Objective
Objective 1: Strengthen capacity to promote and monitor high standard of quality for type 1 diabetes services across a 22-country network using the PEN-Plus strategy.
Objective 2: Support initiation of PEN-Plus in Tanzania and Ethiopia.
Background Rationale
Public health systems in lower-income countries have struggled to sustain high-quality care for people with T1D. PEN-Plus (the Package of Essential Noncommunicable Disease Interventions -Plus) address this problem by packaging T1D care within an integrated set of services for severe chronic diseases that also include sickle cell disease, and childhood-onset heart diseases. PEN-Plus was developed at Brigham and Women’s Hospital’s Center for Integration Science, and is currently being implemented across more than 70 facilities in 14 countries. In 2022, all 47 countries of WHO’s African region adopted a resolution to achieve high levels of PEN-Plus coverage. Now is an essential time to ensure the quality of T1D services within PEN-Plus strategies, and to support the global PEN-Plus movement.
Description of Project
This proposal requests four years of support from JDRF to expand access to T1D care throughout the 22-country Noncommunicable Disease and Injuries (NCDI) Poverty Network. The proposal has two components. The first component will strengthen the capacity of Brigham and Women’s Hospital’s Center for Integration Science (CIS) in Global Health Equity to promote and monitor high standards of quality for T1D services across the Network using the PEN-Plus strategy. The second component will support initiation of PEN-Plus services in Tanzania and Ethiopia. We anticipate that this support from JDRF will contribute to T1D services for more than 3000 people by the end of 2027. This support from JDRF will also sustain a global PEN-Plus Partnership working to scale and sustain high-quality T1D care within the public sector systems of the world’s lowest-income countries, most of which are in sub-Saharan Africa.
The NCDI Poverty Network was established in 2020 based on the recommendations of the Lancet Commission on Reframing NCDIs for Poorest Billion to expand the global NCD agenda in the interest of equity. The Network is composed of 22 National NCDI Poverty Commissions, with a co-secretariat based at the CIS and the Universidade Eduardo Mondlane in Mozambique. The Network has focused on supporting implementation of PEN-Plus programs as one its main initiatives.
PEN-Plus is an integrated healthcare delivery model developed at the CIS. PEN-Plus builds on the World Health Organization’s WHO Package of Essential Noncommunicable Disease Interventions (PEN) for primary care. PEN-Plus was designed to identify and treat people who develop T1D and other severe chronic diseases early. These severe chronic diseases include T1D, as well as other life-threatening conditions such as sickle cell disease, and childhood-onset heart disease. PEN-Plus achieves its goal by training mid-level health care workers such as nurses to deliver a package of specialized services using shared facilities.
Fourteen countries are currently implementing PEN-Plus across more than 70 facilities. These countries include Liberia, Sierra Leone, Haiti, Rwanda, Tanzania, Uganda, Ethiopia, Kenya, Malawi, Mozambique, Zambia, Zimbabwe, Chhattisgarh State (India), and Nepal. In August of 2022, all 47 countries of the World Health Organization’s (WHO) African Region adopted the PEN-Plus strategy. In September of 2022, the NCDI Poverty Network launched a global PEN-Plus Partnership with the support of JDRF, the Helmsley Charitable Trust, the American Heart Association, the American Society of Hematology, UNICEF, and other leading disease-focused organizations. The goal of the Partnership is to sustain and coordinate external support for PEN-Plus.
Giving the incredible growth of PEN-Plus implementation, in 2023, NCDI Poverty Network’s High-Level advisory group (including JDRF) met in New York to discuss a draft 2025-2028 strategic plan for PEN-Plus Partnership. Key priorities identified during that meeting included: (1) promoting high standards of clinical care for T1D by PEN-Plus implementing partners; (2) improving program monitoring and evaluation; (3) strengthening supply chain systems, and (4) improving communication and coordination of the advisory group and Partnership activities.
This proposal to JDRF will allow the CIS to act on these priorities by hiring key staff. The proposal will also continue to sustain T1D care in Tanzania and Ethiopia while leveraging support from a global coalition.
Anticipated Outcome
We anticipate that this support from JDRF will contribute to T1D services for more than 3000 people by the end of 2027. This support from JDRF will also sustain a global PEN-Plus Partnership working to scale and sustain high-quality T1D care within the public sector systems of the world’s lowest-income countries.
Relevance to T1D
This proposal will support delivery of T1D services, and ensure the quality of T1D care within a quickly growing global strategy for integrated care of severe chronic diseases in lower-income countries.