# Patient and provider experiences with PEN-Plus in rural Mozambique: cohort characteristics at baseline

## TL;DR

This study examines patient and provider experiences with a healthcare program for chronic diseases in rural Mozambique, highlighting delays in diagnosis and provider training.

## Contribution

The paper provides baseline insights into the implementation of PEN-Plus in rural Mozambique, focusing on patient journeys and provider task proficiency.

## Key findings

- Most patients experienced prolonged delays in diagnosis, leading to unique clinical presentations and financial strain.
- Providers reported varying levels of task proficiency and generally low burnout at baseline.

## Abstract

Severe chronic noncommunicable diseases (SC-NCDs) globally present a challenge for health systems, particularly in rural settings of low- and lower-middle-income countries (LLMICs). The Package of Essential NCD Interventions-Plus (PEN-Plus) is a strategy currently used in 14 LLMICs to effectively manage people living with SC-NCDs (PLWSC-NCDs), including in Nhamatanda, Sofala Province, Mozambique.

We are conducting a cohort study of PLWSC-NCDs, enrolled at Nhamatanda PEN-Plus clinic, to understand their experiences in care and clinic evolution. Here, we describe our methods and the cohort at baseline.

An 18th month cohort study was initiated shortly after the launch of the PEN-Plus clinic. At baseline, PLWSC-NCD and healthcare providers were enrolled in the study. Qualitative interviews and quantitative measurements including diabetes distress for patients and provider shadowing and task mapping were conducted at baseline and will be carried out semiannually for 18 months.

Twenty-three PLWSC-NCDs and five healthcare providers were enrolled. Most provider training occurred formally pre-service or in service or less formally on job, and providers self-reported varying levels of task proficiencies. Other than personal achievement, we found generally low provider burnout at baseline. We gained insight into patients journey to diagnosis: most patients described a lengthy journey, resulting in unique clinical presentations and associated costs reflected by patients’ borrowing money or selling assets.

There are health systems challenges associated with diagnosis and treatment of SC-NCDs in LLMICs. PEN-Plus is a strategy designed to provide mid-level healthcare workers with the necessary training and tools. This 18-month study will examine the evolution of care at the Nhamatanda clinic.

Main findings: At initiation of this study, most patients living with severe chronic noncommunicable disease experienced prolonged delays in diagnosis, resulting in distinctive clinical presentations and financial strain, while most providers reported varying levels of task proficiency and generally low levels of burnout.Added knowledge: We garnered insight into the patients journey to diagnosis prior to the initiation of the PEN-Plus clinic. We gained understanding into the level of training, task proficiency, and well-being of providers that provides us a foundation to assess how the PEN-Plus clinic impacts this cohort’s experiences over the course of this study.Global health impact for policy and action: Severe chronic noncommunicable diseases pose a growing challenge to health systems globally, particularly in low-and lower-middle-income countries, and PEN-Plus provides a strategy to address this challenge. This study evaluates the evaluation of one PEN-Plus clinic in rural Mozambique.

Main findings: At initiation of this study, most patients living with severe chronic noncommunicable disease experienced prolonged delays in diagnosis, resulting in distinctive clinical presentations and financial strain, while most providers reported varying levels of task proficiency and generally low levels of burnout.

Added knowledge: We garnered insight into the patients journey to diagnosis prior to the initiation of the PEN-Plus clinic. We gained understanding into the level of training, task proficiency, and well-being of providers that provides us a foundation to assess how the PEN-Plus clinic impacts this cohort’s experiences over the course of this study.

Global health impact for policy and action: Severe chronic noncommunicable diseases pose a growing challenge to health systems globally, particularly in low-and lower-middle-income countries, and PEN-Plus provides a strategy to address this challenge. This study evaluates the evaluation of one PEN-Plus clinic in rural Mozambique.