The BMJ Highlights Opportunity to Save Lives Through PEN-Plus

Clinicians tour the site of a future PEN-Plus clinic at Atutur Hospital in Uganda.

An opinion article published this month in The BMJ spotlights the PEN-Plus strategy as a new hope for improving chronic disease care in sub-Saharan Africa.

The editorial—coauthored by Dr. Matshidiso Moeti, the World Health Organization’s regional director for Africa, and Drs. Gene Bukhman and Ana Mocumbi, NCDI Poverty Network co-chairs—describes how PEN-Plus can help rectify the long-term healthcare inequities that have resulted in countless avoidable deaths from chronic diseases in sub-Saharan Africa.

“Inequity has always been one of the biggest health concerns in African countries,” write the authors. “For decades, we’ve witnessed the tragedy of African people in low-income countries dying of severe, chronic noncommunicable diseases because they can’t access the care readily available in higher income countries. Fortunately, thanks to a promising new strategy called PEN-Plus, we are on the brink of a change that could save hundreds of thousands of lives—but only if African countries and the world rise to the occasion.”

The authors go on to identify several factors that have characterized previous breakthroughs in healthcare and equity in sub-Saharan Africa: an innovative strategy for delivering care, the political will to scale that strategy, a strong social movement that demands action, and the resulting global solidarity to mobilize resources.

The authors add that PEN-Plus has tremendous promise for being such a breakthrough: “Data have shown a 10-fold expansion in the number of patients receiving care for severe chronic conditions in health systems implementing PEN-Plus.”

PEN-Plus alleviates the burden of noncommunicable diseases (NCDs) in low- and lower-middle-income countries by improving the accessibility and quality of care services. The program provides nurses and other mid-level providers with the training, equipment, and medicines to treat severe chronic conditions in rural communities.

“PEN-Plus decentralizes the expertise and equipment required to treat severe non-communicable diseases and expands the footprint of available care beyond larger hospitals, making care more accessible to people who don’t live in cities,” the authors write in the opinion. “The innovation lies in training the district health workforce to provide essential cardiac, endocrine, and hemoglobinopathy services in smaller clinic settings, lowering geographic barriers to access.”

The opinion notes that Rwanda has been the leader in PEN-Plus implementation, originating the program in three rural hospitals and expanding it to every district hospital in the country. Malawi has since forged ahead with national scale-up. Eight more African countries have established their first PEN-Plus clinics and an additional six have initiated the planning process. So far, the PEN-Plus team has trained 437 clinical staff across 10 countries and 19 clinics to care for over 5,000 patients with severe NCDs, and those numbers will continue to grow.

In 2022, the 47 countries of the World Health Organization’s African region (WHO/AFRO) unanimously voted to adopt the PEN-Plus strategy. A recent grant to WHO/AFRO from the Helmsley Charitable Trust will support ministries of health in 20 countries as they implement PEN-Plus over the next three years. Yet the success of the PEN-Plus model hinges on continued support and collaboration.

The PEN-Plus Partnership is crucial to overcoming barriers and promoting health equity for those living with severe NCDs in Africa by offering technical and financial support for PEN-Plus implementation. Thanks to the leadership and commitment of PEN-Plus Partnership members, including the Helmsley Charitable Trust, WHO/AFRO, UNICEF, and JDRF International, there is a growing movement to decentralize the expertise and equipment required to treat severe noncommunicable diseases.