The burden of noncommunicable diseases (NCDs) is increasing rapidly across the African Region, posing a significant threat to health systems, economic development, and population well-being. While substantial progress has been made in expanding primary health care services, access to quality care for individuals living with severe chronic NCDs – type 1 diabetes, sickle cell disease, rheumatic heart disease and chronic respiratory diseases – remains limited, especially at decentralized levels of the health system. In response to this urgent need, the World Health Organization Regional Office for Africa has led the development and regional endorsement of the PEN-Plus strategy – the package of essential noncommunicable disease interventions for severe chronic diseases at first-level referral facilities.
PEN-Plus is a public health approach that aims to decentralize and integrate care for severe NCDs within district hospitals and other first-level referral facilities, bridging the gap between primary and tertiary care. The strategy is people-centred, equity-driven, and aligned with universal health coverage and the WHO Global NCD Action Plan for the Prevention and Control of NCDs.
This operations manual has been developed to support countries in the African Region to implement and scale up PEN-Plus services. It provides practical, evidence-based guidance on designing, implementing and monitoring PEN-Plus programmes. Key areas covered include service delivery models, health workforce capacity, clinical protocols, supply chain management, health information systems and programme sustainability. The manual draws on experiences and lessons learnt from early PEN-Plus implementation in countries such as Liberia, Malawi and Rwanda. It reflects the collective expertise of clinicians, programme managers and policy-makers across the Region.
This document is intended to serve as a key resource for ministries of health, health workers, implementing partners and development agencies committed to strengthening NCD care in Africa. Through the implementation of PEN-Plus, countries can take a significant step towards advancing health equity and ensuring that individuals living with severe chronic NCDs receive quality care close to where they live, delivered with dignity.
Dr Benido Impouma
Director,
Health Promotion, Disease Prevention and Control Cluster
WHO Regional Office for Africa
