Implementation tools: Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-resource Settings
(2013; 210 pages)


Two billion people in the world are living below the poverty line and poverty and NCDs are linked through many pathways.

Although providing good quality care for the poor is an ethical imperative, due to weak health systems and inadequate health-care expenditure of many countries, the poor do not have access to services at all or receive substandard services. Furthermore, out-of-pocket expenditure is unacceptably high in many LMIC. Countries need to transform and regulate health systems for universal access and social protection.

This transformation will take several years given the global financial status and wide disparities in domestic resources between countries. In the meantime, Ministries of Health (MoHs) need to take steps to improve health outcomes and to reduce rising health-care costs due to NCDs and their preventable complications.

The WHO Package of Essential Noncommunicable Disease Interventions (WHO PEN) for primary care in low-resource settings is an innovative and action-oriented response to the above challenges. It is a prioritized set of cost-effective interventions that can be delivered to an acceptable quality of care, even in resource-poor settings. It will reinforce health system strengthening by contributing to the building blocks of the health system (table i, table ii). Cost effectiveness of the selected interventions will help to make limited resources go further and the user-friendly nature of the tools that are been developed, will empower primary care physicians as well as allied health workers to contribute to NCD care (table iii). It should not be considered as yet another package of basic services but, rather, an important first step for integration of NCD into PHC and for reforms that need to cut across the established boundaries of the building blocks of national health systems. WHO PEN is the minimum standard for NCDs to strengthen national capacity to integrate and scale up care of heart disease, stroke, cardiovascular risk, diabetes, cancer, asthma and chronic obstructive pulmonary disease in primary health care in low-resource settings. Most importantly, it defines a minimum set of essential NCD interventions for any country that wishes to initiate a process of universal coverage reforms to ensure that health systems contribute to health equity, social justice, community solidarity and human rights.

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