Malawi Launches Operational Plan for National Scale-Up of PEN-Plus
On May 27, Malawi took a major step toward national scale-up of integrated chronic care services at district hospitals for severe NCDs affected children and young adults (PEN-Plus) with the official launch of its PEN-Plus Operational Plan. The plan was prepared by a stakeholder group convened by the Ministry of Health and supported by the NCDI Poverty Network Secretariat, Partners In Health, the World Health Organization, and UNICEF. Representatives from the Ministry of Health, Ministry of Finance, and Ministry of Economic Planning and Development attended the event in Lilongwe in person, along with many academic, clinical, and implementing partners, some of whom participated virtually.
The Operational Plan was presented by Dr. Jones Kaponda Masiye, Deputy Director of Clinical Services for NCDs and Mental Health at the Ministry of Health.
“We have noted that most people suffering from NCDs, actually have more severe conditions such as sickle cell anaemia, type 1 diabetes and rheumatic heart disease that require specialized treatment. But these people live in districts and that means they have to go to specialized facilities such as central hospitals which are very few in the country,” Dr. Masiye said. “So we want NCDs specialized treatment at district hospitals so that these people are assisted right there. This is what we call PEN-Plus. We cannot continue moving patients around. Some live very far in hard to reach places. And lives are lost in the process.”
The first section of the plan provides a situation analysis of the burden of NCDs in Malawi, the baseline availability and gaps in services for priority conditions, and the successful introduction of PEN-Plus services in Neno district by the Ministry of Health and Partners In Health.
The second section presents PEN-Plus and progressive decentralization of NCDI services as a strategy to fill the gap in chronic care services for severe conditions like type 1 diabetes, rheumatic heart disease, and sickle cell disease, detailing how implementation of PEN-Plus at district hospitals addresses gaps in the continuum of care for patients, staffing, training and mentorship for health care providers, the supply chain for medications and supplies, and systems to monitor and evaluate implementation and impact.
The third and final section maps out the steps in governance, clinical implementation, infrastructure, staffing and training, supply chain, monitoring and evaluation, and financing that will be required to scale up PEN-Plus implementation nationwide. The plan calls for expanding from two pilot clinics in Neno District in the South to 18 hospitals in all three regions of the country by 2023 and a total of 56 in 2026.
“Planning and scale-up of PEN-Plus in Malawi is urgent and paramount as the NCD burden continues to grow and affect all segments of the population, placing an increasing burden of morbidity and mortality on the poor,” Dr. Jones Kaponda Masiye states in the Foreword to the Plan. “The PEN-Plus consultation group is optimistic that together we can develop a pro-poor pathway in treating severe and chronic NCDs in Malawi, complementing existing NCD interventions within an inclusive agenda rooted in equity for a comprehensive NCD response in Malawi.”