Research to Measure Demand for PEN-Plus in Africa Finds Ministries of Health Are Determined to Expand Access to Care for Severe NCDs

A study coauthored by researchers from the NCDI Poverty Network and the World Health Organization’s Regional Office for Africa has found that health ministries in Africa have ambitious plans to address gaps in availability of services for severe NCDs by introducing and decentralizing care for insulin-dependent diabetes, heart failure, sickle cell disease, and chronic pain control over the next five years. These priorities align with PEN-Plus (Package of Essential NCD Interventions-Plus), which is designed to complement standardized WHO PEN protocols by offering integrated chronic care services for high-severity, low-frequency conditions at first-level hospitals, also known as district hospitals.

By surveying NCD program managers at ministries of health across Africa, the study—published in Health and Policy Planning—assessed the current availability and demand for decentralization of services for 13 acute and chronic conditions, reflecting a broad cross-section of health system demands. Respondents were asked whether described care packages that included diagnostics and treatment were available at the primary, secondary, and tertiary levels of the health system, as well as whether making the service generally available at that level is expected to be a priority in the coming five years. 

Countries reported widespread gaps in service availability for severe NCDs at all levels. Just under half (49 percent) of respondents reported that services for insulin-dependent diabetes are generally available at district hospitals; 32 percent report the same for heart failure, 27 percent for chronic pain, and just 14 percent for sickle cell disease.

Respondents were also asked to report target coverage of services for these conditions by 2025. A significant majority of countries expect to decentralize services by a least one level over the next five years, and more than half (57 percent) aim to make all four service packages available at first-level hospitals. All but one country reported that they would like support to develop and implement integrated strategies for severe NCDs at secondary facilities.

“The survey results were exciting because they demonstrated a need for decentralized NCD care that aligns with what PEN-Plus offers,” said Dr. Chantelle Boudreaux, research scientist for the NCDI Poverty Network and lead author on the study. “Countries will need strategies to make the most of limited resources as well as a structured approach to meet their own national goals, and PEN-Plus could be a solution.”

“The survey showed that health ministries in Africa recognize gaps in service availability for severe NCDs and have set goals to address them,” observed Dr. Jean-Marie Dangou, coordinator of the NCD Management Programme at the WHO Regional Office for Africa. “In 2019, we convened a regional consultation to evaluate progress in implementation of PEN and discuss a regional strategy for expanding access to high-quality care for severe, chronic NCDs at first-level hospitals (PEN-Plus). That regional strategy has now been developed and placed on the agenda to be adopted at the Regional Committee meeting in August 2022.”

For more information about PEN-Plus, click here.