KOSPEN: Challenges in empowering the community

KOSPENchallenges in empowering the

community

DR ROSNAH RAMLY

PUBLIC HEALTH PHYSICIAN AND SENIOR PRINCIPAL ASSISTANT DIRECTOR (KOSPEN)

MINISTRY OF HEALTH

Increasing Burden of Non-Communicable Diseases

• Increasing trend of NCD and its Risk Factors• Prevalence of undiagnosed cases is ≥ 50%• Burden to the country (management cost and loss of

productivity)

NCD ISSUE

7.00% 7.20% 8.30%

4.50%8.00% 9.10%

2006 2011 2015

PREVALENCE OF DIABETES 2006 - 2015

12.80% 13.10%

19.80% 17.20%

2011 2015

PREVALENCE OFHIPERTENSION2011 - 2015

UndiagnosedDiagnosed

≥ 18 tahun

NHMS (1996) NHMS (2006) NHMS (2011) NHMS (2015)

Age Group ≥ 18 tahun ≥ 18 tahun ≥ 18 tahun ≥ 18 tahun

Overweightand Obesity

21.0% 43.1% 44.5% 47.7%

Diabetes 8.3% 11.6% 15.2% 17.5%

UndiagnosedDM

1.8% 4.5% 8.0% 9.2%

Hypertension 29.9% 32.2% 32.7% 30.3%

UndiagnosedHPT

NA NA 19.8% 17.2%

Smoking 24.8% 21.5% 23.1%(GATS 2011)

22.8%

OUR NCD STATUS?

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11.6

15.2

17.5

7.0 7.28.3

4.5

8.0

9.2

4.24.9 4.7

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

NHMS III (2006) NHMS 2011 NHMS 2015

Prev

alen

ce (%

)

Prevalence of Diabetes, ≥18 years (NHMS 2006, 2011, 2015)

Total diabetes Known Undiagnosed IFG

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32.2 32.7

30.3

12.8 13.1

19.8

17.2

0

5

10

15

20

25

30

35

NHMS III (2006) NHMS 2011 NHMS 2015

Prev

alen

ce (%

)Prevalence of Hypertension, ≥18 years

NHMS 2006, 2011, 2015

Total HPTKnownUndiagnosed

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Prevalence of obesity and overweight, ≥18 years (NHMS 1996, 2006, 2011,2015)

4.5

14 15.1 17.716.6

29.1 29.430

0

5

10

15

20

25

30

35

1996 2006 2011 2015

Prev

alen

ce (%

)

obesityoverweight

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Prevalence of smoking ≥18 years by gender (NHMS1996, 2006, 2015 and GATS 2011)

24.8

49.2

3.5

21.5

46.4

1.6

23.1

43.9

1 0.7

22.8

43

1.4

10.9

0

10

20

30

40

50

60

NationalPrevalence

Male Female Non-smoking

1996 2006 2011 2015

%

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- NCD is very much associated with human behavior, environment and economic and social factor

- Much effort has been focused on creating awareness and educating the community – education sensibility

- Not much emphasis given to prompting healthy behavior adoption and practice

- knowledge does not turned into practice

OUR CHALLENGES

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- Community perception on health- Lack of perceived priority for health- TOMA - Top of their mind- TAC - take a chance

- Level of self regulatory of the community is still poor

- Environments are not supportive

- Multi sectoral involvement needs to be enhanced (MSA)

- Health in all policy (HIA) needs to be advocated

OUR CHALLENGES

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Health promotion and education will increase awareness and knowledge However changes in behaviour is strongly influenced by

our living environment

Awareness Knowledge BehaviouralChange

Supportive living environmentHealth promotion & educations

OUR CHALLENGES

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Personal Choice is Important

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BUT … If we want people to make healthy choices we have to make healthy choices available, accessible and affordable

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KOSPENEmpowering Communities, Strengthening the Nation

A Community-Based Intervention for NCD Risk Factors

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- A community based intervention program for NCD and its risk factors ( educating and prompting people to change)

- Aggressive step taken by MOH to tackle the problem of NCD- Health volunteers as the functioning units - Started in Oct 2013 at 3 states with 100 localities- In 2015,

- 5,000 KOSPEN localities developed- 30,000 volunteers trained

KOSPEN

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To contain the increase in the prevalence of Non Communicable Diseases through a

comprehensive and aggressive approach to empower community and enhance their

participations in prevention and control of NCD and its risk factors

OBJECTIVE OF KOSPEN

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• Build Healthy Public Policy

• Create Supportive Environments

• Strengthen Community Actions

• Develop Personal Skills

• Reorient Health Services towards prioritizing in NCD

BASIS OF KOSPEN : OTTAWA CHARTER

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• Use multiple interventions

• Targets change among individuals, groups and organization

• Requires more active participation of the community• Commitment of the community leader• Skilled health volunteers (accompanied by intensive support

from health provider and local authority)• Provision of technical training

BASIS OF KOSPEN : CONCEPT OF COMMUNITY-BASED INTERVENTION

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• Bringing the NCD prevention and control program to the community by: Establishing Health VolunteersStrategic collaboration with agencies that have established

community organizations/program/networkings (KEMAS danRukun Tetangga)Strengthening Health Sector commitment

o Governance of KOSPEN (I-KOMM Unit @ NCD Section of Disease Control Division

o Supervisory Team at State Health Department (NCD Epid Officer + State Nutritionist + State Health Education Officer)

o Facilitators at Distric Level – iNCD team ( MO, PSP, HEO, MA/SN, PPKP and others)

APPROACH

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Positive behavioural change at the community level through effective

interventions

Coverage of MOH

Extensive coverage through collaboration between KEMAS, RT & Volunteers

KEMAS, RT local committee membersas agent of change

Target:10,000 KOSPEN by

localities with 50,000 trained volunteers by

2022

Basic concept of KOSPEN

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• Setting for intervention• Target of change• As agent with development capacity

• Infrastructure • KEMAS and RT Program

• Resource – ownership and participation

ROLE OF VOLUNTEERS

ROLES OF COMMUNITY IN KOSPEN

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Increasing awareness & knowledge

Health Policy adoption and Health-promoting

environment

Translation of knowledge into sustainable actions

Implementation Strategies

1. Healthy eating2. Active living3. Smoke-free4. Weight

management5. Early detection of

NCD risk factors

The Scopes

22drrosnah.ramly@moh.gov.my

• FUNCTIONING UNITS OF KOSPEN• Promotes and Advocates for healthy policy adoption

related to 5 scope of KOSPEN• Health promotion to local KOSPEN community (KOL

at KOSPEN Localities)• Facilitate establishment of healthy environments that

enable practices of healthy life styles• Screening for BP, RBS and BMI

Referrals to nearest Health Clinics• Interventions - Weight Management Program

ROLE OF VOLUNTEERS

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BY YEAR 2022

• 10,000 KOSPEN localities• 50,000 volunteers trained• 1.5 adults screened by 2022

TARGETS

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Challenges in KOSPEN implementation

Lack of perceived priority for health by the community Health is more of the health sector responsibility Need more moderation, advocacy, lobbying and

sensitization

Need to motivate health volunteers Number of active volunteers still needs to be increased ? Insentive for volunteers

Large scale implementation (nationwide) 3,000 localities (2014), 2,000 localities (2015) and 1,000

localities (2016)

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Challenges in KOSPEN implementation

Needs strong leadership and management Community level Collaborating agencies Health sector

Need to have adequate health technical support and monitoring is needed – iNCD Team (key players in KOSPEN implementation at districts)

Requires strong social mobilization led by community leaders, collaborating agencies and active health volunteers their roles are crucial to sustain and ensure success.

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CURRENT STATUS

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70 % for Diabetic confirmatory test

36.2% BP ≥ 140/90mmHg

6.5 % for BMI ≥35kg/m²

REFERRALS

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TARGETS 2022

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KOSPEN LOCALITIES

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IEC MATERIALS

Healthy Eating

Separation of sugare from hot

drinks

Eating fruits and vegetables

Drinking plain water

Food Callorie

information

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Active Life

Style

Establishment of 10,000 steps

trek

Regular Physical Program

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Weight Management

BMI Measurement

Corner34

Weight Management

Program

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Screening equipments• Glucostrip dan Glucometer• Digital BP measurement set• Stadiometer dan weighing machine• Health Diary

SCREENING EQUIPMENTS

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KOSPEN SCREENING CENTER

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HOME-BASED SCREENING

REFERRALS CRITERIA

RBS ≥ 5.6mmol/L

BP Sistolic ≥ 140 and/or Diatolic ≥190mmHg

BMI ≥ 35kg/m²

REFERRALS OF RISK CASES

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MOVeS KOSPEN

Online system

Data entry by the volunteers

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MONITORING SYSTEM

KOSPEN is positively perceived by volunteers and the community

- Perception Study 2015

- Effectiveness Study – on going

It is hoped KOSPEN would be able to contribute in

- reducing the prevalence of undiagnosed DM and HPT

- Containing the increase the Prevalence of DM and HPT by year 2025, complementing other strategies in the NSP-NCD Malaysia

CONCLUSSION

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Source of icons: World Heart Federation Champion Advocates Programme

Global NCD Targets

20%15%

22.8%15%

HED* <1.2%

33.5%30.0%

8.76.0gm

30.3%24.0%

17.5% <15.0%

Targets for Malaysia

* Heavy episodic drinking

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Thank you for your kind attention