Health Officials from Francophone Countries See PEN-Plus Firsthand

‘Game-changing’ study tour in Sierra Leone introduces Francophone nations to the impact of integrated care for people living with severe noncommunicable diseases.

Health officials from across western and central Africa and partner organizations share a thumbs-up in early February, after introductory sessions with the Sierra Leone Ministry of Health during a study tour. The group included representatives from seven French-speaking countries, along with officials from the NCDI Poverty Network, Partners In Health, and the World Health Organization’s African Region.

A recent study tour in Sierra Leone gave health officials from seven countries a firsthand look at the impacts of the PEN-Plus model of care for noncommunicable diseases. The officials also received an update on how Sierra Leone’s government is preparing to launch its national PEN-Plus operating plan and dramatically scale up services over the next five years.

The NCDI Poverty Network convened the Feb. 3–7 study tour and hosted more than 25 people, including Ministry of Health officials from Sierra Leone as well as six other French-speaking countries—Benin, Burkina Faso, Cameroon, the Democratic Republic of the Congo, Niger, and the Republic of the Congo. The tour featured a visit to the PEN-Plus clinic at Koidu Government Hospital in Sierra Leone’s central Kono District, along with government meetings and presentations in Freetown, the capital of the coastal nation.

Dr. Gene Bukhman, co-chair of the Network and executive director of the Center for Integration Science in Global Health Equity at Brigham and Women’s Hospital in Boston, said a collaboration with the World Health Organization’s African Region spurred the study tour.

WHO’s African Region supports numerous countries in the development and implementation of PEN-Plus. A package of clinical services, 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.

In 2022, all 47 member states of WHO’s African Region adopted the PEN-Plus model as their strategy for advancing access to care for people living with severe, chronic NCDs. Eleven African countries now have PEN-Plus clinics, and WHO’s African Region has set the ambitious goal of having 70 percent of member states initiate PEN-Plus services by 2030.

Among the countries with new and increasing involvement, many share a common thread.

“A big development for us has been this real growth in Francophone countries,” Dr. Bukhman said.

That trend made Sierra Leone a natural location for the study tour. The Network has supported the development of the PEN-Plus program there for several years, in collaboration with Partners In Health and Doctors with Africa CUAMM.

“Sierra Leone is an amazing example of a country that is succeeding with both implementation and planning for scaleup,” said Dr. Neil Gupta, senior policy director for the NCDI Poverty Network and the Center for Integration Science. “Seeing PEN-Plus in action was transformative for our newer partnerships and collaborators.”

The tour created a long-awaited moment for Dr. Remy Nkwiro Bitwayiki, the regional advisor for West Africa for both the Network and the Center.

Dr. Bitwayiki, who also is the internal medicine consultant and NCD lead for Partners In Health in Sierra Leone, said the rare opportunity to share years of work with a high-level audience of health officials from countries across the region made the tour—particularly the visit to the clinic at Koidu Government Hospital—emotional for him.

“Seeing the joy and excitement in everyone’s eyes was so rewarding,” he said. “Everyone was interested, motivated, and curious.”

Dr. Salmane Amidou, national coordinator of the National Plan for the Fight Against Noncommunicable Diseases for the Benin Ministry of Health, said he was struck by the effective care for patients with severe cardiac conditions, “the free provision of insulin glargine and glucometers, and patient involvement.” Dr. Amidou added that in his view, the main challenge for PEN-Plus would be sustaining the high level of care.

Sustainability is a reason training local care providers is a pillar of PEN-Plus. Dr. Stely Leza, who leads the Department for Noncommunicable Diseases at the Directorate of Epidemiology and Disease Control for the Republic of the Congo Ministry of Health, said the well-trained staff at Koidu reflected the emphasis of PEN-Plus on a strong mentorship system.

This program, Dr. Leza noted, calls for a specialist to be present “not just for a typical five-day training session, but in a more ongoing capacity to support staff over time. We will need to adapt this approach to our context to see how we can achieve similar results.”

Piniel Nadège Ade, the health systems specialist and policy coordinator for the Network and the Center, said Ministry of Health officials identified additional beneficial components of PEN-Plus, including:

A pharmacy dedicated to NCD patients, with an extensive stock of high-quality medications for type 1 diabetes and sickle cell disease;
The clinic’s highly knowledgeable pharmacist, who demonstrated expertise in drug dispensation and counseling for people living with NCDs;
Strong professional competence of the health staff, particularly the clinical officers and nurses, who receive regular mentoring and capacity-building sessions; and
Community-focused peer support groups, with participants including a patient with type 1 diabetes who progressed from diagnosis at the Koidu clinic to volunteering there, and now serves as a peer support coordinator.

“The PEN-Plus clinic at Koidu demonstrated how high-quality health services can be effectively delivered in resource-limited and peri-urban settings,” Ade said. “The study tour showed how PEN-Plus fills gaps in social support for people living with NCDs.”

At the PEN-Plus clinic at Pujehun Hospital, in the country’s south, Ade added, the robust community program includes sensitization meetings on market days to address and reduce stigma around NCDs, awareness sessions at local schools, and education for community health workers and traditional healers about signs and symptoms of severe NCDs.

When the study tour group returned to Freetown, Dr. Bukhman said, “We saw the things that are happening with policy there, and how the government is getting ready to launch its PEN-Plus operational plan to scale services.”

Based on the success in the Kono and Pujehun districts, that expansion could include PEN-Plus clinics in three more district hospitals by 2026 and in all 30 of Sierra Leone’s district hospitals by 2030.

Dr. Bukhman said the tour reflected years of priority-setting, led by Sierra Leone’s NCDI Poverty Commission, and the dedication of the clinics’ implementing partners—both Partners In Health at Koidu Government Hospital and Doctors with Africa CUAMM at Pujehun Hospital.

Dr. Bitwayiki echoed that sentiment, saying the tour could energize PEN-Plus expansions in participants’ home countries.

“The tour was game-changing,” Dr. Bitwayiki said. “We’ve had many meetings with people from these French-speaking countries, but seeing them witness PEN-Plus in real life, with patients, was incredible.”

Health Officials from Francophone Countries See PEN-Plus Firsthand

Dr. Ana Mocumbi Touts Integration at Global Diabetes Event

Network Publishes Portuguese Edition of PEN-Plus Clinical Handbook

NCDI Poverty Network Co-Secretariats