Description
Background. Severe non communicable diseases (NCDs) services remain under-served in rural Africa, with specialized care concentrated in tertiary hospitals. In Kenya NCDs accounts for 50% of hospital admission and 39% of hospital deaths. The model WHO PEN-Plus decentralizes care for type 1 diabetes (DM1), sickle cell disease (SCD), cardiovascular disease (CVDs), chronic respiratory disease (CRD), hypertension (HTN) and diabetes type 2 (DM2) by integrating services into primary care.
Objectives: To evaluate the feasibility and early clinical outcomes of implementing the Pen-Plus model in Primary care.
Methods: The study was conducted at PEN-Plus NCD Clinic in Hamisi Sub County Hospital Vihiga County, Kenya. Clinical encounter files and MOH270 register (June 2023 – June 2025) were retrospectively reviewed to assess patient outcomes, continuity of care and access to treatment.
Results: 757 patients were enrolled: HTN 367/757 (48.5%), SCD 178/757 (23.5%), DM1 74/757 (9.8%), CVDs 44/757 (5.8%), CRD 44/757 (5.8%), DM2 33/757(4.4%), structural heart disease 11/757 (1.5%) and heart failure 6/757 (0.8%). All DM1 transitioned from premixed insulin to a basal-bolus regimen; however mean HbAIc was 10.5% in Q2 2025 reflecting suboptimal glycemic control linked to dietary and adherence challenges. Among 178 patients with SCD, 146 (82.02%) on hydroxyurea had mean hemoglobin of 9.2g/dl in Q2. Point of care Echocardiography contributed to diagnosis of 5/11 (45.45%) structural heart disease further highlighting the significance of capacity building. Key challenges included limited blood transfusion access ,absence of regional Hb electrophoresis and socio-economic barriers in care.
Key words: Non communicable diseases, Primary Health, Diabetes Mellitus type 1, Sickle cell anemia and Health Work Force.
Conclusions: The PEN-Plus model at Hamisi clinic demonstrates feasible rural NCD care with improved access to essential services at primary care level. Training mid-level practitioners was pivotal and offers a scalable approach to strengthening rural health systems.
| Country | Kenya |
|---|---|
| Organization | Non-Governmental Organization (NGO) |
| Position | Clinical Officer |
| Received a Grant? | No |
