Care for severe chronic conditions, type 1 diabetes, rheumatic heart disease and sickle cell disease, has historically only existed in tertiary hospitals in Freetown. PEN-Plus moves it down to first-level hospitals by training mid-level providers to run integrated outpatient clinics. Sierra Leone is one of ten countries in the current expansion.

The Package of Essential NCD Interventions puts hypertension, type 2 diabetes and chronic respiratory disease into the hands of frontline health workers at community health centres, alongside the HIV and TB services already running there. It also covers early detection of breast and cervical cancer. Complex cases refer upward to PEN-Plus.

Opened in February 2018 as the first longitudinal NCD service in rural Sierra Leone. Community health officers and state enrolled community health nurses run it under clinician mentorship, following a registered cohort of patients with hypertension, diabetes, stroke and heart failure rather than treating them episodically.

Desktop guidelines, patient treatment cards, staff training and follow-up mentoring, adapted for Sierra Leonean primary care. The feasibility assessment found the package workable and set one clear condition on it: unless training and supervision become routine rather than project-funded, the gains go when the project does.

Roughly 37% of the population lives in the two Western Area districts, much of it in informal settlements where late presentation is the norm. The project built training curricula, clinical protocols and patient education materials, and trained multidisciplinary teams of 130 providers.

The successor programme, working on five fronts: rolling out the national protocol for hyperglycaemia in pregnancy, health promotion through antenatal clinics and radio, training community health workers on risk factors and referral, equipping primary facilities to screen and manage uncomplicated cases, and building NCD data capacity.

Cervical cancer is the second most common cancer among Sierra Leonean women after breast cancer, and the leading cancer killer of women aged 14 to 44. National introduction of the HPV vaccine began in October 2022, delivered through schools and communities by more than 1,400 trained teams so that girls out of school were reached alongside those in it.

Sierra Leone carries one of the highest sickle cell burdens in the world and has no national newborn screening programme. Point-of-care testing has been piloted at Ola During and at rural sites, using rapid tests that give a same-visit result where haemoglobin electrophoresis is not available.