overview of the project is highlighted below.
Briefing of the project
Goals of the Project
- To increase knowledge and skills of target population on the prevention and management of health risks related to NCDs through adoption of healthy lifestyle and early detection of NCDs
- To empower those suffering from NCDs among target population on self-management
- To improve access of target population to high quality integrated NCD services in the primary healthcare centers included in the MoPH primary health network
- To build the capacity of primary healthcare facilities in delivering evidence based high quality NCD services
- To conduct operational research that enhance NCD care and apply findings to advocate the bridging of gaps between NCDs responses and humanitarian frameworks
Project at a Glance
The project will implement its different activities through the network of primary healthcare centers targeting 230 centers. Main components include:
- Operational research: a baseline assessment of the quality of NCD services provided at the primary care level help defining the quality of the NCD services provided and highlight the needs and the gaps at the level of the primary healthcare centers.
- Improved management of NCD patients in primary healthcare centers: this includes building the capacity of healthcare providers (physicians and nurses) in the provision quality person-centered care to patients with diabetes mellitus and hypertension. Moreover, a package of defined health services will be offered to these patients to enhance their access to healthcare.
- Prevention, improved community awareness, and screening for NCD: through organizing outreach activities and NCD awareness campaigns during the lifetime of the project. The aim is to detect early patients suffering from diabetes mellitus and hypertension and increase the awareness of the public on the importance of prevention and management of risk factors (smoking, low physical activity, etc.).
- Patients' empowerment: patients with diabetes mellitus and hypertension will be educated about self-management through different activities conducted in the primary healthcare centers.
- Quality improvement/strengthening primary healthcare centers: this includes the revision of the policies and procedures at the level of primary care and conducting mock surveys as part of the MoPH accreditation program.
- Advocacy at the national level: this includes contribution to the update of the national NCD Prevention and Control Plan (NCD-PCP), development of registry for diabetes mellitus and hypertension, and holding several national meetings with relevant stakeholders.