Zione Chiwaula, who lives in southern Malawi’s hard-to-reach Neno district, has two children who suffer from sickle cell disease. “They spent most of their early years admitted in hospitals, as they would regularly present with severe symptoms that needed special care,” she says.

This used to mean an arduous and mostly an expensive 300 km trip to Kamuzu Central Hospital in Lilongwe, Malawi’s capital. But that all changed in 2018, when Chiwaula’s local district hospital in Neno started offering chronic care services for patients with severe sickle cell disease, diabetes and other noncommunicable diseases. 

“My children’s condition is no longer a barrier to their well-being because of the quality of the health care services they can now get locally. They can now live normally like other children.” – Zione Chiwaula, mother, Neno District.

This is thanks to a World Health Organization (WHO) programme that, in collaboration with the Malawian Ministry of Health and other partners including Partners in Health (PIH), has been successfully piloted in Neno, one the poorest regions of Malawi. 

The programme, called PEN-Plus, looks to broaden the spectrum of care delivery and support for noncommunicable diseases at rural district hospitals and increase the training of health workers using an adapted WHO curriculum. Since 2019, 444 clinicians and nurses have already received this formal training in noncommunicable diseases. 

PEN-Plus is an extension of WHO’s Package of Essential noncommunicable diseases interventions (PEN) programme that was successfully integrated into all 12 of Neno’s first-level health facilities between 2011 and 2015.

The new programme aims to provide critical diagnosis and treatment services at the intermediate level of health care, as well as continue to strengthen the implementation of PEN services in these primary health care facilities. 

Six secondary-level health facilities in the country, including two in Neno district, are now providing PEN-Plus care. This has already spared more than 300 patients from having to travel to referral hospitals, like Kamuzu Central Hospital in the capital Lilongwe, which in turn also helps to decongest these central facilities.

“By decentralizing care for noncommunicable diseases, building the capacity of health workers at primary health centres and at first level referral hospitals and improving the supply chain of medical supplies and equipment, we will strengthen the overall health system to be efficient at all levels,” says Dr Jones Masiye, Deputy Director General of Clinical Services for Malawi’s Ministry of Health.   

The programme has also helped to reduce the financial burden on poor Malawian families. In addition to reducing significant transport costs, the services provided through the PEN-Plus programme are free of charge. By contrast, a 2018 report by the Malawi National Noncommunicable Diseases and Injuries Poverty Commission showed that out-of-pocket spending on such services accounted for 14.7% of monthly per capita household expenditure in 2015. 

“The adoption of this programme is an important step in Malawi’s bid to address the critical care delivery gap for severe and complex chronic conditions,” says WHO Representative to Malawi, Dr Neema Kimambo. “It’s an integral part of building a more efficient and cost-effective healthcare system.”

Over the next five years, the Malawian Ministry of Health aims to scale up the PEN-Plus initiative to incorporate 26 district and community hospitals across three regions of the country, with support from the World Diabetes Foundation and the United Nations Children’s Fund (UNICEF). 

“This strategy is advancing Malawi’s universal health coverage and saving lives,” says Dr Beatrice Matanje, a Medical Director at PIH.

“My children’s condition is no longer a barrier to their well-being because of the quality of the health care services they can now get locally,” says Chiwaula. “They can now live normally like other children.”