kospen: challenges in empowering the community
TRANSCRIPT
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?
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
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
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
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
%
- 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
- 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
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
BUT … If we want people to make healthy choices we have to make healthy choices available, accessible and affordable
KOSPENEmpowering Communities, Strengthening the Nation
A Community-Based Intervention for NCD Risk Factors
- 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
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
• 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
• 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
• 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
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
• 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
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
• 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
BY YEAR 2022
• 10,000 KOSPEN localities• 50,000 volunteers trained• 1.5 adults screened by 2022
TARGETS
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)
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.
70 % for Diabetic confirmatory test
36.2% BP ≥ 140/90mmHg
6.5 % for BMI ≥35kg/m²
REFERRALS
Healthy Eating
Separation of sugare from hot
drinks
Eating fruits and vegetables
Drinking plain water
Food Callorie
information
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Screening equipments• Glucostrip dan Glucometer• Digital BP measurement set• Stadiometer dan weighing machine• Health Diary
SCREENING EQUIPMENTS
REFERRALS CRITERIA
RBS ≥ 5.6mmol/L
BP Sistolic ≥ 140 and/or Diatolic ≥190mmHg
BMI ≥ 35kg/m²
REFERRALS OF RISK CASES
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
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