20 African countries scale up PEN-Plus approach to fight against severe non-communicable diseases: WHO

Twenty African countries increased access to services for severe non-communicable diseases (NCDs) over the last four years since adapting the PEN-Plus approach, a new model to decentralise critical services, according to a new report.

The report, tiled Understanding the PEN-Plus approach to care: expanding access to care for severe non-communicable diseases in the WHO African Region, was released by World Health Organization (WHO) Africa with support from the Leona M. and Harry B. Helmsley Charitable Trust on April 14, 2025.

The burden of NCDs has surged in the WHO African Region, posing a significant threat to public health.

In 2019 alone, more than 2.8 million NCD-related deaths were recorded in the WHO African Region, the equivalent of over 7,900 deaths per day. While the total number of deaths in the Region decreased from 8.7 million in 2000 to 7.8 million in 2019, NCD-related deaths rose sharply, with NCDs accounting for 37 per cent of all deaths in 2019, up from 24 per cent in 2000.

In Africa, the most prevalent, severe non-communicable diseases include sickle-cell disease, type 1 and insulin-dependent type 2 diabetes, rheumatic heart disease, severe hypertension and moderate to severe and persistent asthma.

The PEN-Plus model of care has been developed to complement the WHO Package of Essential Non-communicable Disease (PEN) interventions, which focuses primarily on managing common NCDs at primary health care level.

In sub-Saharan Africa, children and young adults living with these diseases die simply because they do not have easy access to diagnosis and care.

PEN-Plus, an integrated health care delivery model, was originally developed in Rwanda to provide just this care to affected individuals living in extreme poverty.

PEN-Plus trains and equips nurses and clinical officers to deliver essential medical services including diagnosis, symptom management and psychosocial support, across a range of severe NCDs.

The PEN-Plus strategy has shown promising results in Liberia, Malawi and Rwanda, with a significant increase in the number of people accessing treatment for severe, chronic diseases.

According to the report, as of January 2025, over 15,000 people received treatment for severe NCDs across implementing countries, with training provided to local experts. 

In Malawi, the PEN-Plus model national scale-up is well under way, with over 440 clinicians and nurses trained and six secondary-level health facilities providing PEN-Plus care to over 300 patients living with severe NCDs.

The report serves as a vital resource for policymakers, health experts, partners, donors, and communities, aiming to ensure that NCDs remain prioritised on the global agenda. It emphasises the urgent need for continued investment and collaboration to expand PEN-Plus coverage across the region, create sustainable health systems for all, leading to better health outcomes for underserved populations.