Experts Focused on PEN-Plus in Southern Africa During International Conference on Public Health in Africa

Panelists from left to right: Evelyn Chibwe, Bavin Mulenga, Ana Mocumbi, Yolanda Marcelino, Alvern Mutengerere, and Peter Karoli.

The NCDI Poverty Network and the Centre for Infectious Disease Research in Zambia (CIDRZ) hosted a side event, “PEN-Plus Partnership: An NCDI Poverty Network Initiative in Partnership with WHO/AFRO,” on 29 November at the 3rd International Conference on Public Health in Africa, held in Lusaka, Zambia.

During the event, experts from Southern Africa shared their experiences implementing PEN-Plus, a proven model for delivering healthcare to people living with severe, chronic, noncommunicable diseases (NCDs) in resource-limited settings. The event featured two panel discussions in which presenters detailed the national scaleup of PEN-Plus in Malawi as well as PEN-Plus implementation in Mozambique, Tanzania, Zambia, and Zimbabwe.

The first panel discussion focused on national experiences with PEN-Plus implementation. Dr. Yolanda Marcelino, a family doctor who directs the Family Medicine Residency Program at Universidade Eduardo Mondlane in Maputo, shared Mozambique’s experiences in implementing PEN-Plus. During her presentation, she identified several important issues that have arisen during her work as a mentor to providers at the PEN-Plus clinic in Nhamatanda: community screening strategies, the training of healthcare workers, and education about NCDs for teachers and students in the local schools.

Dr. Peter Karoli, a medical research scientist at the National Institute for Medical Research in Dar es Salaam, presented on decentralizing care through mentorship systems. He also discussed Tanzania’s process for determining which conditions to prioritize.

Dr. Alvern Mutengerere—project manager for noncommunicable diseases at SolidarMed, the implementing partner for PEN-Plus in Masvingo, Zimbabwe—shared PEN-Plus implementation successes and challenges in that nation.

“PEN-Plus is bridging a gap in healthcare by making specialized care for severe, chronic conditions accessible,” said Dr. Mutengerere. “PEN-Plus offers individualized education, where the healthcare worker teaches individual patients how to care for themselves. For people living with type 1 diabetes, the PEN-Plus care provider will show them how to inject their insulin and monitor their condition at home.”

During the second panel discussion, Evelyn Chibwe, a nurse specializing in noncommunicable diseases at Abwenzi Pa Za Umoyo (APZU/Partners In Health Malawi), spoke on the success of the PEN-Plus program in Malawi. She noted that Malawi opened its first PEN-Plus clinic in the rural Neno district in 2018 but has since established six more clinics. Her remarks on the powerful impact of health education and mentorship mirrored those of the earlier panelists.

“One of Malawi’s early wins was educating people about noncommunicable diseases, and that momentum allowed us to expand the PEN-Plus program,” Chibwe said. “We’ve trained community health workers to educate the community on noncommunicable conditions, screen community members, and refer them to the clinic if necessary. Another factor in our success has been the involvement of specialists in Malawi, who serve as mentors to clinicians at district hospitals.”

A key theme arose during the second panel: the benefits of the PEN-Plus program’s patient-centric approach. Dr. Bavin Mulenga, a clinical research fellow at CIDRZ, noted that the PEN-Plus clinic in Matero, Zambia, has achieved an 85 percent patient retention rate.

“We developed registers to track missed visits and patients we haven’t been able to follow up with,” said Dr. Mulenga. “We will call a patient to check in when they miss an appointment at the clinic. We will visit them at home if we don’t hear from them to ensure they receive care. Because these are severe, chronic conditions, even after the patient is stabilized, we need to make sure we keep them in care to avoid complications and long-term disabilities.”

Chibwe echoed Dr. Mulenga’s appreciation for putting people living with NCDs first. “A key factor in the success of the PEN-Plus model is patient-centric care,” she said. “PEN-Plus considers each patient individually because each patient has different circumstances and unique comorbidities.”

Professor Fastone Goma, director of the Centre for Primary Care Research at the University of Zambia School of Medicine, and Dr. Ana Mocumbi, co-chair of the NCDI Poverty Network, organized and moderated the event.

“We have heard how the PEN-Plus program differs from country to country,” concluded Dr. Mocumbi, “but in every country, PEN-Plus is built on an agenda of equity.”