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e-Health BulletinIssue No. 4 I JULY - DECEMBER 2013

TOP: Some of the delegates of the 1st ASEAN Regional Forum on Noncommunicable Diseases (NCDs). BOTTOM: (Left) Philippines Health Secretary for Enrique T. Ona leads the parade of colors in the opening ceremony. ABOVE: (Center) Deputy Secretary-General of ASEAN Socio-Cultural Community Alicia dela Rosa Bala, Health Assistant Secretary Enrique A. Tayag and World Health Organization Representative to the Philippines Julie Lyn Hall practice what they preach in the press conference by engaging everyone to do physical activity through dancing to prevent NCDs. (Right) Deputy Secretary- General Bala reads the Bandar Seri Begawan Declaration on NCDs in ASEAN in the closing ceremony.

Highest Political Concern for Noncommunicable Diseases

The Philippines'Department of Health hosted the First ASEAN Regional Forum on Noncommunicable Diseases (NCDs) in Makati City on October 14-16, 2013. The delegates came from Brunei Darussalam, Cambodia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, Viet Nam and China.

The Forum served as a venue to discuss the challenges for NCD prevention and control and the promotion of healthy lifestyle as well as to share experiences of successful interventions and best practices in the region. Notable NCD experts and healthy lifestyle champions across the region were invited to chorus these concerns.

Health Secretary Enrique T. Ona said, “The Philippines was chosen as the lead country in holding the first ASEAN Forum on NCDs following our model and experience in staging the multi-sectoral Public Health Convention on the Prevention and Control of NCDs conducted every two years"

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2 ASEAN e-Health Bulletin I July - December 2013

He added that the Forum provided the Philippines the opportunity to showcase its policies, programs and activities on NCDs, particularly the Excise Tax on Tobacco and Alcohol Products of the Sin Tax Law, Philippine Package of Essential NCD Interventions, and the "Pilipinas Go4Health" Movement for Healthy Lifestyle. Dr. Julie Lynn Hall, World Health Organization representative to the Philippines, said that NCDs remain as the number one killer in the world, and are responsible for about 63% of all deaths globally. Contrary to popular beliefs that NCDs are only the concerns of the rich and the old, about 80% of these NCD deaths are happening in low- and middle-income countries and around a quarter (25%) are happening prematurely in ages below 60 years. NCDs affect men and women alike. She added that the global situation is mirrored in the ASEAN Region, where about 61.5% of the total deaths are now due to NCDs. About 30% of these deaths occur in people aged 15-59 years, thus affecting a large portion of the highly productive labor force of Southeast Asia. With NCDs, the disadvantaged populations are the hardest hit, with death rates inversely proportional to a country's gross national income. Families shoulder the financial burden, and entire economies

suffer as well. Meanwhile, Ona opined that despite limited resources inherent with low- and middle income-country status, the ASEAN nations could address these major health concerns and avert economic decline and stagnation by investing in cost-effective primary prevention and health promotion interventions. Alicia dela Rosa Bala, Deputy Secretary-General of ASEAN Socio-Cultural Community, said that the development cause and concern for NCDs has reached the highest political level within the ASEAN Community and has been constantly in the priority of ASEAN Health Cooperation since the ASEAN Health Ministers Meetings in Yogyakarta, Indonesia in April 2000 and Vientiane, Lao PDR in March 2002. The ministers initiated the strong advocacy for health to be the center of development and that ASEAN Cooperation on Health shall be strengthened to ensure that people in the region are healthy in mind and body and living in harmony in safe environments. They further envisioned that all ASEAN citizens will lead healthy lifestyles consistent with their values, beliefs and culture in supportive environments. The ASEAN is implementing separate operational frameworks and work plans for tobacco control

and NCDs since 2009. The set of regional activities in these work plans are implementing the deliverables of the Joint Statements made by the ASEAN Health Ministers with the Plus Three Health Ministers (China, Japan and South Korea) as well as the expectations of the ASEAN Position on NCDs that was read in the UN High Level Meeting on NCDs in New York in September 2011. More recently, during the 23rd ASEAN Summit in Brunei Darussalam on October 9-10, the ASEAN leaders adopted the Bandar Seri Begawan Declaration on NCDs in ASEAN. The presentation of this declaration culminated the Regional Forum. After the Forum, the 2nd

Meeting of the ASEAN Task Force on NCDs (ATFNCD) was held on October 17-18. The ASEAN Member States revisited and provided updates on the implementation of the Work Plan on NCDs (2011-2015) aimed at ensuring accessibility to adequate and affordable health care medical services and medicines, and promoting healthy lifestyle for the ASEAN population. The ASEAN Member States continue to find innovative ways to improve regional cooperation. The ASEAN Regional Forum on NCDs is one of the activities in the Work Plan in which the Philippines is the lead country.

ASEAN e-Health Bulletin is produced semi-annually by the ASEAN Secretariat · 70A Jl. Sisingamangaraja · Jakarta 12110 · Indonesia ı Tel : (6221) 7262991, 7243372 · Fax : (6221) 7398234, 7243504

Coordinator: Health and Communicable Diseases Division of the ASEAN SecretariatEditor: Assistant Secretary Enrique A. Tayag (Department of Health, Philippines) ı Focal Point: Anthony R. Roda (Department of Health, Philippines)

Note: The articles were contributed by the focal point from each of the ASEAN health subsidiary bodies.

The Association of Southeast Asian Nations was established on 8 August 1967. The Member States of the Association are Brunei Darussalam, Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand and Viet Nam.

The ASEAN Secretariat is based in Jakarta, Indonesia. General information on ASEAN appears online at the ASEAN Website: www.asean.org

Catalogue-in-Publication DataASEAN eHealth Bulletin. Jakarta: ASEAN Secretariat, December 2013

631.059 ı 1. ASEAN - Public Health ı 2. Health - Personal Health ISSN 2301-6809

One Vision. One Identity. One Community.

July - December 2013 I ASEAN e-Health Bulletin 3

Bandar Seri Begawan Declaration on Noncommunicable Diseases in ASEAN

WE, the Heads of State/Government of the Member States of the Association of Southeast Asian Nations (hereinafter referred to as ASEAN), namely Brunei Darussalam, the Kingdom of Cambodia, the Republic of Indonesia, the Lao People’s Democratic Republic, Malaysia, the Republic of the Union of Myanmar, the Republic of the Philippines, the Republic of Singapore, the Kingdom of Thailand and the Socialist Republic of Viet Nam:

HAVING gathered in Bandar Seri Begawan on October 9, 2013, for the 23rd ASEAN Summit;

DEEPLY CONCERNED that noncommunicable diseases, namely, cardiovascular diseases, cancers, diabetes and chronic respiratory diseases, are the leading causes of deaths in ASEAN Member States and that increasingly younger people in low and middle-income members are affected by premature mortality from noncommunicable diseases leading to loss of productivity and social and economic consequences;

EQUALLY CONCERNED on the increasing trends of intermediate risk factors for noncommunicable diseases such as high blood pressure, high blood sugar levels, high blood cholesterol levels, and overweight and obesity in ASEAN Member States as well as behavioural risk factors such as smoking, unhealthy diet, the harmful use of alcohol and physical inactivity, and that these factors are the leading global risks for mortality and disability;

NOTING that noncommunicable diseases are often associated with mental disorders;

RECALLING the commitment stated in the ASEAN Charter, in which ASEAN is resolved to ensure sustainable development for the benefit of present and future generations and to place the well-being, livelihood and welfare of the peoples at the centre of ASEAN Community building process.

GUIDED by the ASEAN Socio-Cultural Community Blueprint adopted in 2009, part of the Roadmap for an ASEAN Community 2009-2015 which calls for programmes, surveillance and access to primary health care for people at risk or vulnerable to diabetes, cardiovascular diseases and cancers;

ENCOURAGED by other provisions in the ASEAN Socio-Cultural Community Blueprint such as promoting information, education and advocacy activities for healthy lifestyles and behaviour change intervention including diet and physical activity, developing a framework for unhealthy food and beverages, establishing an ASEAN Nutrition Surveillance System, promoting research into traditional/complementary and alternative medicine as well as risk factors for noncommunicable diseases, and the strengthening of regional networking in the health sector;

RECALLING that ASEAN Health Ministers have identified nutrition, physical activity, tobacco control and the prevention of noncommunicable diseases as priorities in the Declaration of the 6th ASEAN Health Ministers’ Meeting on Healthy ASEAN Lifestyles adopted in Vientiane in 2002, the ASEAN Strategic Framework on Health Development (2010-2015) endorsed at the 10th ASEAN Health Ministers Meeting in 2010, and the Joint Statement of the 11th ASEAN Health Ministers Meeting in 2012, outlined two levels of actions to intensify strategies to prevent noncommunicable diseases;

FURTHER NOTING that Health Ministers from ASEAN, China, Japan and Korea emphasised during the 5th ASEAN Plus Three Health Ministers Meeting in Phuket in 2012, the need to adopt a Health in All Policies (HiAP) approach to tackle unhealthy lifestyles and risk behaviours as well as the social determinants of health to address unhealthy diets and sedentary lifestyles;

WELCOMING the outcome document of the United Nations Conference on Sustainable Development in 2012, Rio de Janeiro entitled The Future We Want, which commits to strengthen health systems towards the provision of equitable, universal health coverage and promote affordable access to prevention, treatment, care and support related to noncommunicable diseases, and commit to establish or strengthen multi-sectoral national policies for the prevention and control of noncommunicable diseases;

RECALLING the Helsinki Statement on Health in All Policies adopted in Helsinki, in 2013 for governments to commit to health and health equity; ensure effective structures, processes and resources as well as build capacity on Health in All Policies for people’s health and well-being;

CONFIRMING our commitment to the Global Action Plan for the Prevention and Control of NCDs 2013-2020 endorsed by the 66th World Health Assembly in 2013; the Global Strategy on Diet, Physical Activity and Health endorsed by the 57th World Health Assembly in 2007 and the Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children as well as the Global Strategy to Reduce the Harmful Use of Alcohol endorsed by the 63rd World Health Assembly in 2010;

REAFFIRMING the importance of the Moscow Declaration of the First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control and the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases in 2011;

RECALLING the ASEAN statement on noncommunicable diseases at the United Nations High Level Meeting on the Prevention and Control of Noncommunicable Diseases in New York in 2011 to strengthen health systems,


infrastructure and national policies, to accelerate tobacco control programmes as well as strengthen partnerships and involve all stakeholders for health;

WELCOMING the recent establishment of the ASEAN Task Force on Noncommunicable Diseases (ATFNCD) and the subsequent agreement of Member States to monitor a set of noncommunicable diseases indicators in line with the comprehensive global monitoring framework for the prevention and control of noncommunicable diseases adopted at the 66th World Health Assembly in 2013 ; and

COMMENDING the work done by the ASEAN Focal Points on Tobacco Control to accelerate and support progress among Member States towards the full implementation of WHO’s Framework Convention on Tobacco Control;

DO HEREBY DECLARE THAT WE:

AGREE on the urgent need to accelerate actions to reduce risk factors for noncommunicable diseases taking into consideration cost-effective interventions as recommended by WHO;

REQUEST ASEAN Ministers responsible for health, food industry development and trade to work together with other stakeholders, including NGOs and the private sector, for a common understanding on healthier food choices emphasising the roles and responsibilities of the food and beverage industries in providing food choices so as to increase the availability, accessibility and uptake of healthier food options in our communities;

ENCOURAGE intensified efforts to promote the screening of people at risk of noncommunicable diseases to facilitate early detection and primary prevention;

EXPAND EFFORTS to strengthen the capacity of health systems incorporating the principles of Universal Health Coverage to improve early management of noncommunicable diseases as well as prevent and manage complications;

CALL FOR the effective implementation of action lines related to non-communicable diseases in the ASEAN Strategic Framework on Health Development (2010-2015);

URGE ASEAN Health Ministers to enhance efforts towards achieving the set of 9 voluntary global targets for the prevention and control of noncommunicable disease by 2025, which was adopted during the 66th World Health Assembly in, Geneva, in 2013;

CALL ON ASEAN Ministers responsible for health and other relevant sectoral bodies to accelerate the adoption of Health in All Policies (HiAP) in tackling unhealthy lifestyles including risk behaviours for noncommunicable diseases; and

COMMIT to ensuring that reducing the burden of noncommunicable diseases and achieving universal health coverage are featured prominently in the post-2015 development agenda.

ADOPTED in Bandar Seri Begawan, Brunei Darussalam, this Ninth Day of October in the Year Two Thousand and Thirteen in a single original copy in the English language.

ASEAN Health Cooperation National Calendar (January - June 2014)

- NOTE: Exact meeting dates to be confirmed

JANUARY

• ASEAN Expert Group on Communicable Diseases (AEGCD) Core Group Meeting with Canada for Proposal Development - Singapore, 14-16 January

FEBRUARY

• 29th Meeting of ASEAN Working Group on Pharmaceutical Development (AWGPD) - Cambodia

• 5th Meeting of ASEAN Working Group on Pandemic Preparedness and Response (AWGPPR) - Philippines

• Preparatory Meeting for the 5th Traditional Medicine Conference - Yangon, Myanmar

• ASEAN Plus Three Universal Health Care Network - Bangkok, Thailand

• Regional Steering Committee on Regional Artemisinin Initiative - To be confirmed

MARCH

• Preparatory Meeting with SOMHD Viet Nam for the 12th ASEAN Health Ministers Meeting - Viet Nam

• 1st Meeting of ASEAN Plus Three National Laboratory Focal Points Meeting - Singapore

• 5th Meeting of ASEAN Focal Points on Tobacco Control (AFTPC) - Indonesia

APRIL

• 3rd Meeting of ASEAN Task Force on Mental Health (AMT) - Cambodia

• 5th Steering Committee on ASEAN Plus Three Field Epidemiology Training Network (FETN) - Philippines, 4-5 April

MAY

• Joint Consultative Meeting ASEAN Expert Group on Communicable Diseases (AEGCD) and ASEAN Sectoral Working Group for Livestock (ASWGL) for the ASEAN Rabies Elimination Strategy - Singapore

• 9th Meeting of Senior Officials Meeting on Health Development (SOMHD), 4th ASEAN Plus Three SOMHD, and 4th ASEAN China SOMHD - Thailand

JUNE

• ASEAN Dengue Day Conference 2014 - Philippines, 13-14 June

• ASEAN Dengue Day - Philippines, 15 June

• Regional Observation of ASEAN Dengue Day in the Philippines, 15 June


Obesity is a phenomenon that starts in childhood and tends to persist in adulthood. The estimate is that approximately three-quarters of children with obesity will continue to suffer from the condition during adulthood. The trend of overweight/severely overweight prevalence in Singapore shows an increase over the past few decades. Research has shown that obesity and many chronic conditions have their origins in the pre-natal phases of life. Expectant mothers who take care of their health lay an early foundation for a healthy lifestyle for their babies. Singapore has thus moved its health promotion efforts upstream with the ‘Healthier Child, Brighter Future’ initiative – an early preventive health strategy to shape healthy lifestyles for the young from the time of pregnancy. As part of this initiative, a toolkit was developed by the Health Promotion Board (HPB) in collaboration with the nine local hospitals with obstetric services. It empowers parents-to-be and parents to maintain healthy pregnancies and raise healthy children from the early developmental to pre-school years, thereby helping to give these children a healthy head start in life. In addition, HPB conducts workshops and culinary training for parents and caregivers to equip them with knowledge and skills to positively shape the eating and physical activity practices of their children. The Baby Friendly Health Initiative (BFHI), part of the World Health Organisation (WHO)’s Global Strategy for Infant and Young Child Feeding, was

introduced in 2012 to empower hospitals in Singapore to give all mothers the help and support they need to breastfeed and provide optimum nutrition and care for their babies. With BFHI, maternity services are now aligned with WHO guidelines on antenatal education on breastfeeding, skin to skin contact in the first hour after birth, rooming-in, support and consultation post-discharge to encourage exclusive breastfeeding for the first six months. The Championing Efforts Resulting in Improved School Health (CHERISH) initiative, modelled after the WHO’s Health Promoting Schools framework, provides the backdrop against which health promoting environments are put in place in educational settings in Singapore. The CHERISH initiative provides all pre-schools and schools with a guide on how they can put in place appropriate systems, processes and structures to distinguish themselves as settings which promote the health and wellbeing

of their students and staff. As part of this initiative, HPB has developed numerous programmes (e.g. Healthy Eating in Childcare Centres Programme and Healthy Meals in Childcare Centres Programme) for pre-schools to put in place a health promoting environment which fosters healthy nutrition, thereby allowing children in these institutions to have convenient and easy access to healthier food and beverage options. One such programme is the Healthy Meals in Childcare Centres Programme (HMCCP) for childcare centres. Participating pre-schools are required to comply with a set of food service guidelines and serve healthy set meals. These healthy set meals incorporate the appropriate proportions of food from the four main food groups – rice and alternatives, meat and alternatives, vegetables and fruit – thereby ensuring that when children consume meals in pre-schools, they will receive the right nutrients necessary for their growing needs.

Nipping Obesity in the Bud:Singapore's Experience


Culinary training and individual consultation with nutritionists and professional chefs are provided for cooks at the pre-schools. The cooks are advised on menu planning and are trained on healthier cooking methods. They are also taught how to prepare healthier ingredients such as brown rice and the appropriate portioning of food for the children. A wide range of health educational resources (such as wall murals, posters) are provided to participating schools to reinforce the educational messages on healthy lifestyle and obesity prevention. Outreach efforts to teachers and parents / caregivers are also undertaken so that they can complement HPB’s efforts in promoting healthy eating. A new set of National Physical Activity Guidelines for Children and Youth has been developed in 2011. Young children in full-day childcare centres are encouraged to achieve the 180 minutes of physical activity each day and those in half-day kindergartens to achieve 90 minutes of physical activity each day. In order to support pre-school educators in engaging the children in physical activity, they are supported with a resource kit comprising of lessons plans on

physical activity, physical activity break ideas, a series of fun dance DVDs and an educator handbook on physical activity. In addition, the physical activity component in CHERISH Junior criteria has been enhanced to assist pre-schools in establishing supportive health promoting policies and environment, and provide opportunities for physical activity among children. Besides immunisation and development screening from birth to 4 years in private clinics, polyclinics and hospitals, all children are screened in pre-schools to assess their growth and weight status. HPB has piloted a community-based healthy lifestyle programme for severely overweight children and their parents. Through this programme, preschoolers learn to make healthy food choices and be more active through highly interactive games and hands-on activities and their parents will be empowered in the areas of nutrition and physical activity through food preparation and supermarket tours. As part of the broader effort to prevent and manage childhood obesity, HPB is developing food advertising guidelines for children. Evidence shows that food marketing influences

children’s food preferences, purchase requests to parents, food choices and consumption patterns. In Singapore, there is currently no specific guideline in the Singapore Code of Advertising Practice (SCAP) pertaining to the exposure of children to unhealthy food advertisements, other than discouraging confectionery and snack foods as a replacement for main meals. In line with the WHO recommendation of restricting food marketing to children, Singapore is reviewing the standards for advertising of food and beverage products high in fat, sugar or salt to children. Singapore seeks to establish strong foundations of health and well-being for all children from the pre-natal stage of their lives and through their childhood years. It supports parents with easily accessible and readily available services, a supportive environment and skills to ensure optimal growth and development, to encourage positive role-modelling and to nurture healthy habits in their children for a healthy head start to life. By nipping obesity in the bud to mitigate the debilitating effects of chronic diseases, our citizens are more likely to be healthy throughout their adult years and enjoy a high quality of life.

Child First - Work Together Project in Thailand

The Child First - Work Together (CF-WT) Project of the Rajanagarindra Institute of Child Development (RICD), Department of Mental Health, Ministry of Public Health in Thailand was initiated in 2009 to help delayed development children to live normal lives and contribute to

their family and community at their highest potential. Before the project started, health care services in Thailand could not provide appropriate screening, assessment, treatment and rehabilitation for delayed development children who are being considered as burden to

the family and community. The RICD, on its own, could provide treatment and rehabilitation to only 20,000-30,000 children per year and it could not serve an estimated 1,269,483 Thai children who need to promote their development. Therefore, the RICD’s team, which is composed


of psychiatrists, medical doctors, psychiatric nurses, dentists, educators, occupational therapists, psychologists, and speech therapists, initiated the CF-WT Project and worked on it step-by-step. In 2009, the RICD conducted a study to develop the screening and assessment tools on child development, named as the “Thai Development Skills Inventory" (TDSI) for children from birth to five years old. In 2010, the study identified the standard for normal Thai child’s development, and various materials were developed, including the manual on child development promotion

and training course modules for health personnel, other personnel who work with children, and parents. The information was also disseminated in websites and through media for easy access by the public. In 2011, the RICD integrated child development promotion services to the public health service system. By this time, the trained personnel were confident to provide services to the delayed development children who can access the services at their nearest health care facilities. Meanwhile, the parents who were trained can already look after their children at home.

The RICD team closely coordinated with public health personnel in hospitals, academic staff in universities, nursery care takers, kindergarten and primary school teachers, parents’ club, community leaders, village health volunteers, among others. The team received their needed financial resources from many organisations such as the National Research Council of Thailand, Thai National Health Security Office, Thai Health Promotion Foundation, other philanthropic foundations in Thailand as well as international non-government organisations. In 2012, on the auspicious occasion of Her Majesty Queen Sirikit’s 80th Birth Anniversary, the Ministry of Public Health used the TDSI to screen, assess and promote children’s development. Thereafter, at least 400,000 children in Thailand were screened on their development. More than 10,000 well child clinics in general hospitals got involved, and 400,000 copies of manual on child development promotion were distributed to parents. The success of the CF-WT Project can be seen when parents of the delayed development children show their happiness when their children learn to help themselves, go to normal school, and live a normal life as other children; when children become self-reliant and proud of what they can accomplish; and when government save a lot of resources by providing treatment and rehabilitation for the delayed development children. On June 23, 2013, the CF-WT Project was awarded as the First Place winner of the United Nations Public Service Awards 2013 in the category “Improving the Delivery of Public Services” during the 2013 United Nations Public Service Forum held in the Kingdom of Bahrain.

TOP: Child First - Work Together Project: for the sake of the children on earth to grow up with appropriate development and happy life. ABOVE: The Project receives the United Nations Public Service Awards 2013 for Improving the Delivery of Public Services category.


It is crucial that anti-microbial agents must be used judiciously as studies have shown that their use is strongly associated with the emergence of antimicrobial resistance. The development of new antimicrobial agents is not keeping up with the rapid emergence of antimicrobial resistance and as the antibiotic pipeline is running dry, patients’ lives are put at risk. At ASEAN level, the ASEAN Working Group on Pharmaceutical Development (AGWPD) continues to collaborate in organising activities on rational use of medicines, including antimicrobial agents. Annual workshops on rational use of antimicrobial agents were organised among ASEAN countries since 2011. Malaysia hosted the 3rd ASEAN Workshop on Rational Use of Antimicrobial Agents at the Summit Hotel Subang USJ on June 30-July 1, 2013, with the theme “Combating Antimicrobial Resistance.” It was held back-to-back with the 1st National Quality Use of Medicines Conference. The workshop was a collaborativeeffort between the Pharmaceutical Services Division, Ministry of Health Malaysia, AWGPD and the World Health Organization (WHO)

Western Pacific Regional Office (WPRO). Dr. Salmah Bahri, Director of Pharmacy Practice and Development, Ministry of Health Malaysia officiated the workshop while Dr. Anuj Sharma from WPRO assisted in facilitating the workshop. A total of 53 delegates from Malaysia, Indonesia, Philippines, Brunei Darussalam and Lao PDR attended this workshop and they were mainly pharmacists from different areas of practice encompassing clinical and regulatory. The workshop comprised of lectures, presentation of country reports and group discussion session. Representatives from individual countries presented the patterns of antimicrobial resistance and the adoption of the 9-part model of best practice to promote rational use of antimicrobial agents in their own countries. The workshop was successful in achieving its objectives to: 1) establish a platform to discuss and learn the best practices in combating antimicrobial resistance among the ASEAN member countries; 2) obtain the technical experience and expertise from WHO to upgrade

knowledge and understanding about the concept of rational/quality use of medicines, focusing on antimicrobial agents, 3) strengthen knowledge to improve the rational use of antimicrobial agents while learning about the implications from irrational use of antibiotics, 4) discuss and formulate strategies to strengthen the implementation of antibiotic stewardship programme among the healthcare professionals, and 5) formulate action plans and strategies to combat antimicrobial resistance at ASEAN level. At the end of the workshop, several resolutions were made and action plans were developed to address the issues being faced on the use of antimicrobial agents at the different levels, namely the healthcare providers and public at the national level as well as the ASEAN level. Resolutions include to establish comprehensive national plans to combat antimicrobial resistance with political commitment, strengthen laboratory surveillance, improve access to safe and effective antimicrobial agents, improve the use of antimicrobial agents, strengthen infection prevention and control, information sharing among ASEAN Member States, as well as increase awareness campaign on antimicrobial resistance and rational use of antimicrobial agents. The organisation of this workshop is important because there is still a lack of training and intervention for enhancing rational use of medicines, including antimicrobial agents, among the ASEAN Member States. It is hoped that this kind of collaboration continues to bring the gap closer.

Combating Antimicrobial Resistance3rd ASEAN Workshop on Rational Use of Antimicrobial Agents in Malaysia


Viet Nam hosted the successful 3rd regional ASEAN Dengue Day in Ha Noi on June 15, 2013. Vietnamese Deputy Minister of Health Nguyen Thanh Long described it as the Vietnamese Government and people’s commitment to join hands with other regional countries as well as the international community to share experience and boost effective cooperation in combating dengue. The ASEAN Member States (AMS) have prioritised

dengue as one of the communicable diseases to be addressed, and the ASEAN Health Ministers have agreed to designate June 15 of every year as ASEAN Dengue Day to increase public awareness on the mosquito-borne disease. At the opening ceremony, Long warned people in Viet Nam and other ASEAN Member States of the occurrence and spread of dengue in the region and the world. He noted that dengue fever has been reported in over

100 countries and territories, with about 2.5 billion people living in dengue-endemic areas. Of the number, about 1.8 billion are living in Asia-Pacific. In Viet Ntam, between 50,000 and 100,000 dengue cases are reported each year, with nearly 100 deaths. As the host country, Viet Nam conducted several activities leading to the observance of the ASEAN Dengue Day, which carried over last year’s theme, “ASEAN Unity for Dengue-Free Community.”

ASEAN Unity for Dengue-Free Community

3rd Regional ASEAN Dengue Day in Vietnam

3rd Regional ASEAN Dengue Day Conference and Observation in Ha Noi, Viet Nam on June 14-15, 2013.


It emphasised the need to further enhance a unified action from all sectors in achieving a dengue-free community. Dengue cannot be tackled by the health sector alone and involvement of all sectors, including private sector, is necessary. Unity among ASEAN nations to fight against dengue cannot be over-emphasied because of the increasing numbers of cases and the high cost of managing the disease. On June 14, the 3rd

ASEAN Dengue Day Conference was held and attended by the focal points of the ASEAN Expert Group on Communicable Diseases (AEGCD) and other representatives from AMS plus China, ASEAN dialogue partners, and development partners like

the World Health Organization and Australian Assistance for International Development (AusAID) and Sanofi Pasteur. The one day conference was divided into six sessions: 1) strengthening regional cooperation towards the prevention and control of Dengue; 2) strengthening capacity in an efficient and sustainable way; 3) strengthening sustainability of community participation in the dengue prevention activities; 4) Communication for Behavioral Impact (COMBI) by AEGCD Malaysia; 5) early diagnosis and case management for dengue; and 6) new and appropriate initiative from public and private, health and non-health sectors, including collaboration on research and development of

dengue vaccines. At the end of the conference, the “Hanoi Call for Action on the Prevention and Control of Dengue” was endorsed. The conference delegates were also treated to a Regional Observation of ASEAN Dengue Day at the grassroot level showcasing initiatives of local authorities in Ha Noi. Other activities were also staged including exhibits of national initiatives and health talk on combating dengue. Community participation in dengue prevention is one of the important elements in ensuring the Dengue-Free Community. Sustainability of community participation is crucial, and mechanisms and innovative ways should be ensured to gain the commitment of the public.

Sanofi Pasteur Update on Dengue Activities in ASEAN

2nd ADVA Workshop. The 2nd ASEAN Member States Dengue Vaccination Advocacy (ADVA) workshop scheduled in December 2013 has been postponed until February or March 2014 due to logistic issues. This postponement will hopefully enable representatives from each ASEAN Member States (AMS) to attend. This workshop will extend the work of the first workshop held in September 2012 in preparation for the introduction of the dengue vaccine and its central theme will revolve on data sharing between the AMS and the role of ADVA.

ADVASC Independence. A critical topic for discussion in 2014 will be the independence of ASEAN Member States Dengue Vaccination Advocacy Steering Committee (AVASC) from Sanofi. To this end, ADVASC will be registered as a society to be able to solicit financial support from other entities, including donors and the industry.

3rd ADVA Workshop. A 3rd workshop is currently being planned to address optimum strategies for dengue control using modeling. This will take place when the results of the Phase 3 studies are available.

Capacity Building in AMS. Sanofi has provided some limited support to The Asian Foundation for Tropical Medicine in the Philippines to facilitate regionally representative analysis of dengue serotype distribution by the systematic sampling of dengue cases. Capacity building support for Indonesia is in an early planning stage.

Transmission Modeling and Dengue. A modeling tool has been developed by Sanofi and published [See: Laurent Coudeville, Geof P. Garnett. (2012) “Transmission Dynamics of the Four Dengue Serotypes in Southern Vietnam and the Potential Impact of Vaccination” PLoS ONE; Volume 7; Issue 12; e51244] and this can be used by AMS to assess the likely impact of vaccine using country specific and vaccine specific parameters. Key data needed to run the model are historical monthly dengue incidence by age, and geographically representative serotype distribution and evolution, although, the model can be validated with fewer data. The model has been developed with a user friendly web interface allowing access by external parties after suitable training.


WE, THE PARTICIPANTS of the 3rd ASEAN Dengue Conference from the Kingdom of Cambodia, the Republic of Indonesia, the Lao People’s Democratic Republic, Malaysia, the Republic of the Union of Myanmar, the Republic of the Philippines, the Republic of Singapore, the Kingdom of Thailand and the Socialist Republic of Vietnam, and other international development partners, held in Hanoi, the Socialist Republic of Vietnam on 14th

June 2013,

NOTE WITH CONCERN THAT:1. Globally, dengue is the most rapidly spreading mosquito-borne disease with an estimated 50-100 million infections occurring annually.2. Dengue poses a serious challenge to healthcare systems in ASEAN countries as 75% of the global burden occurs in the Asia Pacific region.3. Dengue is a difficult disease to control without enhanced public awareness, individual action and concerted community efforts to reduce its spread.4. Although there has been progress in dengue vaccine research, a number of challenges remain before a commercial dengue vaccine is available.5. Non-health factors such as implication of socio-economic development, climate change, population movement, migration etc. may have negative impacts to Dengue prevention and control.6. Resources mobilization for Dengue prevention and control is needed to ensure regional public health security.7. Current dengue preventive and control approaches need to be enhanced with innovative community efforts and technology.

RECOGNIZING THAT:1. ASEAN Member States have prioritized Dengue as one of the communicable diseases to be addressed, following the mandate of the ASEAN Socio-Cultural Community Blueprint as endorsed by ASEAN Leaders in 2009.2. ASEAN Strategic Framework on Health Development (2010-2015), as endorsed by the ASEAN Health Ministers Meeting in 2010, provides the operational guidelines in the control of communicable diseases including Dengue.3. The 10th ASEAN Health Ministers Meeting in 2010 agreed to designate the 15th of June as the ASEAN Dengue Day, commencing in 2011, in order to increase public awareness of Dengue.

4. ASEAN Expert Group on Communicable Diseases (AEGCD) is the health subsidiary body given the mandate to plan regional interventions on communicable diseases including Dengue under

purview of the Senior Officials Meeting on Health Development (SOMHD).

ACKNOWLEDGE THAT: 1. The World Health Organization Global Strategy on Dengue, emphasizes on integrated vector management with community and inter-sectoral participations in which control is directed towards geographic areas of highest risk of transmission in the most cost effective manner.2. The Republic of Indonesia, as the host for the launch of the first Regional ASEAN Dengue Day on 15th June 2011 resulted in the "Jakarta Call for Action".3. The Republic of Myanmar, as the host for the launch of the second Regional ASEAN Dengue Day on 15th June 2012 resulted in the "Yangon Call for Action".4. All ASEAN Member States agreed and supported the conduct of an Annual Regional ASEAN Dengue Day as well as National ASEAN Dengue Day Campaigns.

REAFFIRM THAT: Our commitment to operationalize the four key messages stipulated in the "Jakarta Call for Action”. Namely:1. Calling for action from all;2. Shifting from reactive to proactive;3. Strengthening capacity in an efficient and sustainable way; and4. United fight against dengue.

SUPPORT:The context of the previous “Calls for Action” from the Jakarta and Yangon ASEAN Dengue Conferences which emphasized:1. Strengthening regional cooperation;2. Enhancing capacity in an efficient and sustainable way; and3. Promoting inter-sectoral collaboration.

CALL UPON ALL STAKEHOLDERS OF ASEAN TO:Continue and further strengthen the actions and activities reflected in the "Jakarta Call for Action" and the “Yangon Call for Action” on the Prevention and Control of Dengue including: 1. Enhance dengue surveillance, prevention and control systems in all member states;2. Increase advocacy and public health information activities to generate individual and community action;

3. Stimulate and strengthen research to improve

Hanoi Call for Action on the Prevention and Control of Dengue

(14 June 2013 ı Hanoi, Socialist Republic of Vietnam)


the evidence base and inform policy; 4. Realign resources at regional and national level to reinforce dengue control and prevention systems;5. Coordinate and collaborate on regional surveillance leveraging on existing regional platform; and6. Strengthen collaboration with existing partners and networks in prevention and control of dengue.

IMPROVING SURVEILLANCE SYSTEMSAlthough individual Member States are responsible for disease surveillance and response, awareness of the importance of regional and global surveillance systems has increased in recent years. The emergence and spread of dengue regionally and globally has been one disease that has highlighted regional shared interests in and vulnerability to infectious diseases. ASEAN Member States are called upon to:1. Provide commitment and leadership to create an enabling environment for public health surveillance and health information systems that are sustainable and coordinated while working toward regional standards (eg. External Quality Assurance programme for Dengue Diagnostics to standardize laboratory testing and build regional capability and capacity);2. Strengthen national surveillance systems for human cases to share information in a timely manner and guide public health action;3. Promote and create conditions for ensuring that vector surveillance systems are strengthened at local level; and4. Invest in surveillance systems that can foster research and support monitoring and evaluation tailored to identifying, addressing and guiding public health policy.

STRENGTHEN COMMUNICATIONTO PROMOTE INDIVIDUAL ACTIONRecognising that reducing the spread of dengue requires a sustained and coordinated response from Member States as much as from communities and individuals to eliminate the presence of mosquitoes, we call for strengthened individual and community action in the ASEAN region by:1. Increasing public knowledge and raising awareness of dengue control and prevention measures through sustained communication campaigns;2. Strengthening national communication capacities that advocate and promote individual action and generate community efforts to reduce the spread of dengue in the ASEAN region;3. Monitoring and evaluating community and individual actions in order to develop a strong evidence base for dengue control and prevention efforts at local level; and4. Developing and sharing best practices for community-led dengue control and prevention activities.

THEREFOREWE, the participants of the 3rd ASEAN Dengue Day, RESOLVED TO SUBMIT THE HANOI CALL FOR ACTION for adoption.

Officials from ASEAN Member States, ASEAN Secretariat, WHO, AusAID, Sanofi Pasteur and other Partners.


Thank You, ASEANfrom the Philippines

Ambassador Elizabeth P.Buensuceso, permanent representative of the Philippines to the ASEAN received cash donations totaling USD5,000 and IDR30,350 million Indonesia rupiah for the victims of Typhoon Yolanda (Haiyan) from the Committee of Permanent Representatives (CPR) to ASEAN and ASEAN’s Dialogue Partners. “I sincerely thank all of you for your kind donations for the victims of typhoon Yolanda. We really appreciate your very touching gesture. It’s not the amount that counts, but what is important is that you gave with your heart. In one Philippine language (Ilocano), “thank you” means God will repay you, and indeed, this is my prayer for all of you that God will bless you abundantly for your kind deeds,” Buensuceso said after receiving the donations in a

simple ceremony at the ASEAN Secretariat on December 11, 2013 in Jakarta. The amount donated represents personal contributions of the members of the CPR and Dialogue Partners. This is over and above the contributions made by the envoys’ respective governments. The Jakarta-based CPR is composed of the 10 Permanent Representatives or Ambassadors to ASEAN of all ASEAN Member States. Aside from supporting the work of the ASEAN Community Councils and ASEAN Sectoral Ministerial Bodies, the CPR also facilitates ASEAN’s cooperation with external partners, especially with the 10 Dialogue Partners of ASEAN namely, Australia, Canada, China, the European Union, India, Japan, New Zealand, the Republic of Korea, Russia and the United States.

ASEAN Secretary-General Le Luong Minh said there is progress in relief distribution as well as in managing assistance from local and international communities. But after visiting typhoon-affected communities in Tacloban City last month, he emphasised that due to the massive scale of the calamity brought upon the country by typhoon Yolanda, the Philippines needs continuous support to restore normality and even bring progress in disaster-stricken communities. Minh said that “ASEAN will continue to work with the Member States in providing the help that matters most to the Philippines at this time." He said that ASEAN will mobilise the sectoral bodies within the Association such as health, transportation and communication, disaster management, among others to support long-term recovery and rehabilitation efforts in the country. In his capacity as ASEAN Humanitarian Assistance Coordinator, Secretary-General Minh led a symbolic hand-over in Tacloban City on November 21 of the initial 2,000 ASEAN Family Kits containing cooking supplies, clothing, sleeping, and hygiene supplies for a family of five. ASEAN also donated 2,000 rolls of tarpaulins. As of December 11, all ASEAN Member States are estimated to have provided more than US$10 million in financial aid and in-kind contribution to the Philippine Government in response to this calamity.

(Taken from a press release of the Department of Foreign Affairs, Philippines)

Ambassador Elizabeth P. Buensuceso (in yellow), permanent representative of the Philippines to the ASEAN, receives cash donations for the victims of Typhoon Yolanda (Haiyan) from the Committee of Permanent Representatives (CPR) and Dialogue Partners at the ASEAN Secretariat in Jakarta on December 11, 2013.


The 21st ASEAN Task Force on AIDS (ATFOA) Meeting in Melaka Historic City in Malaysia on September 3–5, 2013 can be considered historic meeting too by implementing several activities outlined in its ASEAN Work Plan IV (AWP-4) under its current chair, Dr. Bounpheng Philavong of Lao PDR. This meeting was actively participated in by all ASEAN Member States and attended by Steven J. Krauss, director of the Regional Support Team for Asia and the Pacific of UNAIDS or the Joint United Nations Programme on HIV/AIDS, who presented "Towards Generation of Zero HIV" that focuses on "low cost, high impact" activities. The meeting was also attended by representatives from the the ASEAN Security On Drugs (ASOD), Senior Labour Officials Meeting’s Working Group on HIV Prevention and Control in the Workplace (SLOM-WG-HIV), World Health Organization-Western Pacific Regional Office, United Nations Development Program (UNDP), United Nations Office on Drugs and Crime (UNDOC), AIDS Alliance, Seven

Sisters, and My-Plus, a local non-government organization (NGO) in Malaysia. Honorary Datuk Dr Noor Hisham bin Abdullah, director general of health of Malaysia, officiated the opening ceremony during the welcome dinner that was hosted by the Ministry of Health. Local officials – Melaka State Chief Ministers representative, Datuk Ar. Ismail bin Othman and Mayor of Melaka Historic City, Datuk Zainal bin Hj. Abu – graced the event. On the last day of the meeting the "Melaka Historic City - Getting to Zero Project" was launched and jointly officiated by The Rt. Honourable Chief Minister of Melaka State, Datuk Wira Ir. Hj. Idris bin Hj. Haron and Datuk Seri Dr. S. Subramaniam, Minister of Health Malaysia. The Plan of Action for the project was developed by government and private agencies, NGOs and individual experts in late 2012. It was officially handed to the Mayor of Melaka Historic City. The “ASEAN Cities Getting to Zero Project” is in line with the Millennium Development

Goals (MDG) targets to halve and halt new HIV infection. “Getting to Zero” has been the theme for World AIDS Day for the five-year period starting from 2011 to 2015 with three main emphases: Zero New HIV Infection, Zero Discrimination, and Zero AIDS-Related Deaths. Subramaniam said, “These focus reflect high government commitment in ensuring people living with HIV (PLHIV) get proper treatment that covers antiretroviral, counselling, care and support that eventually reduce AIDS mortality.” Aside from the ATFOA meeting, two activities under AWP 4 were also conducted, namely: the Workshop on Good Practices, Evidence-Based and New Initiatives on HIV and AIDS Response, led by Malaysia and Singapore on September 2; and the Workshop on Addressing the 2010 WHO Antiretroviral Therapy for HIV Infection in Adults and Adolescents recommendations, including coverage and resource implications (Treatment 2.0 Initiatives) and TB/HIV, led by Cambodia and Malaysia on September 6.

The 21st ASEAN Task Force on AIDS (ATFOA) Meeting in Melaka Historic City in Malaysia on September 3 – 5, 2013.

ATFOA Meeting in Melaka Historic City


ASEAN Cities Getting to Zeroes In line with the ASEAN Declaration of Commitment: Getting to Zero New HIV Infection, Zero Discrimination and Zero AIDS-Related Deaths, the ASEAN Task Force on AIDS (ATFOA) conducted a satellite symposium on November 20, 2013 at the 11th International Congress on AIDS in Asia and Pacific (ICAAP) which highlighted the ASEAN Cities Getting to Zeros Initiative. H.E. Dr. Agung Laksono, Coordinating Minister for People’s Welfare of the Republic of Indonesia and Steve Kraus, Director of the UNAIDS Regional Support Team-Asia Pacific opened the symposium and supported by the ASEAN Secretariat through the Health Division and UNAIDS. Laksono highlighted the importance of implementing the commitment made by the ASEAN Leaders in the 19th ASEAN Summit in November 2011 when they adopted the Declaration. The ASEAN Cities Getting to Zeros Initiative is the project currently being implemented for the operationalisation of this Declaration. Kraus noted that progress is being made in achieving the targets set in getting to the three zeros and that ASEAN has a critical role in advocating for

progress in these targets. The symposium provided an opportunity to share the progress of the 13 areas/cities among the ASEAN Member States in localising the HIV and AIDS goals of getting to three zeros. Dr. Kamal Siregar, Secretary of the National AIDS Commission of Indonesia, presented the background and overview of the Initiative and the ways forward in the plan of action amongst the 13 ASEAN cities/areas. ATFOA Indonesia is the lead country for this initiative in ASEAN.

LEFT: Jam packed satellite symposium on "ASEAN Cities Getting to Zeros: Localizing the Three Zeros-An Innovation in ASEAN Countries" during the 11th International Congress on AIDS in Asia and Pacific (ICAAP) in Bangkok, Thailand. RIGHT: H.E. Dr. Agung Laksono, Coordinating Minister for People’s Welfare of the Republic of Indonesia, opens the symposium.

The sample cities of Quezon City in the Philippines, Can Tho and Danang Cities in Viet Nam, and the Historical City of Melaka, Malaysia were highlighted in the symposium by their respective presenters, namely: Dr. Rolando Cruz, Deputy Director General Professor Bui Duc Duong (Viet Nam), and the Honoroble Mayor of Melaka, Datuk Zainal Abu. During the symposium, the e-copy of Volume 1 of the compilation of ASEAN Good Practices and New Initiatives in HIV and AIDS Response among ASEAN Member States was launched by the Mayor of Melaka. This initiative was supported by the International HIV Alliance and led by ATFOA Malaysia. The e-publication presents the documented good practices and initiatives in ASEAN as a response to the targets of getting to the three zeros. The symposium was facilitated by Director Larry Maramis and Dr. Ferdinal Fernando of ASEAN Secretariat, Dr. Bounpheng Philavong (Lao PDR, ATFOA Chair), and Dr. Sha’ari Bin Ngadiman (Malaysia, ATFOA Vice Chair). ASEAN also organised an exhibition booth at the ICAAP.

The cover of Volume 1 of the compilation of ASEAN Good Practices & New Initiatives in HIV and AIDS response among ASEAN Member States.

Shared Responsibility:Strengthening Results for an

AIDS-Free Generation

This year’s theme of the World AIDS Day - “Shared Responsibility: Strengthening Results for an AIDS-Free Generation” - resonates well with the current progress of ASEAN towards an ASEAN Community by 2015 with one vision and one identity. An ASEAN Community in a stable political and secure environment amidst a robust economy and progressive socio-cultural development can only be sustainable if the current and future generations are assured of a healthy and disease-free community. Such a community includes an AIDS-free generation. More specifically, a community that is free from the impacts brought about by HIV and AIDS. In commemorating the World AIDS Day this year, the ASEAN Community also marks the second year of moving towards the targets of the ASEAN Declaration of Commitment: Getting to Zero New HIV Infections, Zero Discrimination, Zero AIDS-Related Deaths. This was adopted by the ASEAN Leaders at the 19th ASEAN Summit in November 2011 with specific targets outlined for 2015. The implementation of this Declaration commenced through the ASEAN Cities Getting to Zero Initiative in 13 cities/areas within

the ASEAN region. Progress has already been made in the localisation of this Declaration in these cities/areas in ASEAN. Proactive, dynamic and harmonised actions are constantly called upon from ASEAN Member States in pursuing the targets committed by their respective ASEAN Leaders through this Declaration. ASEAN, through the ASEAN Task Force on AIDS (ATFOA), has progressively worked towards the sharing of responsibilities in getting to three zeros in the ASEAN communities. The shared responsibilities in strengthening the achievement of targeted results include, among others, the need to invest more in developing innovations in

World AIDS Day 2013 Message of H.E. LE LUONG MINH

Secretary-General of ASEAN

preventing the spread of HIV; and to advocate for a committed stance in implementing innovative and evidence-based research programmes and policies to combat HIV and AIDS. ASEAN needs strong political will, adequate financial resources and effective evidence-based approaches and support from partners in order to achieve these three zeros. I urge all concerned to continue to work on the ASEAN Declaration of Commitment in getting to zeros and build on political commitments, investments, energy, activism and determinations that have brought us to this turning point.

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