Executive Summary

Severe, chronic noncommunicable diseases—particularly childhood-onset conditions such as type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease—are largely absent from major global health funding priorities and policies. Yet collectively they represent a devastating burden of disease, particularly for the poorest regions of the world, where diagnosis and ongoing care are difficult to access. When untreated, these conditions are debilitating and deadly, burdening affected families with significant emotional and economic hardship.

The NCDI Poverty Network is leading the charge to change this reality. Over the next three years, we will work with an established coalition of partner organizations and national governments to integrate care for people living with severe NCDs into public health systems. We will accomplish this goal by scaling a package of clinical services called PEN-Plus (the Package of Essential Noncommunicable Disease Interventions – Plus).

Our focus on Equity, Quality, and Financing for PEN-Plus interventions will promote growing efficiencies in care made possible by scale. This focus will also catalyze new, sustainable sources of support for ongoing service delivery.

We are starting this next stage of our journey having already achieved significant progress. Fifteen countries are implementing PEN-Plus, with services now available to a combined catchment area of more than 25 million people in lower-income countries. We are poised to double that impact by 2028, drawing on the momentum made possible by our commitment to patient care, our hard-won experience, and the advocacy we see accelerating across sub-Saharan Africa and South Asia.

Rooted in clinical expertise, research, and community engagement, PEN-Plus is bringing hope to those doubly burdened by severe NCDs and extreme poverty. Nothing changes if nothing changes.

In joining their respective strengths, the global partners of the NCDI Poverty Network have already made significant progress in solving one of the world’s starkest health inequities. We invite you to join us in this ambitious work. The PEN-Plus model represents both an opportunity to dig deep into issues that matter to your mission and an outsized impact as part of the joint work of Network members.

Clinical experts bring their deep knowledge of specific diseases—such as type 1 diabetes, sickle cell disease, and rheumatic and congenital heart disease—to refine clinical protocols, identify referral pathways, and train and mentor lower-level providers.

Nongovernmental organizations—especially those that serve as PEN-Plus implementing partners—are critical players in the expansion of PEN-Plus. They bring operational prowess and creative thinking about how to integrate new clinical capacities into existing public health systems. Their place-based expertise and network of in-country relationships facilitate on-the-ground changes in care and holistic support for patients and their families.

Academic institutions provide the evidence base critical to ensuring quality and action. Care delivery for people living with severe, chronic NCDs in low-resource settings has never been tackled at this scale. Research is essential for understanding and validating the impact of PEN-Plus and related interventions in clinical, economic, and operational terms.

Global policymakers set the standard for determining where global resources should focus to meet minimum viable standards for human health and thriving. These policymakers are critical to ensuring these decisions address the needs of people living with severe NCDs.

Advocates share their lived experiences with severe NCDs in PEN-Plus countries to motivate, inspire, and raise the bar for all stakeholders. In telling their stories, they provide powerful reminders of the costs of inaction to people living with severe NCDs, their families, and society.

Philanthropists provide catalytic capital to a variety of stakeholders to fund innovative approaches to care, strengthen local institutions critical in care delivery, and meet near-term
humanitarian needs. Their networks and influence are valuable assets in change management across stakeholders.

Industry shapes and is shaped by markets. Pharmaceutical and medical-device companies produce essential medicines and supplies. In collaboration with pooled purchasing mechanisms and governments, they also have a critical role to play in reshaping markets to better work for the poorest countries and populations