A Timeline of Network Milestones

Led by its co-chairs, Drs. Gene Bukhman and Ana Mocumbi, the Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion publishes a report detailing gaps in access to treatment for severe noncommunicable diseases. The Lancet Commission also calls for significant new resources to end the avoidable suffering and death these diseases cause among the world’s poorest people.

Based on the findings of the Lancet Commission, Drs. Gene Bukhman and Ana Mocumbi launch the NCDI Poverty Network in collaboration with the National NCDI Poverty Commissions of 15 low- and lower-middle-income countries in sub-Saharan Africa, southern Asia, and the Caribbean.

NCDI Poverty Network researchers found that expanding an existing community health worker program for HIV and tuberculosis in Malawi to include noncommunicable diseases reduced the number of patients defaulting from chronic NCD care each month by approximately 20 percent while maintaining the already low default rate for HIV patients. The study demonstrated that community health worker programs can be effectively expanded to address health needs more comprehensively in a population.  

The Leona M. and Harry B. Helmsley Charitable Trust and JDRF International—now known as Breakthrough T1D—awarded the NCDI Poverty Network with additional support for PEN-Plus Expansion.

Leading noncommunicable disease researchers, care providers, policymakers, and advocates joined Mozambique’s minister of health and the Universidade Eduardo Mondlane rector in Maputo for the launch of the NCDI Poverty Network’s Maputo co-secretariat and Southern Africa Regional Hub. The co-secretariat is based at Universidade Eduardo Mondlane.

A study coauthored by researchers from the NCDI Poverty Network and the World Health Organization’s Regional Office for Africa found that health ministries in Africa have ambitious plans to address gaps in availability of services for people living with severe NCDs. The research also revealed that the countries’ priorities align well with PEN-Plus, which is designed to complement standardized WHO PEN protocols.

All 47 Member States of the WHO African Region adopt PEN-Plus as the official strategy for providing care to people living with severe noncommunicable diseases. “WHO has been providing support to member states to implement PEN for primary health care in low-resource settings since 2008,” Dr. Benido Impouma, director of the WHO/AFRO Regional Office’s Communicable and Noncommunicable Diseases Cluster, stated in presenting the resolution. “The region now needs to focus on specific severe NCDs such as type 1 diabetes, sickle cell disease, and rheumatic fever, ensuring that vulnerable populations with these diseases have access to diagnosis and treatment within their communities.”

More than 60 representatives of leading global health policy, technical, advocacy, and financing institutions and people living with noncommunicable diseases gathered at UNICEF House in New York City to introduce the PEN-Plus Partnership, a major international initiative to address the global burden of severe, chronic noncommunicable diseases on children, adolescents, and young adults living in extreme poverty. More than a thousand other participants joined the event via livestream.

To mark its official launch, the Center for Integration Science in Global Health Equity—one of the Network’s co-secretariats—hosted its inaugural symposium. The event was intended as a platform for clinicians, researchers, and academics to collaborate in applying integration science to design, implement, evaluate, and bring to scale models for decentralizing services progressively and integrating those services to optimize both health system resources and patient outcomes and well-being.

The NCDI Poverty Network and Partners in Health hosted a side event, “Caring for People Living with Severe Chronic NCDs: Practical Lessons Learned from Early PEN-Plus Initiatives,” at the 2nd International Conference on Public Health in Africa in Kigali, Rwanda.

WHO African Region experts on noncommunicable diseases met with leaders and staff from the NCDI Poverty Network Secretariat and major funders to explore strategies for PEN-Plus expansion in sub-Saharan Africa.

The World Health Organization names the Center for Integration Science in Global Health Equity—one of two Network co-secretariats—the WHO Collaborating Centre on Integration Science and Service Delivery.

Apoorva Gomber, the Network’s associate director of advocacy, provided passionate testimony on the promise of PEN-Plus during the Multi-Stakeholder Hearing on Universal Health Coverage, held at the United Nations Headquarters in May.

The Leona M. and Harry B. Helmsley Charitable Trust awarded a three-year grant to the WHO African Region to support expansion of PEN-Plus to 20 additional countries. “Chronic diseases are projected to become the leading cause of death in sub-Saharan Africa by 2030,” said Dr. Matshidiso Moeti, then WHO regional director for Africa. “To lower the burden, we’re working with countries to enhance the availability and quality of care for severe chronic diseases at district hospitals through the PEN-Plus strategy. The support from Helmsley will be key in the region’s efforts to bridge the gap in access to treatment and care and help reduce premature deaths from these diseases.”

The first International Conference on PEN-Plus in Africa, held in Dar es Salaam, Tanzania, drew health experts, policymakers, government officials, civil society organization representatives, donors, people living with noncommunicable diseases, and advocates from 52 countries. “The conference was a triumph,” said Dr. Gene Bukhman, co-chair of the NCDI Poverty Network. “The energy, connections, and momentum from our week in Tanzania will undoubtedly enrich our work and strengthen our commitments to PEN-Plus and each other.”

The Network launched during the height of the pandemic in 2020, and its Steering Committee members are spread across nearly a dozen countries. And so when the first International Conference on PEN-Plus in Africa provided the Steering Committee with an opportunity to come together, the event represented the first time that members could transcend Zoom screens to share their insights in person.

The Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital—one of the Network’s co-secretariats—joined collaborators in publishing a study of people living with type 1 diabetes in two rural clinics in Malawi. Their research found a high level of acceptability and satisfaction among those using continuous glucose monitoring, suggesting that the technology is feasible in low-income settings.

Delegations from all eight countries in UNICEF ROSA—the Regional Office for South Asia—convened in Kathmandu for a three-day workshop on severe childhood-onset noncommunicable diseases. During the workshop—which UNICEF ROSA hosted in collaboration with the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital, one of two co-secretariats of the NCDI Poverty Network—participants discussed strategies for integrating these severe conditions into health system interventions and noncommunicable disease and child health policies in South Asia.

The Leona M. and Harry B. Helmsley Charitable Trust provided the NCDI Poverty Network with another three-grant to continue supporting countries’ initiation and expansion of PEN-Plus programs. Several Helmsley representatives, including trustee David Panzirer; Dr. Gina Agiostratidou, program director for type 1 diabetes; and program officer James Reid (pictured at the first International Conference on PEN-Plus in Africa)—work closely with the Network’s co-chairs to help guide the Network’s strategic vision and direction.

The Network published PEN-Plus Clinical Tools and Programmatic Standards, a document aimed at informing clinic planning, budgeting, and operations by providing a crisp definition of PEN-Plus clinical care, including the diagnostic, treatment, and patient support services available.

In the PEN-Plus Partnership Strategic Plan for 2025–2028, Network partners articulated their vision for enhancing and expanding PEN-Plus over the next several years. “It is our commitment, our testimony, and our witness to the collective progress of NCDI Poverty Network partners in delivering healthcare and hope to people in lower-income countries,” said Dr. Gene Bukhman, co-chair of the Network.

During the Springboard for Action celebration, notable voices rose in passionate advocacy of PEN-Plus. Other voices soared in song, as Broadway cast members of Disney’s The Lion King performed two classics.

The NCDI Poverty Network—through one of its co-secretariats, the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital—joined UNICEF in publishing a report on the burden on noncommunicable diseases on children, adolescents, and young adults in South Asia.

A “game-changing” study tour of a PEN-Plus clinic in Sierra Leone introduced Ministry of Health officials from six other Francophone nations to the role integration can play in providing quality care for people living with severe noncommunicable diseases in low- and lower-middle-income countries.

The NCDI Poverty Network’s recent week of advocacy in Rwanda included visits to two hospitals, a conference with more than 700 attendees, a panel with four expert speakers, and one recurring theme: the recognition that PEN-Plus is an effective model for mobilizing action and financing to increase access to care for people living with severe, chronic noncommunicable diseases.

The NCDI Poverty Network published a position statement that identifies the crucial pieces—and populations—missing from the global NCD agenda. With this statement, the Network sought to inform policy discussions in the lead-up to the Fourth United Nations High-Level Meeting on the Prevention and Control of Noncommunicable Diseases in September.

A NCDI Poverty Network research team published findings that only two of 16 health facilities assessed in nine lower-income countries had all the functional equipment needed to diagnose and manage care for people living with type 1 diabetes. Two of the facilities had none of the necessary equipment.

The WHO Regional Office for Africa published a landmark report that details the impact and momentum of the PEN-Plus model, providing a valuable tool for advocacy and information about integrated care for people living with severe, chronic noncommunicable diseases.

On behalf of the NCDI Poverty Network, Rachel Gasana, senior director of advancement, testified at the multistakeholder hearing on noncommunicable diseases, held at the United Nations Headquarters in New York City. The Network was one of 70 organizations selected to deliver testimonies as a prelude to the United Nations High-Level Meeting on NCDs in September.

At the second International Conference for PEN-Plus in Africa, recently held in Abuja, health leaders, policymakers, and development partners across Africa renewed their commitment to an accelerated implementation of the PEN-Plus to significantly expand access to care for people living with severe noncommunicable diseases.

“I am a warrior. I am brave. I am triumphant.” With that mantra, participants in Camp Tuli Bonse—an integrated camp for young people living in Zambia with type 1 diabetes or sickle cell disease—learned how a sense of unity can confer benefits beyond physical health.

Following the Network’s High-Level Advisory Group meeting in New York City during United Nations Assembly Week, Dr. Mohamed Janabi, director of the WHO African Region, pledged his continued support in a public statement. “At UNGA80, I joined the NCDI Poverty Network to celebrate five years of progress—proof that when leadership, resources, and partnerships align, transformation is possible,” Dr. Janabi stated. “The WHO African Region deeply values this partnership, which has been central to advancing the PEN-Plus vision across Africa. We reaffirm our commitment to scale up PEN-Plus so no family is left behind.”

At the opening plenary of the High-Level Meeting on NCDs and Mental Health, delegates from eight African countries used valuable time from their allotted three minutes to highlight PEN-Plus. “Effective responses to NCDs will rely on integrating services within primary care,” said the Hon. Kwabena Mintah Akandoh (pictured), Ghana’s minister of health. “Ghana is using the PEN-Plus framework for that integration.”

PEN-Plus is not only improving treatment and accessibility for people living with type 1 diabetes, but it’s also bringing new attention to the condition, Dr. Gene Bukhman, co-chair of the NCDI Poverty Network, said during a talk at the annual conference for the International Society for Pediatric and Adolescent Diabetes. “That’s incredible news for the type 1 diabetes community, because there’s actually a strategy in which type 1 is at the base of it,” he added. “When people talk about PEN-Plus in Africa, when they talk about ministries launching their plan for PEN-Plus, they’re saying ‘type 1’ in the first sentence.”