Request for Interest (RFI) PEN-Plus Implementation – 2020

PEN-Plus is an integrated strategy that builds on the World Health Organization’s Package of Essential Noncommunicable Disease Interventions (WHO PEN) in order to increase the quality of services for severe chronic NCDs at primary referral facilities (e.g. district hospitals). PEN-Plus also seeks to accelerate decentralization of services for common NCDs at primary care facilities (e.g. health centers). Conditions addressed by PEN-Plus providers typically include relatively complex diseases such as type 1 diabetes, advanced rheumatic heart disease, and sickle cell disease. PEN-Plus providers also train and mentor WHO PEN workers addressing conditions such as type 2 diabetes, uncomplicated hypertension, and asthma at health centers.

The Program in Global NCDs and Social Change at Harvard Medical School (HMS), the NCD Synergies project at Partners In Health (PIH), and the Division of Global Health Equity at Brigham & Women’s Hospital (BWH) have been working with WHO, the Leona M. and Harry B. Helmsley Charitable Trust, and other partners to support Ministries of Health (MOHs) in LLMICs to: 

  1. assess their NCDI priorities through National NCDI Poverty Commissions
  2. identify integrated delivery strategies to implement priority interventions 
  3. establish PEN-Plus training sites when relevant, 
  4. develop national operational plans for PEN-Plus, and 
  5. seek financing for national scale-up of these services.

These partners have now issued a Request for Interest (RFI) soliciting preliminary Letters of Interest from countries who have already gone through the process of identifying their NCDI priorities through National NCDI Poverty Commissions and would like support with establishing PEN-Plus training sites and developing national operational plans for national PEN-Plus scale-up. The capacity to support countries is dependent on funding availability.

Application Requirements 

1. Eligibility

  • Applicants are eligible to apply from countries with an established National NCDI Poverty Commission.
  • These countries include: Afghanistan, Chhattisgarh State (India), Ethiopia, Kenya, Madagascar, Mozambique, Nepal, Tanzania, Uganda, Zambia, Zimbabwe. Countries that have already been supported to initiate PEN-Plus implementation are not eligible (Rwanda, Malawi, Liberia, Sierra Leone, and Haiti).
  • Locally registered organizations and institutions, such as non-governmental organizations, academic institutions, non-governmental clinical centers, and UN agencies based in a country with an established NCDI Poverty Commission (as above) are eligible to apply.

2. Applicants should demonstrate the following:

  • A strong relationship with the Ministry of Health and other relevant in-country partners.
  • An in-country office that is legally recognized by the local government as a domestic entity able to hire local staff.
  • An established record of successful implementation together with the MOH of outpatient care delivery at a rural, first-level hospital(s).

Selection Process

1. Letter of Intent (due July 1, 2020) 

2. Full proposal (due October 1, 2020) 

  • Successful applicants from round 1 will be invited to submit a full proposal and will be sent specific questions to answer. Follow up conversations will be set up with the candidates to discuss scope of work, budget allocation, and contractual mechanisms.  



(Updated 3 August 2020)

Is it recommended for the project application to focus on one specific area of NCDs (e.g cardiovascular diseases) or an integrated approach covering several NCDs?

It is recommended that proposed projects focus on an integrated approach to multiple NCDs.  Please see the full RFI for more details.

Is a letter of support from the Ministry of Health required for the Letter of Intent?  

Letters of support from the Ministry of Health or other collaborating institutions may be submitted with the the first-stage Letter of Intent (LOI) submission; however, letters of support are NOT required for this LOI stage.    For applicants who submit an LOI and are invited to proceed to the second stage, a letter of support from the Ministry of Health will be required when they submit a full application.  Please note that the LOI should be submitted by an eligible organization and not by the Ministry of Health. 

Can more than one organization apply per country?  Can more than one organization per country receive an award? 

Multiple applications may be submitted from the same country; however, no more than one applicant per country will be funded.  

Does the national NCDI Poverty Commission decide on which organization(s) should apply?

It is recommended that organizations interested in submitting an LOI contact the leadership of their respective national NCDI Poverty Commissions. National NCDI Poverty Commissions may advise or facilitate communication, learning, and cooperation among interested applicants. However, national NCDI Poverty Commissions are not involved in the award selection process.

Are professional societies eligible to apply?

Yes, locally registered institutions and organizations with capacities listed in the RFI are eligible to apply.

Are there suggested word limits for the Letter of Intent? 

There is no minimum or maximum word count limitation.  We would suggest 500-1000 words for each of the three sections as a reasonable word target.

Are the application forms or reference documents available in alternative formats (i.e., Word, PDF, etc.) 

The LOI template form is available for download in both PDF and Word formats.

What is the recommended focus and scope of the proposed PEN-Plus project?

The objectives of this project are to 1) pilot PEN-Plus services in 1-3 first-referral level hospital facilities (i.e., primary or district hospitals); 2) establish one PEN-Plus training center to support PEN-Plus replication in other catchment areas; and 3) develop a costed plan for potential national scale-up of this model. Please refer to full RFI document for more details.

What is the projected budget for this project?

Based on prior experience, we estimate the cost of achieving the objectives of this RFI to be approximately US$200,000 – US$350,000 per year over a three-year period.

What is the ideal health system facility level for the PEN-Plus clinical site and training site?  Are they the same or can they be in different sites?

The primary consideration for site selection would be the first-referral facility level for severe NCD conditions within access of rural catchment populations and where clinical specialists are not routinely available.  It is not absolutely required that training capacities be strictly co-located with the clinical demonstration site though training sites should reflect a similar clinical settings and resource availability to the demonstration site.

What is the best process for obtaining baseline data on severe NCDIs (such as RHD or sickle cell) in our population? 

We would recommend first exploring any primary studies or surveys that have been done in your country (or closely surrounding countries).  If adequate primary data cannot be found, we would suggest modeled point estimates from meta-analyses or the Global Burden of Disease Study 

The application period is now closed.  Funding decisions are currently pending and will be communicated to all applicants when available.