By Michael Gwarisa
Non-communicable Diseases (NCDs), continue to exert unwarranted pressure on Africa’s healthcare system, with data from the 2022 World Health Organisation (WHO) NCDs progress monitor estimating that between 50 percent and 88 percent of deaths being recorded in seven African countries, mostly small island nations, are due to non-communicable disease.
The UN Sustainable Development Goal (SDG) target 3.4 calls for all Member States to reduce premature mortality from non-communicable diseases (NCDs) by one-third in 2030 through prevention, treatment and promoting mental health and well-being.
However, over the years, most low and Middle-income (LMICs) countries have struggled to deal with the growing burden of NCDs. According to WHO data, most low and middle-income countries (LMICs) are off track to reach SDG target 3.4 for NCD mortality since NCDs account for 41 million deaths each year, equivalent to 71 percent of all deaths globally. Further, 77 percent of all NCD deaths are in Low- and Middle-Income Countries (LMICs) which are currently experiencing the double burden of diseases with unprepared heath systems.
By 2030, WHO’s goal is for 70 percent of African Region’s member states to have national plans for integrated care, NCD training for healthcare workers and essential medicines in direct hospitals. In a bid to address the growing NCDs mortality and morbidity burden, in 2010, WHO adopted a Package of Essential Non-communicable disease interventions (PEN) strategy in a bid to capacitate primary health facilities to treat common NCDs such as Hypertension, Type 2 Diabetes, Breast Cancer Detection and Chronic Respiratory Diseases in an integrated outpatient package.
While progress has been made regarding common NCDs, the growing burden of severe NCDs cannot be ignored. These severe NCDs include but are not limited to Type 1 Diabetes, Rheumatic heart disease, and Sickle Cell disease. According to WHO data, the average life expectancy for a child newly diagnosed with type 1 diabetes in rural sub-Saharan Africa is less than one year. There is a 50 percent chance that babies born with sickle cell disease will die before their fifth birthday. The odds that a nine-year-old with rheumatic heart disease in a low-incline country will die before the age of 25 is greater than 70 percent.
Despite these worrying trends, treatment of people with severe NCDs in Sub-Saharan Africa remains luxury many who access services at the primacy level of care cannot afford, as treatment is only available at referral hospitals in major cities. Families also face devastating costs associated with treatment and care for severe NCDs. In most cases, patients risk disability and even death as a result. At least 540,000 children, adolescents and young adults die every year due to NCDs.
To bridge the treatment and care gap as well as address disparities to care, WHO member states have since expanded focus beyond common NCDs to these more severe NCDs, and have included the palliative care and psychosocial support component for patients with severe NCDs and their caregivers. The approach is dubbed the “PEN-Plus,” and unlike the PEN initiative, care delivery under the PEN-Plus is focused at first-level hospitals, as opposed to health centres.
Speaking in an interview with HealthTimes on the side-lines of the inaugural PEN-Plus conference in Africa, held in Dar Es Salaam, Tanzanai, WHO Afro Region’s Director of Communicable and Noncommunicable Diseases Cluster, Dr Impouma Benido said, communities have been critical in the implementation of the PEN-Plus initiatives in the region.
The success of the PEN-Plus strategy in addressing severe NCDs in Africa is attributed to its comprehensive approach to healthcare delivery. By focusing on task-shifting, capacity building, and strengthening health systems, PEN-Plus has made strides in improving access to NCD care, particularly in low-resource settings,” said Dr Benido.
He added that the PEN-Plus has helped reduce the burden on hospitals by decentralizing care and fostering community involvement.
“This approach has shown promising results in increasing early detection, enhancing treatment adherence, and ultimately improving health outcomes as demonstrated in countries such as Rwanda and Tanzania. Communities play a central role in the PEN-Plus strategy. They are vital for extending healthcare services beyond hospitals and clinics, ensuring that people with non-communicable diseases (NCDs) receive consistent care in their local settings.”
Under PEN-Plus strategy, communities have also been at forefront, supporting early detection, promoting healthy behaviours, and facilitating adherence to treatment regimens through community-based healthcare workers and peer support systems.
“The strategy aims to create a continuum of care that connects hospitals to local health systems, thus leveraging community networks for broader reach and greater impact. Communities are crucial in managing NCDs because they enable healthcare to be more accessible, culturally relevant, and sustainable. By integrating community-based interventions, such as health education, lifestyle changes, and peer support, the management of NCDs becomes more effective. Communities can also address social determinants of health, reduce stigma, and promote healthier environments, leading to improved prevention and early intervention,” said Dr Benido.
Meanwhile, the PEN-PLUS also equips community and village health workers to manage NCDs at the community level. These workers receive training to identify, monitor, and support individuals with NCDs. They play a critical role in promoting health education, facilitating early detection, and encouraging treatment adherence. By bridging the gap between formal healthcare systems and local communities, these workers can ensure continuity of care, especially in remote or underserved areas.
“PEN-Plus can be seen as Africa’s unique approach to managing severe NCDs, emphasizing community-based care and sustainability. The model’s programmatic sustainability is achieved through capacity building, task-shifting, and integration into existing healthcare systems. Financial sustainability comes from leveraging local resources, cost-effective interventions, and partnerships with international organizations.”
Dr Benido reiterated that while challenges remain, such as funding and healthcare infrastructure, the WHO PEN together with the PEN-Plus strategy have demonstrated the potential to provide a scalable and sustainable framework for addressing NCDs in Africa.
To date, more than 10,000 people are receiving treatment for severe NCDs in PEN-Plus clinics across 11 Sub-saharan countries. All 47 member states of the WHO African Region adopt PEN-Plus as their official strategy for providing care to people living with severe NCDs. 20 countries in Sub-Saharan Africa are currently at various stages of initiating, implementing, or scaling up PEN-Plus.
The PEN-Plus partnership aims to continue working with lobal partners to reach US100 Million in annual funding by 2030 to help save countless live, transform NCDs care, and accelerate progress toward universal health coverage (UHC).
PEN-Plus includes training and mentorship of health workers to provide diagnosis, treatment, support, and referral for severe NCDs. It also equips health facilities with the necessary medical apparatus, supplies, and medicines to deliver quality care for these conditions. PEN-Plus follows a patient-centered, community-focused approach that involves the active participation of the patients and their families in the management of their diseases.
PEN-Plus brings high level expertise in chronic care of severe NCDs to district hospitals for the first time. The initiative also trains and equips nurses and clinical officers to deliver crucial services including diagnosis, symptom management, and psycho social support across a range of severe NCDs.
