Facility readiness for decentralized Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus) care in nine lower-income countries

Severe chronic noncommunicable diseases (SC-NCDs) are important causes of avoidable disease burden in low- and lower-middle income countries (LLMICs) where care is often available only at tertiary, urban facilities. The Package of Essential Noncommunicable Disease Interventions - Plus (PEN-Plus) strategy aims to address gaps in access to care for SC-NCDs by integrating and decentralizing care. This study aims to assess baseline readiness of 16 facilities in nine LLMICs to provide care for SC-NCDs as part of a mixed-methods evaluation of PEN-Plus implementation. Cross-sectional surveys were utilized to collect baseline data from 16 facilities initiating new PEN-Plus programs. These surveys assessed the state of facility infrastructure and the availability of equipment and medicines for three priority conditions (type 1 diabetes (T1D), sickle cell disease (SCD), severe cardiac conditions (SCC)). Analysis consisted of descriptive statistics and summary index scores based on availability of key items. Facilities reported a high baseline availability of basic infrastructure. Readiness to provide care for priority SC-NCDs varied. Availability of functional diagnostic and management equipment and supplies for T1D was especially low in many facilities but higher for SCD. Medicine availability was overall highest for T1D (75%) but lower for SCD (39%) and SCC (49%), with significant gaps in essential medicines including hydroxyurea, anticoagulants, and medium- or long-lasting insulins.These findings highlight the need for tailored, context-driven implementation approaches to address gaps in readiness for SC-NCD care in LLMICs. Baseline results will guide ongoing implementation and evaluation of the PEN-Plus clinics.