The Package of Essential NCD Interventions-Plus (PEN-Plus) is an integrated, decentralized care delivery model bringing lifesaving chronic care for severe non-communicable diseases — including type 1 diabetes, rheumatic heart disease, sickle cell disease, and neurodevelopmental disorders — directly to first-level district hospitals across Nepal.
The Package of Essential NCD Interventions-Plus (PEN-Plus ) is an integrated care delivery strategy initiated globally by the NCDI Poverty Network, whose co-secretariat is housed at Harvard Medical School and Brigham and Women's Hospital, USA.
PEN-Plus complements the World Health Organization's Package of Essential Non-communicable Disease Interventions (WHO PEN ), which provides basic services for common and less severe cardiovascular disease, diabetes, and cancer at primary health centers.
In low- and middle-income countries (LMICs) like Nepal, chronic care for severe conditions has historically been restricted to elite tertiary hospitals in major metropolitan areas. As a result, impoverished children and young adults frequently go without treatment — suffering premature, preventable deaths or catastrophic out-of-pocket expenses.
PEN-Plus decentralizes this care by training clinical officers, medical officers, and nurses at first-level district hospitals with structured mentorship from referral center specialists, advancing Universal Health Coverage (UHC) and the UN Sustainable Development Goals (SDGs).
KIOCH received grant support from the NCDI Poverty Network in 2021 as an initiative of the Nepal NCDI-Poverty Commission , which is proudly housed within KIOCH.
In close collaboration with the Ministry of Health and Population (MoHP) and its departments, KIOCH is scaling this decentralized model nationwide.
In 2022, UNICEF Nepal partnered with KIOCH to expand PEN-Plus across four additional districts with a dedicated emphasis on children, adolescents (0–19 years), and neurodevelopmental conditions.
PEN-Plus incorporates integrated clinical teams to manage diagnosis, long-term medication, symptom management, psychosocial support, and timely referral for complex surgical needs.
Supported by international academic consortia, multilateral agencies, and the Government of Nepal.
“The PEN-Plus Partnership: Country-level PEN-Plus Project Initiation & Implementation in Nepal”
“Strengthening Primary Health Care and Referral System for Prevention and Management of NCDs including Neuro-developmental Disorders among Children and Adolescents in Nepal”
PEN-Plus systematizes a bidirectional referral chain from Primary Health Care Centers (PHCC) to first-level district hospitals and onwards to specialized provincial and tertiary centers.
| # | First-Level Hospital (PEN-Plus Site) | District & Province | Higher Referral Level Hospital | Referral Location |
|---|---|---|---|---|
| 1 | District Hospital, Gulariya | BardiyaLumbini Province | Bheri Hospital | Nepalgunj, Banke |
| 2 | Damak Hospital | Damak, JhapaKoshi Province | BP Koirala Institute of Health Sciences (BPKIHS) | Dharan, Sunsari |
| 3 | Dolakha Hospital | Charikot, DolakhaBagmati Province | Dhulikhel Hospital | Dhulikhel, Kavre |
| 4 | Provincial Hospital Lahan | Lahan, SirahaMadhesh Province | Madhesh Academy of Health Sciences | Janakpur, Dhanusha |
| 5 | Health Service Office, Dailekh | DailekhKarnali Province | Province Hospital | Birendranagar, Surkhet |
| 6 | District Hospital, Bajhang | Chainpur, BajhangSudurpaschim Province | Seti Provincial Hospital | Dhangadhi, Kailali |
| 7 | Gulmi Hospital | Tamghas, GulmiLumbini Province | Lumbini Provincial Hospital | Butwal, Rupandehi |
Three interconnected strategic pillars designed to demonstrate, train, and institutionalize PEN-Plus within the national health system.
Establish model NCD units/PEN-Plus clinics in first-level hospitals for heart failure, RHD, hypertension, T1D, respiratory illness, malignancies, and palliative care. Training staff for early detection, continuous chronic care, and bidirectional referral linkages.
Support clinics to mature into PEN-Plus training hubs in partnership with the NCD Section (EDCD), MoHP, WHO, and National Health Training Center (NHTC). Conducting Training of Trainers (ToT) for GPs, Medical Officers, and nurses.
Collaborate with national stakeholders and the Ministry of Health and Population to draft national operational guidelines, supported by rigorous evidence generation with the Nepal Health Research Council (NHRC).
Strengthening primary health facilities for prevention and management of pediatric NCDs, improving engagement of policymakers across government tiers, and mobilizing Female Community Health Volunteers (FCHVs) for grassroots disease awareness.
Major programmatic and clinical milestones completed to date under the PEN-Plus Partnership in Nepal.
PEN-Plus clinics officially inaugurated at Damak Hospital by the Chief of Health Coordination Division (MoHP), and at Bardiya Hospital by the Secretary of MoHP.
Local MoUs signed across all implementation sites. Provincial stakeholder summit in Lumbini Province attended by the Health Minister, MoHP Secretary, and leadership.
PEN-Plus clinics fully set up with diagnostic and therapy equipment. Dedicated clinical and nursing officers recruited and deployed at all active facilities.
Standardized PEN-Plus clinical treatment protocols and training manuals developed in coordination with the National Health Training Center (NHTC), under MoHP endorsement.
Electronic Medical Records (EMR) system established. Tripartite agreements executed with health-tech software vendors for continuous digital patient tracking and research.
Patients linked to the National Health Insurance Program. PEN-Plus subsidizes insurance premiums for impoverished families and covers medical costs prior to activation.
Your partnership and contributions support health worker training, essential medical supplies, diagnostic equipment, and health insurance subsidies for vulnerable families.
