From Words to Action

Tanzanian children—billed by the moderator, Sauda Simba Kilumanga, as “future-generation champions for noncommunicable diseases”—presented important messages during the opening ceremony of the International Conference on PEN-Plus in Africa.

A six-year-old girl holding a colorful placard stepped onto the stage and spoke with confidence into the mic. “Children across Africa are fighting type 1 diabetes, sickle cell disease, and heart disease,” she said. “These are life-threatening without easy access to care.”

The girl then took her place at the front of the stage as a nine-year-old boy followed with a placard and a warning. “NCDs are responsible for over 70% of deaths globally, with a rapidly increasing burden in Africa,” he said. “Every life counts. It’s time for action—not tomorrow, but today.”

Seven more children followed with messages, and once all nine were assembled across the stage, they lifted their placards above their heads to reveal the overarching message their T-shirts spelled out: #BeatNCDs.

Seated before the children were the more than 400 participants from 52 countries who had assembled for the first International Conference on PEN-Plus in Africa (ICPPA 2024), held in Dar es Salaam, Tanzania, in late April.

The children’s messages resonated across all levels of the three-day meeting, in which speaker after speaker highlighted the dramatically inequitable access to prevention, diagnosis, treatment, and ongoing care for people living with severe noncommunicable diseases in sub-Saharan Africa.

In the African region, healthcare services for severe noncommunicable diseases are predominantly confined to major urban centers, leaving countless individuals without sufficient care and burdened with high financial costs. The conference highlighted the urgency of decentralizing care for type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease, to save millions of lives over the next decade, including those of many children, adolescents, and young adults living with those conditions.

The conference also provided a platform for health experts, policymakers, civil society organization representatives, donors, people living with noncommunicable diseases, and community advocates to expedite political and financial backing for PEN-Plus, an innovative healthcare delivery model that was developed in Rwanda nearly two decades ago.

“We are honored to have you all here for this critical conference at a time when hundreds of thousands of Africans of all ages suffer preventable, premature deaths from NCDs due to health inequities,” said Hon. Ummy Mwalimu, Minister of Health of the United Republic of Tanzania. “This is a chance for us to unite to advance regional efforts to tackle the crisis, by investing in and scaling up PEN-Plus.”

Conference leaders committed to advocating for increased focus on severe, chronic noncommunicable diseases within existing health systems and extending prevention, diagnosis, treatment, and quality care to the primary health level. They also called on governments to provide public health leadership in ensuring adequate and quality services, to reduce the known risk factors for noncommunicable diseases, and to increase domestic investments.

A range of speakers delved into strategies for reinforcing the management of noncommunicable diseases within health systems continent-wide and sought collaborative opportunities to align PEN-Plus with other regional public health programs.

“Africa is severely affected, and in the region, more than any place in the world, NCDs are called ‘the silent epidemic,’” said Dr. Matshidiso Moeti, WHO regional director for Africa. “Africa must invest more now in addressing NCDs with adequate and sustained resources. With support from partners, we aim to strengthen the implementation of the PEN-Plus Regional Strategy, mainstream the prevention and control of chronic and severe NCDs in the region, and ensure that people living with these chronic and severe conditions receive the lifesaving care they deserve.”

All 47 member states of the WHO African region have endorsed the model as their official strategy for caring for people with severe noncommunicable diseases. To date, 17 African countries have initiated PEN-Plus, with 11 actively implementing the program.

The PEN-Plus strategy expands on the WHO Package of Essential Noncommunicable Disease Interventions in Primary Health Care (WHO PEN), which decentralizes care for common noncommunicable diseases to primary healthcare facilities. PEN-Plus extends this care to first-level referral facilities, such as district hospitals, and has demonstrated significant success in increasing patient access to treatment for severe noncommunicable diseases, improving patient outcomes.

“PEN-Plus addresses a critical gap in healthcare for the world’s poorest billion, bringing lifesaving chronic care for severe NCDs to first-level rural hospitals for the first time,” said Dr. Ana Mocumbi, a co-chair of the NCDI Poverty Network. “It also bridges major gaps in health systems for training, mentorship, and referral pathways.”

WHO Africa, The Leona M. and Harry B. Helmsley Charitable Trust, and the Government of Tanzania co-sponsored the conference, with the NCDI Poverty Network serving as a technical partner.

“PEN-Plus showcases the lifesaving impact of collaborating with local health leaders and designing health systems around people,” said Dr. Gina Agiostratidou, type 1 diabetes program director for The Helmsley Charitable Trust. “Now, children with noncommunicable diseases in rural areas can receive the care they need to lead full, vibrant lives. At ICPPA, we have had the opportunity to join partners in discussing how we can expand the program to reach even more communities.”

At the closing ceremony of the conference, Dr. Charles Sagoe-Moses, the World Health Organization Representative for Tanzania, reminded participants of the children’s presentation with placards during the opening ceremony.

“I was so impressed with the children who wanted to beat NCDs,” he said. “But I’m wondering whether, in 30 years, they’ll be able to say they’ve beaten NCDs. Or will NCDs have beaten them?”

That challenge was echoed by Emmanuel Kisembo, an advocate from Kampala, Uganda, who lives with type 1 diabetes and serves as a Voices for PEN-Plus advocate with the NCDI Poverty Network.

“We bring a very important perspective, a very important voice to such conversations,” he said. “We need to get more opportunities like this for us to share, for us to shine a spotlight on these diseases. Today, we are eight people living with these diseases in the room, but we hope and pray that the next time, we shall have many of us in the room. Because this conversation is about us. It is for us.”

Kisembo alluded to a Swahili proverb that Dr. Gene Bukhman, a co-chair of the NCDI Poverty Network, had repeated earlier in the conference.

“Dr. Bukhman said something very profound when he said, ‘Lisilo budi hutendwa,’ which can be translated to, ‘What must be done will be done,’” Kisembo said. “What we’re saying is, let’s all go back and implement the things that we say we shall do. Let’s go back and walk the talk.”