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The PEN-Plus Approach
20 African countries scale up PEN-Plus approach to fight against severe non-communicable diseases: WHO
Context: The PEN-Plus approach has expanded access to care for severe non-communicable diseases (NCDs) in 20 African countries over the past four years.
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A new report titled “Understanding the PEN-Plus approach to care: Expanding access to care for severe non-communicable diseases in the WHO African Region” was released on April 14, 2025, by the World Health Organisation (WHO) Africa with support from the Leona M. and Harry B. Helmsley Charitable Trust.
The Growing Burden of NCDs in Africa
- NCD-related deaths surged in the WHO African Region, with over 2.8 million deaths recorded in 2019 alone—an average of more than 7,900 deaths per day.
- NCDs accounted for 37% of all deaths in 2019, up from 24% in 2000, signalling a sharp rise in the disease burden.
- The total number of deaths in the region declined from 8.7 million in 2000 to 7.8 million in 2019, but NCDs have become a larger contributor to this mortality.
The PEN-Plus Model of Care
Most Prevalent Severe NCDs in Africa
- Common severe NCDs affecting people in Africa include:
- Sickle-cell disease
- Type 1 and insulin-dependent Type 2 diabetes
- Rheumatic heart disease
- Severe hypertension
- Moderate to severe and persistent asthma
- It was developed as an extension of the WHO’s Package of Essential Non-communicable Disease (PEN) interventions, which focuses on managing common NCDs at the primary healthcare level.
- The PEN-Plus model aims to provide comprehensive care for severe NCDs by training and equipping nurses and clinical officers to deliver essential services, such as:
- Diagnosis
- Symptom management
- Psychosocial support
Challenges in Access to Care
- In many low-income countries, severe NCD care is only available at referral hospitals in major cities, making it inaccessible and unaffordable for rural populations.
- This lack of access results in premature deaths due to untreated severe NCDs.
- Example: Children with type 1 diabetes in sub-Saharan Africa have a life expectancy of less than one year after diagnosis due to the lack of treatment.
Impact of PEN-Plus in Africa
- The PEN-Plus model was originally developed in Rwanda to provide care for individuals living in extreme poverty, addressing their need for diagnosis and care.
- The model has shown promising results in Liberia, Malawi, and Rwanda, where it has significantly increased access to treatment for severe, chronic NCDs.
Significance
- PEN-Plus is a critical initiative to ensure that the poorest billion of the world’s population, especially those in rural, under-resourced areas, have access to life-saving chronic care for severe NCDs.
- Integrating care at the first-level hospitals improves health outcomes and reduces preventable deaths from conditions like type 1 diabetes and rheumatic heart disease in underserved populations.
Key Statistics and Achievements
- 15,000+ people have received treatment for severe NCDs in PEN-Plus implementing countries as of January 2025.
- Malawi has made significant strides with the national scale-up of PEN-Plus, training 440+ clinicians and nurses.
- Six secondary-level health facilities in Malawi are providing PEN-Plus care to over 300 patients living with severe NCDs.
Future Directions and Urgency for Action
- The report emphasises the need for sustained investment and collaboration to expand PEN-Plus coverage across the WHO African Region.
- It calls for continued prioritisation of NCDs on the global health agenda, and for creating sustainable health systems that ensure better outcomes for underserved populations.
- The PEN-Plus approach serves as a critical step in addressing severe NCDs in low-resource settings and creating equitable access to healthcare.
