Bringing care for severe noncommunicable diseases closer to communities in Eswatini

In a major move to increase access to care for severe noncommunicable diseases such as type 1 diabetes, sickle‑cell disease, and rheumatic and congenital heart diseases, Eswatini is preparing to implement the World Health Organization (WHO)’s PEN‑Plus model.

The PEN‑Plus model decentralizes the management and treatment for severe noncommunicable diseases, expanding access to care and improving health and well‑being in the African Region. Currently, more than 18 000 people are receiving treatment for severe noncommunicable diseases across 20 implementing countries.

In Eswatini, severe noncommunicable diseases disproportionately affect children and young adults and often require advanced diagnostics, specialized treatment, and long‑term care, services typically available only at regional or specialized facilities.

The country is also witnessing a growing burden of noncommunicable diseases, The 2024 STEPS survey, - an internationally standardized tool for determining the burden of NCDs risk factors - showed low control rates for hypertension and diabetes. While almost 41% of people with diabetes were on treatment, nearly half (48%) were not adequately controlled. Further assessments show that although many health centres have basic infrastructure, including laboratories, x‑ray units, and pharmacy services, gaps remain in essential laboratory equipment, reagents, medicines, medical supplies, and ultrasound machines.

The first international conference on PEN‑Plus in Africa, organized by the WHO African Region in partnership with the NCDI Poverty Network and with support from The Leona M. and Harry B. Helmsley Charitable Trust, held in Tanzania in 2024, showcased Malawi’s successes with PEN‑Plus, generating significant interest among Eswatini’s health authorities. As one of the earliest adopters, Malawi has made substantial progress in implementing the model in 46% of district hospitals, providing specialized care to more than 300 patients living with severe noncommunicable diseases across six secondary-level health facilities.

Inspired by the Malawian example, the Government of Eswatini aims to decentralize severe noncommunicable disease services to ensure that patients can receive comprehensive, timely care close to their homes. 

Under the PEN‑Plus model, general practitioners at first‑level health centres will be trained and equipped to manage severe noncommunicable diseases. PEN‑Plus extends the WHO Package of Essential Noncommunicable Disease Interventions (PEN) by delivering specialized services at first‑level referral facilities such as district hospitals.

To operationalize PEN‑Plus implementation in Eswatini, the Ministry of Health has selected two pilot health centres - Mkhuzweni in the North and Sithobela in the South. These rural sites are far from specialist hospitals and were chosen to improve continuity of care for people in hard‑to‑reach areas. PEN‑Plus is expected to close critical gaps in early diagnosis, continuity of care, and timely management of complications. Rollout is scheduled to start in June 2026.

“Too many patients are traveling long distances for simple check‑ups or medication refills. This overwhelms specialist hospitals and delays care for those who truly need it. With PEN‑Plus, we will bring treatment closer to communities so people can get the care they need in a timely way - without unnecessary referrals, risk of medical complications or premature deaths,” said Ntombi Ginindza, Noncommunicable Diseases Programme Manager at the Ministry of Health in Eswatini.

Preliminary findings from the needs assessment report highlights country readiness such as human resource, substantial chronic disease caseloads, existence of referral pathways and a national electronic data system upon which PEN‑Plus will strategically build on and further strengthen.

“PEN‑Plus will mark a transformative shift in how severe NCDs are managed. The implementation of this framework will strengthen the country’s health system and save lives,” said Dr Susan Tembo, WHO Representative in Eswatini.