HMS & PIH co-host session with WHO on addressing gaps for severe NCDs such as T1D through “PEN-Plus” strategies at WHO AFRO in Dakar, Senegal

Author: Maia Olsen, NCD Synergies
September 5, 2018

From August 27th-31st 2018, Ministers of Health throughout the WHO African region (WHO AFRO) convened in Dakar, Senegal on health policy at this year’s WHO Regional Committee for Africa. At this meeting, Harvard Medical School – with support from the NCD Synergies team at Partners In Health – had the opportunity to co-organize an official side-event on the integrated management of severe NCDs such as type 1 diabetes and advanced rheumatic heart disease in collaboration with the NCD cluster at WHO AFRO.

This session was held on Tuesday evening August 28th, and was attended by numerous Ministers of Health, additional high-level representatives from member state delegations, and civil society advocates in attendance.  

Noel Kasomekera / Partners In Health
Honorable Minister Diane Gashumba from Rwanda, Joseph Waogoda Caboré, Dr. Gene Bukhman and Dr. Steven Shongwe speak on a panel at WHO African Regional Meeting on August 28, 2018 in Dakar, Senegal.

Speakers for the event included:

  • Joseph Waogodo Caboré, Director of Programme Management at WHO AFRO
  • Steven Shongwe, acting Director of the Noncommunicable Diseases cluster at WHO AFRO
  • Honorable Minister Diane Gashumba, Ministry of Health, Rwanda
  • Gene Bukhman, Director of the Program on Global NCDs and Social Change at Harvard Medical School and Director of the NCD Synergies program at Partners In Health

The session served as both a review of progress on the WHO package of essential NCD interventions for primary health care in low resource settings (PEN), as well as discussion on how to address a critical delivery gap in current resources regarding longitudinal outpatient services for severe and complex chronic NCDs that cannot generally be managed and treated at the primary care level.

In the side event, Dr. Bukhman, with support from the team leading the NCD cluster at WHO AFRO, proposed a strategy to address this gap by developing specialized outpatient NCD clinics at first level hospitals (PEN-Plus), which provides an essential first step to establishing the follow-up of patients with severe, chronic NCDs. In the session, Dr. Bukhman also mentioned the role that specialized outpatient clinics can play in supporting the expansion of WHO PEN implementation at health center level through task-sharing and mentorship, training, and supervision of integrated chronic care providers.

Noel Kasomekera / Partners In Health
Meeting attendees engage in a discussion with session panelists on treatment and decentralized care for severe, chronic NCDs such as type 1 diabetes and rheumatic heart disease across the African Region.

In her remarks, Honorable Minister Diana Gashumba elaborated on the technical presentations from Dr. Shongwe and Dr. Bukhman on PEN and PEN-Plus by presenting on the experience of the government of Rwanda in addressing NCDs at national level. The Honorable Minister mentioned critical national efforts in prevention and at community level, as well as efforts that the Ministry of Health in Rwanda has prioritized in decentralizing and strengthening care for NCDs at district hospitals.

Given the recent adoption of Director General Dr. Tedros’ Thirteenth General Programme of Work for 2019-2023, which focuses heavily on targets to achieve universal health coverage, it was no surprise that UHC was a running theme for the side session. The content presented on management of severe NCDs transitioned into a lively discussion by Ministers of Health attending the session regarding how to accelerate progress in NCD care and treatment across all levels of the health system.

Maia Olsen / Partners In Health
Dr. Gene Bukhman and Dr. Steven Shongwe of WHO AFRO during the opening gala at the WHO Regional Committee for Africa in Dakar. 

Specifically with respect to the PEN-Plus portion of the dialogue, Ministers of Health and country delegations reiterated challenges around the unaddressed burden for conditions like rheumatic heart disease, severe mental illness, and kidney failure. Some comments, from Ministers representing countries like Central African Republic, also underscored that technical expertise on care delivery packages like PEN-Plus would potentially help support countries in more adequately responding to the kinds of conditions their colleagues see in clinics and 1st level hospitals throughout the African region.

Our teams at Harvard Medical School and Partners In Health hope that this discussion is merely a preview of regional dialogue and technical efforts that will continue across the African region to develop and define a package of interventions for severe, chronic NCDs at first-level hospitals (PEN-Plus). We look forward to future collaboration to come.