PEN-Plus in Action Introduces a Global Partnership to Fight Severe, Chronic NCDs

From left: Raoul Bermejo (UNICEF); Ana Mocumbi and Gene Bukhman (NCDI Poverty Network); and Aboubacar Kampo and Reem Batarseh (UNICEF)

More than 60 representatives of leading global health policy, technical, advocacy, and financing institutions and people living with NCDs gathered at UNICEF House in New York on September 15, 2022, to introduce the PEN-Plus Partnership, a major international initiative to address the global burden of severe NCDs and injuries that cause more than 500,000 avoidable deaths every year among children and young adults living in extreme poverty. More than 1,000 others joined the PEN-Plus in Action event via livestream.

The PEN-Plus Partnership is dedicated to mobilizing the technical and financial resources required to rapidly scale up implementation of PEN-Plus – a proven strategy for delivering integrated chronic care services for type 1 diabetes (T1D), sickle cell disease (SCD), rheumatic and congenital heart diseases (RHD/CHD), and other severe NCDs at first-level hospitals in poor, rural areas of low- and lower-middle-income countries (LLMICs). 

Aboubacar Kampo, Director of Health Programmes at UNICEF, Dr. Matshidiso Moeti, WHO Regional Director for Africa (WHO AFRO), Juan Pablo Uribe, Global Director for Health, Nutrition and Population at the World Bank, and Bente Mikkelsen, Director of Noncommunicable Diseases at WHO Headquarters delivered opening addresses for the event, following welcoming remarks from moderator Anatole Manzi, Deputy Chief Medical Officer and Director of Clinical Quality and Health Systems Strengthening at Partners In Health (PIH).

NCDI Poverty Network Steering Committee Co-Chairs Dr. Gene Bukhman and Dr. Ana Mocumbi highlighted the heavy burden of severe NCDs that cause hundreds of thousands of avoidable deaths every year among children and young adults living in extreme poverty, and emphasized that through investment in PEN-Plus and global involvement in the PEN-Plus Partnership, we can increase tenfold the number of children and young adults receiving treatment for severe, chronic NCDs by 2030.

Following the presentations by Dr. Bukhman and Dr. Mocumbi, participants watched a video that highlights the impact of PEN-Plus in bringing lifesaving NCD care to rural communities in LLMICs and the strong commitment of key founding members of the PEN-Plus Partnership, including UNICEF, WHO AFRO, and the Helmsley Charitable Trust, whose support has fueled dramatic growth in PEN-Plus implementation and scale-up over the past two years.

Panelists highlight the lifesaving impact of PEN-Plus and the vital importance of global solidarity

From left, Emily Wroe (NCDI Poverty Network), Biraj Karmacharya (Dhulikhel Hospital), Bright Mailosi (Partners In Health), Raoul Bermejo (UNICEF), and Anatole Manzi (Partners In Health)

The event included two panel discussions. The first discussion focused on PEN-Plus as a proven model for bringing integrated chronic care services for severe NCDIs that affect children and young adults to district hospitals in poor, rural areas and bridging a gap in services for chronic conditions across all levels of the health system. Panelists included Dr. Emily Wroe, Director of Programs for the NCDI Poverty Network, Dr. Biraj Karmacharya, Director of Public Health and Community Programs at Dhulikhel Hospital in Nepal, Bright Mailosi, Clinical Officer for Partners in Health Malawi, and Raoul Bermejo, UNICEF Health Specialist.

Panelists shared their experiences implementing and supporting PEN-Plus and the discussion highlighted the urgent need to expand and scale up PEN-Plus in other low- and lower-middle-income countries in order to ensure that every child and young adult has access to lifesaving care for severe NCDs.

“Children with severe, chronic conditions have been left behind - this is a rights issue. We need health access for every child everywhere, not for some children somewhere.” — UNICEF Health Specialist Raoul Bermejo

From left, Anatole Manzi (Partners In Health), Isaac Odame (Global Sickle Cell Disease Network), Paladei Mategeko (NCDI Poverty Network), Dhruv Kazi (Harvard Medical School), Aaron Kowalski (JDRF), and Ana Mocumbi (NCDI Poverty Network)

The second panel discussion focused on the vital importance of strengthening the PEN-Plus Partnership and mobilizing a global movement of solidarity to generate the funding that will be required to strengthen NCD care for the world’s poorest. The panelists included Dr. Isaac Odame, medical director of the Global Sickle Cell Disease Network; Dr. Aaron Kowalski, president and CEO of the Juvenile Diabetes Research Foundation (JDRF); Paladie Matageko, Voices of NCDI Poverty Advocacy Fellow; Dr. Ana Mocumbi, NCDI Poverty Network Steering Committee Co-Chair; and Dr. Dhruv Kazi, associate professor of cardiology at Harvard Medical School. Panelists stressed the importance of unlocking financial commitments to ensure accessible and affordable NCD care for everyone, regardless of where they live.

“The cost of inaction is perpetuation of poverty. These are diseases of poverty, and they cause poverty. Funding creates opportunities for care providers as well as healthy children who will live life to the fullest and contribute to society.” — NCDI Poverty Network Co-Chair Ana Mocumbi

Following the panel discussions, Nancy Brown, CEO of the American Heart Association, who was not able to attend the event in person, affirmed the association’s strong commitment to the PEN-Plus Partnership in a short video statement.

Gina Agiostratidou (Helmsley Chartiable Trust)

Dr. Gina Agiostratidou, T1D Program Director for the Helmsley Charitable Trust, concluded the event with a reminder that treatment for severe NCDs must be prioritized to advance health equity and the PEN-Plus Partnership is an opportunity for collective action to achieve this aim.

“PEN-Plus has already proven to be cost effective and impactful on the lives of people living with NCDs...but the success of this model hinges on global and local support.” — Helmsley Chartiable Trust T1D Program Director Dr. Gina Agiostratidou

The event highlighted the need for a global movement of solidarity in order to support LLMICs in implementing NCD services as even with optimistic projections regarding economic growth, taxation, and domestic investments in healthcare, low-income countries will not be able to fund basic services without external support for the next decade.

Thanks to support from the Helmsley Charitable Trust, WHO AFRO, UNICEF, JDRF, and the World Diabetes Foundation, the past two years have seen dramatic progress in PEN-Plus initiation and implementation across Africa and South Asia. Four countries — Rwanda, which established the very first PEN-Plus clinics and training sites beginning in 2006, and Malawi, Liberia, and Haiti, which initiated PEN-Plus successfully a decade later — are now at various stages of scaling up PEN-Plus nationwide. And 10 additional countries — Ethiopia, Mozambique, Tanzania, Kenya, Uganda, Zambia, Zimbabwe, Sierra Leone, Nepal, and Chhattisgarh State in India — are preparing to open their first PEN-Plus clinics and training sites in the fourth quarter of 2022 and first quarter of 2023.

The NCDI Poverty Network has projected that in the next three-year cycle (2024-2026), the 10 countries that are opening their first PEN-Plus clinics and training sites this year will move from initiation to national scale-up and eight new countries will initiate PEN-Plus. And WHO AFRO has set even more ambitious targets for expansion of PEN-Plus with the regional PEN-Plus strategy to address severe NCDs at first-level referral health facilities adopted at the Regional Committee meeting in August, which calls for 50% of Member States to be rolling out PEN-Plus services to district hospitals by the year 2025, 65% by 2028, and 70% by 2030.

Founding members of the PEN-Plus Partnership, including the Helmsley Charitable Trust, JDRF, UNICEF, and the World Diabetes Foundation, have provided the $10 million per year required to support PEN-Plus initiation and scale-up in the current cycle.

Maintaining that momentum to achieve the projected growth in PEN-Plus initiation and scale-up will require both an additional $20 million in annual financing and significant broadening of participation and commitment to the PEN-Plus Partnership from multilateral and bilateral institutions, philanthropic foundations, and individual and institutional donors focused on specific, severe NCDs treated at PEN-Plus clinics.