Managing Bronchial Asthma in Primary Health Care (PHC) in Syria as Example of Middle Income Developing Country: An Expert Opinion

Introduction In Syria, the official primary health care facilities are dispensaries under the governance of Ministry of Health, and hosting WHO programs. But In reel practice, PHC is also part of emergency rooms, outpatient general clinics in public hospitals; school health dispensaries; manufactories’ clinics; and Internal and General Clinics of the private sector. Asthma patients present most often for treatment in any of these primary care facilities. A multicenter survey showed that 13% of patients > 6 years old presenting to primary care have asthma. An other showed that 51% of asthma patients are treated only in emergency rooms. There is also over prescription of oral corticosteroids and antibiotics and under-prescription of Inhaled corticosteroids following GINA guidelines. But a Pilot program to test the feasibility of a methodic follow up of uncontrolled asthma patients in a general free of charge hospital showed that it is possible to achieve asthma control following to GINA guidelines even in very deprived areas. Accordingly we recommend training sessions for the essential on asthma needs for health workers at primary care level. This needs to adapt educational materials. To Audit and evaluate continuously. Collaboration with WHO-GARD is an asset. According to the International Study for Asthma and Allergies in Childhood, 5.2% of children in Syria have asthma [1]. According to the World Health Organization-Global Alliance Against Chronic Respiratory Diseases (WHO – GARD) multicenter survey,13% of patients treated at primary care level have asthma in Syria [2]. In Syria, the official primary health care facilities are dispensaries under the governance of Ministry of Health (MOH), and hosting WHO programs (1465 dispensaries for 23 million inhabitants). But In reel practice, PHC is part of emergency rooms (ER) and outpatient general clinics in public hospitals; school health clinics and dispensaries; manufactories’ clinics; Internal and General Clinics of the private sector. Asthma patients present most often for treatment in any of these primary care facilities. As participant in an international survey of the Union in 2006: 9% of asthma patients were treated in PHC dispensaries of MOH, 51% are treated only in ED [3]. Patients who can afford it have the right to directly access specialized private pulmonologists, without referral from primary care. Public health facilities of PHC are free of charge although physicians (But not nurses) working in dispensaries share their time between public and private. Since 2oo6 programs for asthma and COPD have been adopted at primary care level in Syria [4-7]. We feel it is worthwhile to share our experience from a developing country: Following we will expose first what we learned from surveys; Second National Programs, Third Core messages from health surveys and from our experience in implementing national programs, then we will present the situation of asthma management failure in other countries and regions, and we will end by the conclusion. Citation: Yousser Mohammad. “Managing Bronchial Asthma in Primary Health Care (PHC) in Syria as Example of Middle Income Developing Country: An Expert Opinion”. EC Pulmonology and Respiratory Medicine 1.S1 (2015): S1-S5. Managing Bronchial Asthma in Primary Health Care (PHC) in Syria as Example of Middle Income Developing Country: An Expert Opinion