By Michael Gwarisa
According to the World Health Organisation (WHO) data, more than 560 000 avoidable deaths occur annually among the world’s poorest children and young adults with nearly 100 000 of these deaths being caused by only four conditions namely Type 1 diabetes mellitus, sickle cell disease, rheumatic and congenital heart disease.
Just like most countries in the Sub-Saharan Africa region, Zimbabwe is experiencing a huge burden in Severe Non-Communicable Diseases which, unlike ordinary NCDs, do not get much public health attention despite them accounting for several deaths every year.
To address the growing burden of Severe NCDs, the World Health Organisation African Regions (WHO-Afro) set ambitious goals to have 50% of member States rolling out PEN-Plus services to district hospitals by the year 2025, 65% by 2028, and 70% by 2030. The PEN-Plus is the WHO-AFRO regional strategy to address severe non-communicable diseases in Africa which was adopted by the African health ministers in 2022 in Togo who signed an agreement to implement the strategy with the support of WHO.
This strategy prioritizes a person-centred approach to chronic severe NCDsHence the emphasis on these four NCDs in the early phase of implementation of the PEN-PLUS strategy. Zimbabwe is among the countries implementing the PEN-Plus strategy.
In an interview with HealthTimes at the just-ended first International Conference on the PEN-Plus Regional Strategy to Address Severe NCDs in Africa (ICPPA 2024) in Tanzania, the Deputy Director of NCDs at the Ministry of Health and Child Care, Dr Justice Mudavanhu said Zimbabwe is already advanced in the implementation of the PEN-Plus strategy.
The PEN-Plus is already being Piloted in three districts in Masvingo supported by Solidermed and the Clinton Health Access Initiative (CHAI). Training of six provinces (Masvingo, Mashonaland East & West, Chitungwiza, Harare and Bulawayo) trainers of trainers ready for scale-up of health worker training in all districts has been initiated (didactic component almost complete but the mentorship phase is not yet complete),” said Dr Mudavanhu.
A number of organisations in Zimbabwe are actively participating in the activities to adopt and support the MOHCC NCD department to implement the PEN-Plus strategy. These include WHO, UNICEF,CHAI and Solidermed. The strategy is being implemented and integrated within the existing MOHCC NCD strategy framework and addresses the NCDs of childhood-onset that are lethal without treatment in the short term.
There are already recognized passionate advocacy communities in Zimbabwe: The Zimbabwe diabetes association, Brave Little Heart Zimbabwe and SickleinAfrica (represented by SHAZ programme and SCATZ).
WHO has pledged support to countries for implementing the programme according to the four phases. Zimbabwe is now in phase 3 in the implementing provinces.
Speaking to this publication, the Non-communicable Disease Technical Officer at WHO office, Dr Tsitsi Siwela said the collaborative efforts between WHO and the Ministry of Health.
“WHO’s technical and financial support empowers the MoHCC to effectively implement and scale up the PEN-Plus program, ultimately improving access to specialized NCD care for Zimbabweans suffering from severe chronic conditions,” said Dr Siwela.
In terms of Technical Support, WHO is providing expertise and guidance to the MoHCC on various aspects of the PEN-Plus program. This involves developing training materials, establishing best practices for NCD care at the district level, or sharing successful models from other countries. For Supportive Supervision Visits, WHO supported visits to healthcare facilities implementing PEN-Plus. These visits involve experienced healthcare professionals who assess progress, identify challenges, and offer recommendations for improvement.
“In terms of Implementation Assessments, WHO supported PEN-Plus assessments to measure the effectiveness of the PEN-Plus program in Zimbabwe. This helps identify areas where the program is working well and areas that need further development. For Operational Plan Development, WHO collaborates with the MoHCC to develop a comprehensive plan outlining the implementation strategy for PEN-Plus in Zimbabwe. This plan would typically address staffing needs, training requirements, referral systems, and resource allocation.”
Meanwhile, WHO has catalytic funding for supporting MoHCC to coordinate PEN Plus partners and to support PEN-Plus scale up. While WHO doesn’t directly support individual facilities within the PEN-Plus program in Zimbabwe, they have been actively involved in assessments and supportive supervision visits for implementing sites
“While Zimbabwe’s national public health interventions haven’t yet fully integrated childhood NCDs nationwide, pilot programs in select districts are showing promise. Notably, Masvingo has seen efforts through SolidarMed and more recently UNICEF to address childhood NCDs. WHO has played a supportive role by providing technical expertise to these initiatives. While the national picture is still developing, these pilot programs and WHO’s technical support offer valuable insights and pave the way for a more comprehensive approach to childhood NCDs in Zimbabwe’s public health interventions,” said Dr Siwela.
WHO played a supportive role by providing technical expertise to the Ministry of Health. There’s limited nationally available data specifically on the progress of Type 1 Diabetes management under the PEN-Plus program in Zimbabwe.
PEN-Plus offers a promising approach to tackle the growing burden of severe, chronic Non-Communicable Diseases (NCDs) in Zimbabwe. This model equips district and community hospitals with a specialized team of mid-level healthcare providers, such as clinical officers and nurses, specifically trained to manage these complex conditions. PEN-Plus recognizes the need for more advanced skills, mentorship, and diagnostic tools (labs and imaging) to effectively care for patients with diseases like type 1 diabetes and rheumatic heart disease. By decentralizing care from central hospitals, PEN-Plus creates a network of specialized NCD teams in every district. These teams can not only manage more complex cases directly but also provide mentorship and support to primary care providers, ensuring a more comprehensive approach.
PEN-Plus directly addresses the critical gap in NCD care at the district level, making treatment more accessible for Zimbabweans suffering from these chronic conditions. With the NCD burden rising across the population, implementing and scaling up PEN-Plus in Zimbabwe is a pressing need to improve health outcomes and alleviate the strain on the healthcare system, particularly for low-income populations.
