‘A Solution That Works’: PEN-Plus Praised at the Global NCDA Forum
NCDI Poverty Network leaders also visited Rwinkwavu and Masaka hospitals during a week of advocacy in Rwanda.
Enjoying a lighthearted moment at the Global NCDA Forum are, from left, Neil Gupta, senior director of policy at the NCDI Poverty Network; Lea Kilenga Bey, an advocate living with sickle cell disease in Kenya and executive director of the Africa Sickle Cell Organization; Anu Gomanju, a person living with rheumatic heart disease in Nepal and a Voices for PEN-Plus advocate for the Network; and Arafa Said, a person living with sickle cell disease in Tanzania and a Voices for PEN-Plus advocate.
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 the PEN-Plus integrated package of clinical services is an effective model for mobilizing action and financing to increase access to care for people living with severe, chronic noncommunicable diseases (NCDs).
The week centered around the 2025 Global NCD Alliance Forum, held Feb. 13–15 at the Kigali Convention Centre in Rwanda’s capital. The forum drew participants from 90 countries to mobilize interventions, awareness, and resources for the prevention and treatment of NCDs, which account for more than 75 percent of annual deaths worldwide and place a disproportionate burden on low- and lower-middle-income countries, where access to care is often limited.
The forum occurred as NCD advocates were preparing for the Fourth High-Level Meeting on NCDs at the United Nations General Assembly, to be held in September. Rachel Gasana, senior director of advancement for the NCDI Poverty Network and the Center for Integration Science at Brigham and Women’s Hospital in Boston, reported that throughout forum events, meetings, and conversations, she heard strong support for PEN-Plus. A proven model in more than a dozen countries already, PEN-Plus enables frontline providers in low-income health systems to provide high-quality care for people living with severe, chronic NCDs such as type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease.
“There was a real feeling that something has to change for NCDs to gain more traction from investors and governments,” she said, “and PEN-Plus as a solution was interwoven organically throughout the whole conference, which was heartening to hear.”
The PEN-Plus model, which focuses on integrating care for severe NCDs into public health systems and decentralizing resources to bring affordable care closer to people in rural and peri-urban areas, can be transformative and sustainable for families and communities.
“It was incredible to see the level of engagement around PEN-Plus,” Gasana said. “Conference presenters noted again and again that it’s a solution that works.”
The Power of Integration
Pragmatic solutions were a focus of the Network’s Feb. 14 panel at the forum. Cosponsored by the Scottish Government, the panel was titled, “From Intention to Action: Designing & Financing Effective, Accessible, and Fully Integrated NCD Interventions.”
Panelists included Professor Liz Grant, director of the Global Health Academy at the University of Edinburgh and chair of the Scottish Government’s International Development Technical Advisory Group; Dr. Gene Bukhman, co-chair of the NCDI Poverty Network and executive director of the Center for Integration Science; Dr. Mary Amuyunzu-Nyamongo, founder and director of NCD Alliance Kenya; and Dr. Evariste Ntaganda, director of cardiovascular diseases in the NCD Division of the Rwanda Biomedical Centre. The moderator was Dr. Fredrick Kateera, deputy executive director of Partners In Health in Rwanda.
Professor Grant and Dr. Amuyunzu-Nyamongo emphasized clinical structures and systems built on equity. Dr. Amuyunzu-Nyamongo said that PEN-Plus is helping to mitigate the stigmatization of people with sickle cell disease in Kenya. She added that NCDs must be viewed as affecting not just people in poverty, but “families, households, and communities.”
Dr. Bukhman said leading with equity has been a pillar of Rwanda’s approach to NCDs over the past two decades, as health interventions in Rwanda have sought to address the needs of people “who are most at risk right now” across a diverse range of NCDs, including type 1 diabetes and childhood-onset heart disease.
“Rwanda has shown the way forward on NCDs and on universal health coverage more broadly,” Dr. Bukhman said.
Broadening the Agenda
This year’s Global NCDA Forum marked the first time the annual event was held in an African nation. Notable events included a UNICEF-hosted panel focusing on the experiences of youth living with severe, chronic NCDs and the subsequent launch of the Kigali Youth Statement on NCDs; a panel sponsored by the American Heart Association that explored the need for gender-responsive NCD policies; and a “community zone” discussion about advancing the NCD response through integrating NCD care into health systems. At that discussion, Gasana spoke about the importance of integration in program design and advocacy work.
Dr. Bukhman said the entire forum offered an opportunity to reflect on Rwanda’s impact and leadership in NCDs and health systems, and to expand the focus for advocacy ahead of the upcoming UN High-Level Meeting.
“There’s an opportunity to finally broaden the global NCD agenda to include children and the diverse set of conditions that affect the world’s poorest people,” Dr. Bukhman said. “This Global NCDA Forum was the first one I’ve attended in which those kinds of issues were highlighted.”
Visiting Hours
Earlier in the week, before the forum began, the NCDI Poverty Network co-hosted visits to two PEN-Plus clinics at district hospitals. These visits illustrated the effectiveness of the NCDI Poverty Network’s approach to driving access to NCD care: prioritizing the needs of children and young people living with severe conditions through integrated models of care.
On Feb. 11, the delegation hosted representatives of the Helmsley Charitable Trust and Breakthrough T1D on a trip to Rwinkwavu District Hospital in eastern Rwanda’s Kayonza District. The hospital serves a catchment area of about 300,000 people, in a rural region challenged with drought, food scarcity, poverty, and a limited infrastructure.
Rwinkwavu District Hospital is home to the first-ever PEN-Plus clinic, established two decades ago during hospital renovations supported by Partners In Health in Rwanda and a group of clinicians, including Dr. Bukhman.
Gedeon Ngoga, a nurse who worked with Dr. Bukhman in those early years and who now serves as clinical advisor for the NCDI Poverty Network, said the clinic has grown substantially over the years, with a refined operational model that boosts efficiencies of scale and provides social and economic support to patients, alongside clinical expertise.
Ngoga said the clinic focuses on a specific condition each day of the week. Monday focuses on patients with cancer-related conditions, for example, while Tuesday and Wednesday are for patients with cardiovascular conditions and Thursday and Friday are for those with type 1 diabetes. That style of organization enables specialists to visit the clinic on the appropriate days, not only to treat patients but also to provide mentorship to providers. In addition, patients with the same condition can meet with their peers on their designated day, to share experiences and attend education sessions together.
That doesn’t mean, however, that patients are limited to attending only on the day dedicated to their condition. On the day the Helmsley Charitable Trust and Breakthrough T1D delegation visited, a Tuesday, the clinic was bustling not only with cardiovascular patients but also with patients with type 1 diabetes who were there to attend follow-up appointments, check their A1C levels, and deposit savings.
Ngoga said patients with type 1 diabetes have formed a group that meets regularly and deposits small amounts of money into a shared fund, for community savings and uses. The clinic supports the group as part of the hospital’s social support programs, which help patients tackle social determinants of health such as finances, food security, and education.
“It was interesting for both the visitors and us to witness people living with type 1 diabetes receiving care,” Ngoga said. “It was also gratifying to see how they’ve organized themselves into a group that shares experiences and resources in a meaningful way.”
The delegation then saw the impact of that social support firsthand, during a visit to the home of a family with two children who are living with type 1 diabetes. In addition to the children’s care and insulin, the family receives money to offset transportation costs to the clinic. Sometimes travel is not necessary, though—during the delegation’s visit, a drone dropped off insulin at the home.
Media at Masaka
The following day, Dr. Bukhman and Gasana joined a group of international and Rwandan journalists on a visit to the PEN-Plus clinic at Masaka District Hospital on the outskirts of Kigali. The trip was organized by the NCD Alliance and led by Dr. François Uwinkindi, division manager for NCDs at the Rwanda Biomedical Centre.
Masaka District Hospital serves a catchment area of about 350,000 people, which Ngoga noted is “the usual size for a district hospital in Rwanda.” Unlike the Rwinkwavu clinic, the Masaka clinic is not supported by Partners In Health; instead, it is operated solely by the Rwanda Ministry of Health.
The visiting journalists heard presentations from Ministry of Health and Rwanda Biomedical Centre experts, who covered the nationwide progress on NCDs over the past decade. The presenters noted that the country has seen steady increases in type 1 diabetes diagnoses, vast improvements in the equipment and capacity at NCD clinics, and the integration of PEN-Plus into the national strategy for NCDs.
During the visit, journalists were able to interview PEN-Plus patients and their families.
Ngoga said the increasing accessibility of cardiac surgery and care in Rwanda stood out to the visitors to both the Rwinkwavu and Masaka hospitals.
“Both visits were testaments to government-driven partnerships and supporting organizations in Rwanda,” Ngoga said. “The success of those clinics showed what is possible in moving the global health agenda forward when people are working in solidarity.”
Surviving and Thriving
Reflecting on those clinic visits, Dr. Bukhman said the work to improve care for people living with NCDs in some ways has mirrored Rwanda’s long battle with the AIDS pandemic. After recalling the early days of HIV programs in Rwanda, Dr. Bukhman said witnessing the transformative effects on people before and after receiving treatment was powerful.
“To see the continued advances in healthcare and the growth of NCD programs is inspiring in a different way,” Dr. Bukhman said. “Now there are mature health systems that have been sustaining prevention, treatment, and resources for decades, and people and communities who have benefited over that time.”
During the Rwinkwavu visit, group members were able to reunite with several patients who have been receiving treatment for their NCDs at the clinic for as long as 20 years.
“These reunions gave me a before-and-after snapshot of NCD care, with patients who had been terribly sick not only still alive but thriving,” Dr. Bukhman said. “This is why we do what we do.”
