Essential Medicines Program In Lebanon


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  • Sections of the Lebanon Primary Care Standards
  • The following seven Measures of Quality are woven throughout the Lebanese Primary Car Standards and each criterion is linked to a dimension:1. Accessibility Through ensuring availability, affordability, and acceptability of services.2. Appropriateness In relation to the needs and expectations of both clients and service providers,considering current state-of-art and efficacy.3. Continuity of care For clients across all healthcare providers and various levels of care over time,from prevention to cure, to wellness and health promotion.4. Effectiveness Through ensuring provision of the right service to the right client, the right way, atthe right time.5. Efficiency Through optimizing skills and minimizing duplication in services.6. Safety Through protection and risk management of clients, the community, serviceproviders, and property in a learning environment.7. Continuous Improvement of PerformanceCompared to current established standards and leading healthcare "industry“ benchmarks
  • The standards are designed to provide organizations that are new to accreditation with the building blocks of qualityand at the same time, provide them with a guide toward excellence. Recognizing that organizations may be atdifferent points along the excellence continuum, the primary care services Measures of Quality are distributed amongthe following three levels: Basic, Advanced and Excellence.
  • Essential Medicines Program In Lebanon

    1. 1. Randa Hamadeh MPC, CMC Head, PHC departmentImmunization and Essential Drugs Program Manager Ministry of Public Health Lebanon September 2012 R. Hamadeh MPH, CMC 1
    2. 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 R. Hamadeh MPH, CMC 2
    3. 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% R. Hamadeh MPH, CMC palestine 3
    4. 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. R. Hamadeh MPH, CMC 4
    5. 5. R. Hamadeh MPH, CMC 5
    6. 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. R. Hamadeh MPH, CMC 6
    7. 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. R. Hamadeh MPH, CMC 7
    8. 8. R. Hamadeh MPH, CMC 8
    9. 9. 9R. Hamadeh MPH, CMC
    10. 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 R. Hamadeh MPH, CMC 10
    11. 11.  Accessibility Appropriateness Continuity of care Effectiveness Efficiency Safety Continuous Improvement of Performance R. Hamadeh MPH, CMC 11
    12. 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 R. Hamadeh MPH, CMC 12
    13. 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, R. Hamadeh MPH, CMC 13
    14. 14. 1. Available at all times2. In appropriate amounts3. Timely accessible4. At an Affordable cost: at both individuals and community levels5. 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. R. Hamadeh MPH, CMC 14
    15. 15. How to secure the said criteria???through an appropriate Management Information System.To efficiently Capture, Analyse, and use health data. R. Hamadeh MPH, CMC 15
    16. 16. R. Hamadeh MPH, CMC 16
    17. 17. R. Hamadeh MPH, CMC 17
    18. 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 cases. R. Hamadeh MPH, CMC 18
    19. 19. The magnetic band includes the beneficiaries number and the serial number of the card R. Hamadeh MPH, CMC 19
    20. 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. R. Hamadeh MPH, CMC 20
    21. 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 systemCenters 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. 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) R. Hamadeh MPH, CMC 22
    23. 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 R. Hamadeh MPH, CMC 23
    24. 24. Lebanon has succeeded in decreasing deaths from NCDs before age 60 throughsecuring Essential Drugs for chronic diseases in PHC facility network .This rateis about 25% in Lebanon compared to 40% as average in EMRO region 24 R. Hamadeh MPH, CMC
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