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“When I got sick, I couldn’t play. My heart would beat so fast. Since my heart surgery, I’m fine, and I can run and play.”

Meet João Mindo, a 14-year-old living with rheumatic heart disease in a rural area of northern Mozambique. João lives with his widowed mother and three siblings in a home with neither electricity nor plumbing. The family’s only means of support is his mother’s small-scale farming.

João’s health problems began in 2020. For three long years, he had difficulty walking, eating, and even breathing. It wasn’t until February 2023, when a PEN-Plus clinic opened at Nhamatanda Rural Hospital, 20 kilometers away from his home, that João finally received a diagnosis: rheumatic heart disease.

“We were told he needed surgery for his heart condition,” said João’s older brother, Lazaro. “My mother was heartbroken João had received such a serious diagnosis, and she had difficulty accepting that he needed surgery. I told her we had to pursue treatment for him.”

The severity of his condition meant João would have to travel 800 kilometers to the south, where he could undergo mitral valve repair surgery at ICOR (Heart Institute) in the capital city of Maputo.

Complicating matters was the fact that João’s family had lost their identification papers in 2019, when cyclone Idai devastated the area. Without those papers, João could not travel to Maputo.

“The lack of resources in the area often means we have to solve one problem before we can confront the next,” said Dr. Ana Mocumbi, a cardiologist who co-chairs the NCDI Poverty Network. “João didn’t have the identification papers required to fly in Mozambique, so we had to make him exist on paper before he could travel for his surgery.”

The PEN-Plus Partnership provided all the necessary support for João to undergo surgery, which included help in obtaining identification papers, travel arrangements to Maputo, and negotiating an agreement with Lazaro’s school to ensure he could continue his studies while accompanying his brother to Maputo.

João and Lazaro stayed in the capital for three months, during which João underwent a successful surgery and recovered well. The brothers are now back in their hometown with their mother.

Access to essential medicines is often a significant health barrier in rural Mozambique. The PEN-Plus program ensures that João has consistent access to lifesaving chronic care for his condition, including specialized treatment and medicine. This has not only improved his health but also alleviated his family’s financial pressures.

“I will forever be grateful that everything went well,” Lazaro said, “and I expect João to have a healthy life.”

In rural Mozambique, where noncommunicable diseases often go undiagnosed and untreated, João’s story highlights the importance of specialized treatment, access to lifesaving medication, and financial support to ensure that young people like João can defy the odds.

Written by Ivanilson Abilio, membership and engagement manager of the Maputo Co-secretariat of the NCDI Poverty Network.

As an infant, Tawonashe Mugura was always in and out of the hospital. Sometimes, he had difficulty breathing; other times, he was jaundiced. His body pains were so severe he cried constantly. The provincial hospital in Masvingo, Zimbabwe, treated his symptoms, but he still lacked a diagnosis.

Then, when he was nine months old, an aunt provided a critical clue: Three of her grandfather’s siblings had died of sickle cell disease. A test confirmed Tawonashe’s diagnosis.

Treatment for sickle cell reduced both Tawonashe’s crying bouts and hospitalizations. The hospital pharmacy did not have the needed medication, though, so his mother, a university assistant administrator, and his father, a primary schoolteacher, bought it from private pharmacies. The more than US$30 they spent monthly on medication alone represented more than a tenth of their combined income.

“The hospital bills and medication costs meant we barely had enough food for the family,” said his mother. “We couldn’t afford to pay for Tawonashe’s medical expenses and sustain the family.”

Tawonashe’s parents occasionally missed doses or underdosed their son to stretch the medicine for a few more days. He would be hospitalized several times a year with severe joint pain, difficulty breathing, abdominal pain, anemia, and chest pain. Those visits usually corresponded with the times he lacked adequate dosing.

In 2022, after presenting to the hospital with diabetic ketoacidosis, a potentially fatal condition, Tawonashe received a second diagnosis: type 1 diabetes. Fortunately, with insulin treatment, he was able to stabilize.

“Sometimes Tawonashe gets angry when his friends ask him why he goes to the hospital so often,” his mother said. “One question that broke me was when he asked why he was sick, yet his siblings and friends were always healthy. Apart from those moments, though, he’s positive and happy.”

In June 2023, Tawonashe enrolled in the PEN-Plus clinic at Masvingo Provincial Hospital. The clinic provides him with continuous pharmaceutical support, including hydroxyurea for his sickle cell disease, insulin for his diabetes, and pain medications. The nurses educate him about his illnesses, and he receives free routine laboratory and radiology tests.

“With this treatment, we hope to reduce both his sickle cell complications and his hospitalizations in general,” said Dr. Alvern Mutengerere, project manager for noncommunicable diseases at SolidarMed, the implementing partner for the PEN-Plus clinic in Masvingo. “Tawonashe is exactly the kind of patient for whom PEN-Plus was designed.”

PEN-Plus, an integrated healthcare delivery model, was originally designed in Rwanda in 2006 to provide lifesaving care to children and young adults living with severe, chronic noncommunicable diseases in extreme poverty. Nearly two dozen countries are now pursuing the model in collaboration with the NCDI Poverty Network. In addition, 47 member states of the World Health Organization’s African region have adopted it as their official strategy for treating people with severe NCDs.

“The PEN-Plus clinic has been a silver lining in our lives,” said Tawonashe’s mother, Stella Mugura. “I feel we got another chance to breathe. And I am thankful for our education about sickle cell; I thought it was a death sentence, but now we have hope.”

Tawonashe’s mother added that the clinic has relieved their financial pressures.

“PEN-Plus has lifted a huge burden from us,” she said. “The extended help from SolidarMed and the clinic reminds me of the meaning of my son’s name. In English, Tawonashe means ‘we have seen God.’ Indeed, we have seen God in our lives; thank you.”

Tawonashe—now ten years old and attending fifth grade—echoed his mother’s gratitude during a recent conversation at Masvingo Provincial Hospital, adding, “My dream of becoming a doctor will succeed because of PEN-Plus.”

The Center for Integration Science in Global Health Equity participated in an Africa CDC/African Union workshop, “Non-Communicable Diseases, Injuries, and Mental Health Surveillance: Situational Analysis and Peer Learning,”from 24 to 28July in Ghana.

Ministry of Health leaders in noncommunicable diseases and injuries (NCDI), mental health (MH) and surveillance from six countries¬—the Democratic Republic of Congo, Ghana, Morocco, Nigeria, Senegal, and Sierra Leone—attended the meeting.

Africa CDC/African Union is working to create a guidance document for assessing, developing, and implementing surveillance of noncommunicable diseases and injuries and mental health (NCDI/MH) for the continent. The Ghana workshop was the second one Africa CDC/African Union hosted to inform the development of the guidance document; the earlier one was held in Zambia.

Dr. Emmanuel Mensah, managing director of the Center for Integration Science and the West Africa regional advisor for the NCDI Poverty Network, helped facilitate the Ghana workshop in his role as a member of the high-level advisory committee on NCDI/MH for Africa CDC/African Union . He noted that the workshop was designed to:
• enable country-specific insights into the strengths and weaknesses of NCDI and mental health national surveillance activities;
• foster peer learning on NCDI and mental health surveillance among countries;
• support countries in their development of action points to strengthen the integration of national NCDI and mental health surveillance;
• cultivate awareness and collaboration among stakeholders to strengthen NCDI and mental health surveillance; and
• help boost the implementation of relevant infrastructure and governance for NCDI and mental health surveillance.

As part of the workshop, member state representatives completed a self-assessment of their surveillance program using tools that the Africa CDC/African Union NCDI team developed in collaboration with the Robert Koch Institute in Germany. Participants also visited the Center for Health Information Management System at the Ghana Health Service and the Accra Psychiatric Hospital.

“Public health surveillance is essential to monitor the burden of NCDIs,” said Dr. Mensah. “Such surveillance provides information required to help policymakers, researchers, and implementers make relevant decisions. Noncommunicable diseases and intervention surveillance across Africa Union member states has been challenging because of a lack of prioritization, inadequate funding, a shortage of trained personnel, and difficulty integrating with current health information systems.”

“This work will give member states the necessary tools to build and sustain efficient surveillance systems for NCDIs and mental health,” Dr. Mensah concluded.

The WHO Regional Office for Africa (WHO/AFRO) and the NCDI Poverty Network met in Accra, Ghana, from 17 to 19 July to discuss the region’s PEN-Plus implementation strategy.

In 2022, to alleviate the NCD burden in sub-Saharan Africa, WHO/AFRO adopted a landmark resolution to implement PEN-Plus, which provides diagnosis and treatment services at first-level referral hospitals for people living with severe NCDs, including type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease.

The meeting aligned key partners on the project implementation plan, which lays out principal benchmarks and goals. In attendance were leadership from the NCDI Poverty Network Secretariat (an initiative of the CIS), the PEN-Plus project manager for WHO/AFRO, WHO/AFRO technical leads, and representatives from WHO country offices in the region, including Ghana and Ethiopia.

The meeting agenda included a site visit to a first-level referral hospital and a district hospital in Ghana to understand better how patients with severe NCDIs are managed.

“Site visits and discussions with hospital leadership, care providers, and patients help to contextualize the PEN-Plus implementation strategy and understand the expected nuances in different countries,” said Dr. Emmanuel Mensah, managing director of the Center for Integration Science in Global Health Equity. “It was helpful for the team to see how patients with these severe NCDs are managed at various levels of care in Ghana.”

With a recent $9 million grant from the Helmsley Charitable Trust, WHO/AFRO is working to advance the implementation of PEN-Plus by:

• Developing communication materials in multiple languages to garner country support;
• Adapting NCD assessments and evidence-based tools for district-level healthcare facilities;
• Exploring sustainable financing frameworks to strengthen local governance;
• Integrating NCD care protocols to enable consistent and high-quality healthcare; and
• Designing an evaluation framework, including measurable key performance indicators.

As the WHO Collaborating Centre on Integration Science and Service Delivery, the Center for Integration Science in Global Health Equity will continue to work closely with WHO/AFRO to support member states on engagement, assessment, planning, and implementation for PEN-Plus. The center also serves as the Boston co-secretariat of the NCDI Poverty Network.

“The center’s collaboration with WHO is bolstering the fight against type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease,” said Dr. Gene Bukhman, executive director of the Center for Integration Science and a co-chair of the NCDI Poverty Network. “Access to PEN-Plus services will bridge the treatment gap across the region for people living with severe, chronic NCDs.”

Efforts to expand PEN-Plus across sub-Saharan Africa received a major boost when the Leona M. and Harry B. Helmsley Charitable Trust announced a $9 million grant to the World Health Organization Regional Office for Africa to expand care for people living with severe noncommunicable diseases (NCDs).

Following a landmark 2022 resolution to curb chronic diseases, WHO in Africa is leading the continent-wide implementation of PEN-Plus, a model that trains providers in remote communities to diagnose and treat a suite of severe NCDs, including type 1 diabetes, rheumatic and congenital heart disease, and sickle cell disease. Building on the model’s current success, the grant will support the efforts of WHO to scale and spread PEN-Plus to 20 selected African countries, with a goal of reducing deaths from severe NCDs by 15 percent within three years of implementation.

“Chronic diseases are projected to become the leading cause of death in sub-Saharan Africa by 2030,” said Dr. Matshidiso Moeti, WHO regional director for Africa. “To lower the burden, we’re working with countries to enhance the availability and quality of care for severe chronic diseases at district hospitals through the PEN-Plus strategy. The support from Helmsley will be key in the region’s efforts to bridge the gap in access to treatment and care and help reduce premature deaths from these diseases.”

With Helmsley’s funding, the WHO Regional Office for Africa will advance the implementation of PEN-Plus by:

• Developing communication materials in multiple languages to garner country support;

• Adapting NCD assessments and evidence-based tools for district-level healthcare facilities;

• Exploring sustainable financing frameworks to strengthen local governance;

• Integrating NCD care protocols to enable consistent and high-quality healthcare; and

• Designing an evaluation framework, including measurable key performance indicators.

The Helmsley Charitable Trust has supported the development of PEN-Plus since 2014 through Partners In Health, the NCDI Poverty Network, and the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital. As the world’s largest private philanthropic funder of type 1 diabetes programs, Helmsley is committed to shaping markets for essential medicines and expanding integrated systems of care through its Global Access portfolio.

“At Helmsley, we build partnerships that center people — not diseases — and that strengthen whole health ecosystems,” said Gina Agiostratidou, program director for type 1 diabetes at the Helmsley Charitable Trust. “WHO Africa’s diverse NCD programming and regional expertise make them an ideal partner in our mission to ensure that everyone with a severe NCD has access to quality care and support — no matter where they call home.”

The PEN-Plus model complements the WHO Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care by equipping nurses and mid-level providers with the skills to effectively treat severe chronic NCDs and ensuring the availability of lifesaving medicines and supplies. In collaboration with Rwanda’s Ministry of Health, Partners In Health first introduced the model at two rural hospitals more than a decade ago. PEN-Plus proved so successful that the Rwandan Ministry of Health expanded it to every district hospital in the country.

With support from the NCDI Poverty Network, an additional 13 global partners — Chhattisgarh State in India, Ethiopia, Haiti, Kenya, Liberia, Malawi, Mozambique, Nepal, Sierra Leone, Tanzania, Uganda, Zambia, and Zimbabwe — have since implemented PEN-Plus in at least one district-level clinic. Another eight countries — Bangladesh, Benin, Burkina Faso, Cambodia, Cameroon, the Democratic Republic of Congo, Ghana, and Nigeria — have begun initiating PEN-Plus.

With the new grant, WHO Africa will significantly extend the geographic reach of PEN-Plus.

“PEN-Plus has proven its value for expanding lifesaving care in resource-limited areas,” said Dr. Ana Mocumbi, co-chair of the NCDI Poverty Network. “In Rwanda, we watched the model’s impact grow exponentially when the Ministry of Health integrated PEN-Plus into its national strategy for NCD care. Under WHO Africa’s leadership, we cannot wait to see the model create new pathways to critical care for communities across the continent.”

In May 2023, Helmsley separately announced $10 million to support the implementation of the Global Diabetes Compact through the World Health Organization in Geneva. Together, these grants aim to advance progress in diabetes diagnosis and care on both global and national levels.

“Where a child lives should not determine whether a child lives,” declared Dr. Apoorva Gomber, associate advocacy director for the NCDI Poverty Network. “And yet children with type 1 diabetes in rural areas of sub-Saharan Africa often die within a year of diagnosis. This reality is morally unconscionable.”

Dr. Gomber delivered those statements at the Multi-Stakeholder Hearing on Universal Health Coverage, held on May 9 in the United Nations Headquarters in New York City. Selected organizations were allowed to deliver two-minute testimonies during an afternoon session; Dr. Gomber represented the NCDI Poverty Network in her testimony.

A physician trained in global health centered around type 1 diabetes, health equity, and disease epidemiology, Dr. Gomber also serves as associate advocacy director for the network’s Boston co-secretariat, the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital. As a long-time advocate for the treatment of type 1 diabetes, Dr. Gomber also works toward overcoming both health inequities in diabetes care globally and the stigmatization of people with diabetes.

“It’s past time that we form a global movement to better serve people doubly afflicted by NCDs and extreme poverty,” Dr. Gomber said, in concluding her United Nations testimony. “The international community can make the fight against disease more equitable and just through leadership, policies, and funding that prioritize NCDs within universal health coverage.”

The World Heart Federation has presented its Outstanding Contribution to Cardiovascular Health Award to Drs. Gene Bukhman and Ana Mocumbi, co-chairs of the NCDI Poverty Network. The presentation took place in May at the World Heart Awards ceremony in Geneva.

The two cardiologists were celebrated in part for their work as co-chairs of the groundbreaking Lancet Commission on Reframing NCDs and Injuries for the Poorest Billion. The commission launched in 2016 to address the crushing burden of noncommunicable diseases (NCDs) and injuries on the world’s poorest people.

In addition to its many findings, the commission highlighted the need for expanded financing and technical partnerships to address this burden. The commission also catalyzed the formation of the NCDI Poverty Network, which aims to prevent and reduce the death and suffering of those doubly afflicted by NCDs and extreme poverty. Drs. Bukhman and Mocumbi now co-chair the network.

Dr. Bukhman, who directs the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital, is an anthropologist as well as a cardiologist. He also serves as director of the Program on Global Noncommunicable Disease and Social Change at Harvard Medical School, where he is an associate professor of medicine and an associate professor of global health and social medicine. He is also the senior health and policy advisor on NCDs at Partners In Health. Between 2010 and 2015, he served as senior technical advisor on NCDs to the Rwanda Ministry of Health.

Over the past 15 years, Dr. Bukhman has argued that for those living in extreme poverty, NCDs are best understood as part of the “long tail” of global health equity, one that demands a new science of integration. He has translated this critique into practical health delivery strategies now being implemented in more than a dozen countries. He has authored more than a hundred peer-reviewed publications and book chapters that apply a range of methodologies — from ethnography and archival research to epidemiology and mathematical modeling — to identify solutions for people living in poverty with severe NCDs.

“It’s an honor to be recognized for carrying on in the tradition of African cardiologists focused on diseases of poverty,” Dr. Bukhman said. “We’re optimistic that by working together with the type 1 diabetes and sickle cell disease communities, we can finally make significant progress on these neglected conditions.”

Dr. Bukhman’s fellow awardee, Dr. Mocumbi, is both an associate professor of cardiology at Universidade Eduardo Mondlane in Maputo, Mozambique, and an affiliated professor in the Department of Global Health at the University of Washington in Seattle. Based in Mozambique, she also leads the Non-Communicable Diseases Division at the National Public Health Institute Mozambique (Instituto Nacional de Saúde).

Although Dr. Mocumbi’s research interests are broad, spanning from education to health management to clinical research, her particular focus is on neglected cardiovascular diseases, including cardiomyopathies and heart failure in children; women’s cardiovascular health; and the use of point-of-care technologies for improving access to health care in low-income settings.

Dr. Mocumbi serves as co-chair of the Taskforce for Access to Reproductive Health Services for Women with Cardiovascular Disease of the Pan African Society of Cardiology, as well as co-chair of the World Heart Federation’s Working Group on Rheumatic Heart Disease Prevention and Control.

“Merci à tous! Thank you!” Dr. Mocumbi said to a group of NCDI Poverty Network members upon being congratulated on the honor. “But this award belongs to all of us. Without you this would not be possible.”

The World Heart Awards celebrate individuals and organizations who have gone above and beyond in their mission to fight cardiovascular disease and promote healthy hearts.

The Center for Integration Science in Global Health Equity has been named a WHO Collaborating Centre in recognition of its work in designing integrated care delivery systems for people living with severe noncommunicable diseases in extreme poverty.

 

Childhood heart diseases, type 1 diabetes, and sickle cell disease customarily fall into disparate clinical specialties. Even so, those conditions share certain disheartening characteristics: They’re all severe, chronic noncommunicable diseases that cannot be prevented. Their treatment protocols are complex. And, when left untreated, they kill the world’s poorest children and young adults at devastating rates.

Fortunately, these diseases also share a clinical cadence, and it’s in that pattern of services that the field of integration science can offer a solution. In this instance, the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital has been working with an international network to integrate expertise and resources across these diseases to save young lives in rural sub-Saharan Africa and South Asia, where 90 percent of the world’s poorest people live.

For its leadership work in integration science, the Center for Integration Science was recently named the WHO Collaborating Centre on Integration Science and Service Delivery. With this designation from both the World Health Organization and the Pan American Health Organization, the center joins a global network of organizations supporting WHO initiatives.

“We’re honored that both the World Health Organization and the Pan American Health Organization are recognizing our work,” said Gene Bukhman, MD, PhD, executive director of the Center for Integration Science. “We also appreciate the value they’re placing on integration science, a relatively new field that has tremendous potential for delivering care to the people who need it most, which is an essential ingredient in achieving global health equity.”

In many low- and lower-middle income countries, care services for severe, chronic noncommunicable diseases are available only at referral hospitals in major cities, making treatment both inaccessible and unaffordable for the rural poor. As a result, many children and young adults die prematurely — and preventably. The model the Center for Integration Science principally uses, PEN-Plus, addresses this gap by bringing lifesaving care to first-level rural hospitals.

In aiming for an optimal configuration of health care resources, PEN-Plus trains mid-level providers such as nurses and clinical officers to provide crucial services across these diseases. Last summer, all 47 member states of the WHO Regional Office for Africa adopted PEN-Plus as their official strategy for providing care for people with severe noncommunicable diseases.

As part of its WHO Collaborating Centre mandate, the Center for Integration Science will provide technical support to WHO’s work in characterizing and classifying existing models of integrated care for noncommunicable diseases, collaborate with WHO in the integrated care of these diseases in selected countries, and share best practices and lessons learned in the implementation of integrated care of these diseases. The WHO Collaborating Centre designation is slated to continue through April 2027.

The Center for Integration Science is a joint initiative of Brigham and Women’s Hospital, Harvard Medical School, and Partners In Health. In addition to pursuing an ambitious research agenda, the center serves as the Boston co-secretariat of the NCDI Poverty Network, a global partnership that seeks to bridge the gap in universal health coverage for the world’s poorest billion.

The only other current Harvard-affiliated WHO Collaborating Centre — the Program in Global Surgery and Social Change — is also based at both Harvard Medical School and Brigham and Women’s Hospital. Past Harvard-affiliated WHO Collaborating Centres include three at the Harvard T.H. Chan School of Public Health (one on the biostatistical evaluation of cancers from  1981 to 1994, one on health legislation from 1987 to 2004, and one on nutritional epidemiology and advanced training in public health nutrition from 1993 to 1999); one at Brigham and Women’s Hospital (on surveillance of antimicrobial resistance from 1985 to 2021); and one at Harvard Medical School (on research and training in mental health from 1987 to 1994).

 

The stark realities of living with severe noncommunicable diseases in extreme poverty became clear to members of the High-Level Advisory Group of the PEN-Plus Partnership when they convened in Mozambique in March to discuss strategies for supporting initiation and scale-up of PEN-Plus in resource-poor countries.

PEN-Plus is an integrated care model that provides diagnosis and treatment for severe NCDs in rural areas of low- and lower-middle-income countries, where more than 90 percent of the world’s poorest people live.

During the three-day meeting, participants visited the new PEN-Plus clinic and training center in Nhamatanda, nearly 800 kilometers north of the capital city of Maputo. The trip provided the participants with the opportunity to meet firsthand those livning with severe NCDs as well as their caregivers.

The plight of the rural poor was underscored for participants when they met with a 14-year-old boy recently diagnosed with rheumatic heart disease. The boy had presented at the PEN-Plus clinic with severe breathing difficulty soon after the clinic opened in February. Upon listening to the boy’s chest, the cardiologists in the group—including the co-chairs of the NCDI Poverty Network, Drs. Gene Bukhman and Ana Mocumbi—immediately realized he had a heart murmur indicative of a serious condition.

At the time of the group’s visit, arrangements were being made for the boy to undergo additional testing and mitral valve repair surgery in Maputo. The matter was complicated, however, by the 900-kilometer distance from the family’s home to the capital city.

On the nearly two-hour drive from Nhamatanda back to the airport, Advisory Group members peppered Dr. Mocumbi with questions about the boy’s future.

“Welcome to Ana’s World, where you have to solve one problem before you can confront another,” she responded. “He doesn’t have the identification papers required to take a flight in Mozambique. So we need to make him exist on paper before he can even travel for his surgery.”

Compounding the boy’s situation is his family’s extreme poverty. The boy lives with his widowed mother and three siblings 20 kilometers from Nhamatanda in a home with neither electricity nor plumbing. The family’s only means of support is his mother’s small-scale farming.

Fortunately, the PEN-Plus clinic provides the boy with additional social support, including money to travel to Nhamatanda for his monthly checkups and a cell phone to enable follow-up calls with his care provider. After his heart operation, the clinic will continue to provide him with the anticoagulation medicine he will need to take for the rest of his life.

“The Nhamatanda PEN-Plus clinic just opened in February,” said Dr. Mocumbi, “and it’s already saving lives.”

Unfortunately, the difficulties the boy’s family faces are familiar to many people living with severe NCDs in rural Mozambique and other low-income areas where PEN-Plus clinics provide health services.

Those difficulties were exactly why representatives from the organizations that compose the High-Level Advisory Group—including the Helmsley Charitable Trust, JDRF International, UNICEF, the World Health Organization Regional Office for Africa, the American Heart Association, the Foundation of Cardiovascular Care in Africa, and the World Diabetes Foundation—had gathered in Mozambique.

In addition to their Nhamatanda visit, members of the group met in Maputo—where the Network’s co-secretariat at Universidade Eduardo Mondlane hosted the event—to review an initial draft of the PEN-Plus Partnership’s strategic plan. The final plan will both clarify the role of PEN-Plus in the global NCD landscape and outline expansion strategies for 2025–2028.

The need to improve the quality and reach of PEN-Plus services was a clear theme throughout the meeting.

“Seeing firsthand the challenges of those living with severe NCDs in extreme poverty underscored for everyone the urgent need to support health systems in low-resource settings, especially in rural areas where health inequities are so stark,” said Dr. Bukhman.

Dr. Mocumbi agreed.

“Integrated care delivery strategies like PEN-Plus make it possible not just to improve access to health care in underserved communities,” she said, “but also to save lives.”