Brazzaville– More than 170 000 people have been attending health facilities offering PEN-Plus services across 20 African countries during the three years of implementation of the PEN-Plus Regional Strategy, according to a new report by the World Health Organization (WHO) Regional Office for Africa.
These facilities provide screening, diagnosis, treatment, long-term care and referral, as needed, for people living with severe noncommunicable diseases (NCDs), including type 1 diabetes, sickle cell disease, rheumatic and congenital heart diseases.
The report, released today by WHO African region with support from The Leona M. and Harry B. Helmsley Charitable Trust, provides insights into the burden of severe chronic diseases in Africa and highlights the significant progress of the PEN-Plus model in addressing these conditions across implementing countries.
The PEN-Plus model expands upon the WHO PEN (Package of Essential Noncommunicable disease interventions), which decentralizes care for common NCDs to primary healthcare facilities. PEN-Plus extends this care to first-level referral facilities, such as district hospitals, and has demonstrated significant success in increasing patient access to treatment for severe NCDs, improving patient outcomes
The report, Scaling up PEN-Plus: Expanding life-saving care for severe noncommunicable diseases in Africa, finds that 20 countries are at different phases of implementing the PEN-Plus model of care, with services delivered in more than 120 district hospitals and training provided to more than 1750 health workers to manage severe NCDs.
Specialized care closer to communities
Severe NCDs disproportionately affect children, adolescents and young adults in Africa, particularly in poor, rural and underserved communities where access to specialized services remains limited. To address these gaps, the WHO Regional Committee for Africa endorsed PEN-Plus in 2022 as a regional strategy to strengthen district and first-level referral hospitals to deliver comprehensive care for severe NCDs. The initiative was launched in 2023 with support from the Helmsley Charitable Trust.
Since its launch, all 20 implementing countries have completed readiness assessments and developed costed operational plans to guide implementation. Rwanda has achieved nationwide coverage of PEN-Plus services, while Ethiopia launched a national operational plan in 2026 that aims to establish clinics in 150 hospitals and enrol approximately 82 000 patients. In Malawi, for example, more than 440 health workers have been trained with PEN-Plus services now covering 55% of planned districts.
Transforming health systems and saving lives
The report reveals that PEN-Plus is strengthening public health systems by decentralizing specialized NCD services, expanding workforce capacity, and improving access to essential medicines and diagnostics. The initiative has led to significant increases in patient enrolment and service utilization, reflecting greater public confidence in district-level care.
In Uganda, patient enrolment in PEN-Plus clinics increased by 178% between the end of 2022 and early 2025. Across 10 countries supported by the NCDI Poverty Network, the number of patients enrolled in PEN-Plus clinics grew from fewer than 100 in 2022 to nearly 7 500 by mid-2025.
“The progress achieved through PEN-Plus demonstrates what can be accomplished through strong political commitment, regional solidarity and coordinated action,” said Dr Mohamed Janabi, WHO Regional Director for Africa. “By bringing life-saving care closer to communities, countries are reducing preventable suffering and ensuring that children and young adults living with severe NCDs are no longer left behind”.
The PEN-Plus model has gained strong political momentum in the region through national stakeholder engagement, policy integration and advocacy. All 20 implementing countries have developed clinical guidelines for severe NCD management based on WHO standards.
To build on these achievements, WHO and partners are preparing for a second phase of implementation aimed at expanding PEN-Plus from 20 to 30 countries. Priorities include increasing domestic financing, strengthening the health workforce, expanding digital learning opportunities, reinforcing data systems and promoting innovations such as telemedicine and locally produced diagnostics and medicines.
Despite this progress, severe NCDs continue to pose a growing challenge in Africa. Noncommunicable diseases account for 37% of all deaths in the WHO African Region, and NCD-related mortality increased by 13 percentage points between 2000 and 2019. Shortages of trained specialists, diagnostics, medicines and clinical protocols continue to limit access to quality care in many countries.
Sustained political commitment, predictable financing and stronger partnerships will be essential to expand access and ensure that severe NCD care becomes an integral part of universal health coverage.
“There is significant work ahead: expanding the model to 10 additional countries, increasing domestic financing to sustain impact and strengthening the health workforce to deliver care in every community. Fortunately, we have seen the power of this model and the coalition behind it,” said James Reid, Program Officer, Type 1 Diabetes, The Leona M. and Harry B. Helmsley Charitable Trust
