On Thursday July 30, 2020, The Program in NCDs and Social Change at Harvard Medical School and the WHO Regional office for Africa (WHO/AFRO) hosted over 60 implementers, clinical experts, national policy makers, partners and donors for a virtual partnership meeting to further explore avenues to mobilize around PEN-Plus an integrated approach to decentralize high-quality care for severe, chronic noncommunicable diseases among the world’s poorest people. Supporting institutions who had prominent roles in the agenda included Partners In Health, the Division of Global Health Equity at Brigham & Women’s Hospital, the Leona M. and Harry B. Helmsley Charitable Trust (HCT), and the Juvenile Diabetes Research Foundation (JDRF).
The meeting included participation from over 60 attendees representing leading institutions, including WHO HQ, UNICEF, The World Bank, World Diabetes Foundation (WDF), Medtronic Foundation, the Agha Khan Development Network, American Heart Association, Novartis, among others. The aim of the meeting was to identify new opportunities for technical collaboration and partnerships to pilot and expand PEN-Plus clinical services nationally across numerous countries in sub-Saharan Africa and South Asia.
The meeting was moderated and chaired by Dr. Ana Mocumbi, co-chair of the Lancet NCDI Poverty Commission and Director of the Mozambique Institute for Health Education and Research (MIHER). First, participants heard opening remarks from Dr. Prebo Barango of WHO/AFRO, Dr. Gina Agiostratidou from HCT and Sydney Yovic from JDRF. The opening speakers discussed the global disparities in access to care for severe NCDs such as type 1 diabetes, rheumatic heart disease and sickle cell anemia. They also highlighted that decentralized care for severe NCDs at first-level hospitals, (PEN-Plus), as a compliment to the Package of Essential NCDs (WHO PEN) for more common NCDs such as hypertension, type 2 diabetes and asthma is not only feasible, but possible in the next decade.
Next, the participants heard from Dr. Gene Bukhman, Director of the NCD Synergies program at Partners In Health and the Program in Global NCDs and Social Change at Harvard Medical School. Dr. Bukhman further highlighted the gross disparities in global health financing for NCDs, particularly severe NCDs, noting that the world’s poorest people continue to lack access to quality care. He explained that without significant institutional investment of additional funds and technical resources and partner collaboration, communities living in extreme poverty will continue to face the same challenges accessing care for severe conditions for years to come as domestic resources are also unlikely to be made available.
Following this presentation, participants heard from Dr. Fred Amegashie, Head of the NCD Division at the Liberia Ministry of Health and Social Welfare, Dr. Jones Masiye, Deputy Director of Clinical Services, Ministry of Health of Malawi and Dr. Darius Fenelon, Director of NCDs at Zanmi Lasante, as PIH is known in Haiti. Each presenter shared their experience piloting PEN-Plus and walked through next steps, as well as current challenges and barriers to achieving national scale-up. Finally, the group heard from Dr. Neil Gupta. Dr. Gupta presented on the success and progress of the 15 National NCDI Poverty Commissions established between 2016-2019. Of these 15 groups, 11 submitted Letters of Interest outlining plans to implement outpatient care for NCDs at first-level hospitals using the PEN-Plus approach. In the coming years, these outpatient clinics in rural hospitals would progress to serve as regional training sites for the country on the pathway to achieving national scale-up.
As the presentations came to a close, Drs. Bukhman and Mocumbi invited partners and participants to share any reflections and comments on the meeting and dialogue. The group heard from Miriam Schneidman at the World Bank, Bent Lautrup-Nielsen of WDF and Drs. Temo Waqanivalu and Ould Sidi Mohammed from WHO HQ and WHO/AFRO respectively. These final comments drew on key themes from the discussion, acknowledging how difficult it has historically been to ensure that NCDs that disproportionately impact communities in extreme poverty are a priority given so many competing priorities in the global health and development spaces. However, each speaker underlined the moral imperative to address these disparities and work together to strengthen care for PEN and expand PEN-Plus if we collectively want to achieve quality universal health care.