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.”