Short (6-minute) video introduces the PEN-Plus model for decentralizing integrated chronic care services for type 1 diabetes, sickle cell disease, rheumatic heart disease, and other severe NCDs that cause tens of thousands of avoidable deaths every year among the world’s poorest children and young adults. Video includes statements of support from leaders of WHO/AFRO, which has adopted a regional strategy to implement PEN-Plus continent-wide, UNICEF, WHO headquarters, the World Bank, and the Helmsley Charitable Trust.
Chantelle Boudreaux, Prebo Barango, Alma Adler, Patrick Kaobre, Amy McLaughlin, Mohamed Ould Sidi Mohamed, Paul H. Park, Steven Shongwe, Jean Marie Dangou, Gene Bukhman
Health Policy and Planning 2022
Severe chronic non-communicable diseases (NCDs) pose important challenges for health systems across Africa. This study explores the current availability of and demand for decentralization of services for four high-priority conditions: insulin-dependent diabetes, heart failure, sickle cell disease, and chronic pain. Countries reported widespread gaps in service availability at all levels. We found that just under half (49%) of respondents report that services for insulin-dependent diabetes are generally available at the secondary level (district hospital); 32% report the same for heart failure, 27% for chronic pain and 14% for sickle cell disease. Reported gaps are smaller at tertiary level (referral hospital) and larger at primary care level (health centres). Respondents report ambitious plans to introduce and decentralize these services in the coming 5 years. Respondents from 32 countries (86%) hope to make all services available at tertiary hospitals, and 21 countries (57%) expect to make all services available at secondary facilities. These priorities align with the Package of Essential NCD Interventions-Plus. Efforts will require strengthened infrastructure and supply chains, capacity building for staff and new monitoring and evaluation systems for efficient implementation. Many countries will need targeted financial assistance in order to realize these goals. Nearly all (36/37) respondents request technical assistance to organize services for severe chronic NCDs.
This 11-minute video shows how decentralizing and integrating chronic care services for type 1 diabetes, sickle cell disease, rheumatic and congenital heart disease, and other severe NCDs has brought lifesaving care to poor rural communities in Rwanda, Malawi, and Haiti … and how this PEN-Plus model is now expanding to other lower-income countries in Africa and South Asia.
Progressive Decentralization and Integrated Care Teams –
Keys to Bridging the Gap in Services for NCDs and Injuries
Non-communicable diseases and injuries (NCDIs) account for a large and growing proportion of the burden of disease in all World Health Organizations (WHO) regions, including in low- and lower-middle-income countries (LLMICs). Among the world’s poorest billion people, NCDIs cause almost 800,000 deaths under the age of 40 every year – more than HIV, tuberculosis, and maternal deaths combined.
Proven, cost-effective, and equitable NCDI interventions exist that could save millions of lives each year, if scaled to reach everyone in need. But in many LLMICs, these interventions are available only at referral hospitals in capital cities, which makes them inaccessible and unaffordable for the rural poor.
The key to achieving both Universal Health Coverage and Sustainable Development Goal targets for reducing mortality from NCDIs is to develop and implement strategies for progressive decentralization and integrated service delivery that can deliver these interventions, with quality, at lower levels of the health system and in rural areas.