NationalStrategicPlanforNon-CommunicableDisease

MediumTermStrategicPlantoFurtherStrengthentheNCDPreventionandControlPrograminMalaysia(2016-2025)

DepartmentofPublicHealthMinistryofHealthMalaysia

2016

Copyright©MinistryofHealthMalaysiaAllrightsreserved.Thisdocumentmaynotbereproduced,inwholeorinpart,inanyformormeans,electronicormechanical,includingphotocopying,recording,orbyanyinformationstorageorretrievalsystemnowknownorhereafterinvented,withoutwrittenpermissionfromthepublisher.Firstedition2016Publishedby:Non-CommunicableDisease(NCD)SectionDiseaseControlDivisionMinistryofHealthPutrajayaLevel2,BlockE2,ComplexEFederalGovernmentAdministrationCentre62590PutrajayaMALAYSIATel:+603-88924409Fax:+603-88924526Website:www.moh.gov.myISBN__________________

TABLEOFCONTENTSExcerptFromThe11THMalaysiaPlan2016-2020......................................................................................1MessagefromTheMinisterofHealthMalaysia............................................................................................2MessagefromTheSecretaryGeneral,MinistryofHealthMalaysia....................................................3MessagefromTheDirectorGeneralofHealthMalaysia..........................................................................4ExecutiveSummary..................................................................................................................................................51. INTRODUCTION...................................................................................................................................................62. NSP-NCD2010-2014..........................................................................................................................................72.1Background......................................................................................................................................................72.2AnalysisoftheImplementationofNSP-NCD2010-2014............................................................82.3BurdenofNCDinMalaysia.......................................................................................................................9

3. NSP-NCD2016-2025.......................................................................................................................................133.1.Background...................................................................................................................................................133.2.NCDTargetsforMalaysia.......................................................................................................................143.3.ObjectivesofNSP-NCD2016-2025....................................................................................................15

4. OPERATIONALISINGNSP-NCD2016-2025..........................................................................................164.1.Background...................................................................................................................................................164.2.SummaryofActionPlanandInitiatives...........................................................................................17

4.2.1.National Strategic Plan for Tobacco Control 2015-2020 .............................................. 174.2.2.Policy Options to Combat Obesity in Malaysia 2016-2025 .......................................... 174.2.3.Salt Reduction Strategy to Prevent and Control NCD For Malaysia 2015-2020 .......... 174.2.4.National Strategic Plan for Active Living 2016-2025 ................................................... 184.2.5.National Action Plan: Prevention and Harmful Use of Alcohol 2013-2020 ................. 194.2.6.National Strategic Plan for Cancer Control Program 2016-2020 .................................. 194.2.7.Strengthening Chronic Disease Management At Primary Care Level through the

Enhanced Primary Health Care (EnPHC) initiative ...................................................... 204.3.MainActivitiesundereachObjectiveofNSP-NCD2016-2025..............................................21

4.3.1.Objective 1: To strengthen national capacity, leadership, governance, multi-sectoral action and partnerships to accelerate country response for the prevention and control of NCDs ............................................................................................................................. 21

4.3.2.Objective 2: To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments ............................... 21

4.3.3.Objective 3: To strengthen and orient health systems to address the prevention and control of NCDs and the underlying social determinants through people-centred primary health care and universal health coverage ....................................................... 21

4.3.4.Objective 4: To promote and support national capacity for high-quality research and development for the prevention and control of NCDs .................................................. 22

4.3.5.Objective 5: To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control ........................................................................................... 22

5. EMPOWERINGMALAYSIANSTHROUGHKOSPEN............................................................................23

5.1.Background...................................................................................................................................................235.2.EvaluationofPhase1implementation.............................................................................................245.3.Statusofimplementation........................................................................................................................24

6. MONITORINGANDEVALUATION.............................................................................................................256.1.GlobalLevel...................................................................................................................................................256.2.NationalLevel..............................................................................................................................................256.3.NationalIndicatorsandTargets..........................................................................................................26

7. CONCLUSION......................................................................................................................................................28

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EXCERPTFROMTHE11THMALAYSIAPLAN2016-2020

“Focus area A - Achieving universal access to quality healthcare” Good health is essential for a good quality of life. Consequently, the Government remains committed to achieving universal access to quality healthcare during the Eleventh Plan by continuing efforts to improve the fundamentals of the health system. This means that every Malaysian will have equal access to affordable and good quality healthcare services, whether delivered by public or private providers. “Intensifying Collaboration with Private Sector and NGOs to Increase Health Awareness” Strategy A4 of the 11th Malaysia Plan 2016-2020 focused on measures that will be undertaken to reduce communicable diseases (CD) and non-communicable diseases (NCD), which includes the provision of preventive healthcare services and the promotion of a healthy lifestyle, where the role of the private sectors and non-governmental organisations (NGOs) are emphasised. The private sector will be encouraged to undertake corporate social responsibility (CSR) programmes and to collaborate with the Government in research and development. NGOs will be encouraged to provide health advocacy activities, health screening, and early health interventions, as well as to work with the private sector in carrying out health-related CSR programmes. Community participation in health promotion programmes, such as the use of public parks and recreational areas to promote healthy lifestyles will be encouraged. Intervention programmes where the community will be trained to promote health, such as KOSPEN, will continue to address lifestyle related diseases.

Chapter4:ImprovingWellbeingForAll(page115-116)

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MESSAGEFROMTHEMINISTEROFHEALTHMALAYSIA It is a privilege and honour for me to present the 10-year National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2016-2025. This Strategic Plan follows the earlier NSP-NCD 2010-2014 and is presented at the right moment when the world recognises the impending danger of NCDs and their impact on economy as well as productivity of the nation. The NSP-NCD was developed based on current global themes and mandates from the World Health Organization (WHO). This latest edition of the NSP-NCD will continue to provide the over-arching framework for strengthening NCD prevention and control in Malaysia. This Strategic Plan is in-line with the Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2020. The NCD situation in Malaysia is like that of an epidemic and must be dealt with like any Public Health Emergency. The Ministry of Health (MOH) has taken the lead in the formulation of this Strategic Plan to combat NCDs where the risk factors are already known and well described. The emphasis on whole-of-government and whole-of-society approach to NCDs is important as health is not only MOH’s responsibility but also everyone’s responsibility. It relies on the support of all stakeholders and therefore I urge everyone to work together to implement the recommended interventions and make Malaysia a healthier place to live in. Malaysia aspires to be a developed nation by 2020 and a great nation by 2050. Its greatest asset is the people, we Malaysians. We have to be a Healthy Nation first in order to reach those targets. Hence, we have to act now to prevent our population suffering from disability and premature deaths due to NCDs, including for our children who will reach early adulthood soon. This is the healthy future that we want for all Malaysians. Datuk Seri Dr S. Subramaniam Minister of Health Malaysia

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MESSAGEFROMTHESECRETARYGENERAL,MINISTRYOFHEALTHMALAYSIA I am delighted to share my thoughts on our National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2016-2025. Facts and figures from our latest population-based health survey known as the National Health and Morbidity Survey (NHMS) in 2015 showed that the prevalence of NCD risk factors continue to rise. We now have an estimated 3.5 million adult Malaysians living with diabetes, 6.1 million with hypertension, 9.6 million with hypercholesterolemia and 3.3 million with obesity. The rapid increase in the number of people suffering from NCDs presents one of the biggest challenges to the current healthcare system in Malaysia. Although much has been done for NCD prevention and control, there is scope for a more coordinated approach for better health returns. This will require multi-sectoral cooperation from government, public, private and communities to build up an environment that enables healthy living that makes healthier choices easier for Malaysians. NCDs are preventable. It requires a shift in people’s attitudes and preferences. The current behavior such as the detrimental eating patterns, sedentary lifestyles and smoking among many Malaysians adds to the increasing burden of NCD in this country. We must change this. Health is no longer the business of Ministry of Health alone. It has to be everyone’s business. This Strategic Plan calls for concerted efforts on addressing these risk factors and sets out directions that will shape an environment that is conducive to NCD prevention and control. Although the challenges we face due to NCDs may seem overwhelming, I am confident that the momentum that has been initiated by these and other efforts will continue to build and spread throughout the whole-of-government and society as we come together to fight these diseases and ensure that our communities promote healthy lifestyles. Dato' Seri Dr Chen Chaw Min Secretary General Ministry of Health Malaysia

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MESSAGEFROMTHEDIRECTORGENERALOFHEALTHMALAYSIA I am pleased to present the new edition of National Strategic Plan for Non-Communicable Diseases (NSP-NCD) 2016-2025 which sets out our role in addressing the significant and increasingly challenging threats posed by NCDs in Malaysia. I wish to congratulate the Public Health Division for the successful publication of this document. There is no doubt that the lifestyle in Malaysia has changed over the years as a result of urbanisation and globalisation. These in turn give rise to the dual burden of diseases; increasing incidences of overweight, obesity and NCDs as well as micronutrient deficiencies. The number of people with NCDs such as diabetes, hypertension, cancers, and heart diseases keeps growing bringing the ‘Health of the Nation’ is at a critical crossroad. NCDs are the leading causes of death and morbidity among adults in Malaysia, which have resulted in heavy emotional as well as financial toll on all of us. The increasing medical cost to treat patients with NCDs is of serious concern. If the trend of NCDs continue to rise, healthcare costs will not only be unsustainable, the human costs would be unimaginable. Over the next 10 years, we will focus on five strategic priorities that are critical to the success in reducing the burden of NCDs in Malaysia. This strategic plan is built on current prevention themes, while drawing references from learnings of the earlier NSP-NCD 2010-2014. The Strategic Plan calls for whole-of-government and whole- of-society approaches in the prevention and control on NCDs. It spells out the need to address common risk factors of smoking, poor nutrition, physical inactivity and unhealthy use of alcohol, and improved disease control via re-oriented integrated healthcare services and personalised healthcare. The Ministry of Health is committed in reducing the burden of NCDs and to work in partnership as a nation to save our people from this disease burden. Let us work together to implement this Strategic Plan so that we can realise our vision of a truly healthy nation. Datuk Dr Noor Hisham Abdullah Director General of Health Malaysia

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EXECUTIVESUMMARYThisNationalStrategicPlanforNon-CommunicableDiseases(NSP-NCD)2016-2025isacontinuationofthepreviousNSP-NCD2010-2014.ThisStrategicPlanisevidenceofthecommitmentoftheGovernmentinreducingtheburdenofNon-CommunicableDiseases(NCDs)inMalaysia.ThemainfocusofthisStrategicPlaninonthreetypesofNCDi.e.cardiovasculardiseases,diabetesandcancer,andonfoursharedNCDriskfactorsi.e.tobaccouse,unhealthydiet,physicalinactivityandharmfuluseofalcohol.TheNSP-NCD2016-2025hasfivemainobjectives,basedontheGlobalActionPlanforthePreventionandControlofNCDs2013-2020:1. Tostrengthennationalcapacity,leadership,governance,multi-sectoralactionand

partnershipstoacceleratecountryresponseforthepreventionandcontrolofNCDs.2. ToreducemodifiableriskfactorsforNCDsandunderlyingsocialdeterminantsthrough

creationofhealth-promotingenvironments.3. TostrengthenandorienthealthsystemstoaddressthepreventionandcontrolofNCDs

andtheunderlyingsocialdeterminantsthroughpeople-centredprimaryhealthcareanduniversalhealthcoverage.

4. Topromoteandsupportnationalcapacityforhigh-qualityresearchanddevelopmentforthepreventionandcontrolofNCDs.

5. TomonitorthetrendsanddeterminantsofNCDsandevaluateprogressintheirpreventionandcontrol.

Anintegratedapproachisessentialforeffectiveimplementationoftheplan,andthereforetheNSP-NCD2016-2025willbein-line,includesorover-archesthefollowingactionsplansandinitiatives:

1. NationalPlanofActionforNutritionofMalaysia(NPANM)III2016-20252. NationalStrategicPlanforTobaccoControl2015-20203. PolicyOptionstoCombatObesityinMalaysia2016-20254. SaltReductionStrategytoPreventandControlNCDForMalaysia2015-20205. NationalStrategicPlanforActiveLiving2016-20256. MalaysiaAlcoholControlActionPlan2013-20207. NationalStrategicPlanforCancerControlProgram2016-20208. StrengtheningChronicDiseaseManagementAtPrimaryCareLevelthroughthe

EnhancedPrimaryHealthCare(EnPHC)initiative9. KOmunitiSihatPErkasaNegara(KOSPEN)initiative

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1. INTRODUCTIONNon-CommunicableDiseases(NCDs),mainlycardiovasculardiseases,cancers,chronicrespiratorydiseasesanddiabetes,arethebiggestcauseofdeathsworldwide.Morethan36milliondieannuallyfromNCDs(63%ofglobaldeaths),including14millionpeoplewhodietooyoungbeforetheageof70.Morethan90%oftheseprematuredeathsfromNCDsoccurinlow-andmiddle-incomecountries,andcouldhavebeenlargelyprevented.Mostprematuredeathsarelinkedtocommonriskfactors,namelytobaccouse,unhealthydiet,physicalinactivityandharmfuluseofalcohol.TheemergenceofNCDsastheleadingcauseofdeathgloballyandincludingMalaysiawereduetomanychangesoccurredinsocio-economicdeterminantsinhealthsuchasglobalisationoftradeandmarketing,lifestylechanges,shiftofsocio-demographicpattern,improvedeconomicaffordability,easeoftravelling,economictransitionandmovementofunhealthyproducts,leadingtohighriskbehavioralchangesandincreasemetabolicriskfactors.Tobaccouse,harmfulalcoholuse,unhealthydietasconsumptionoflessfruitsandvegetables,highsaltandtrans-fatconsumption,andphysicalinactivityarethecommonbehaviorallymodifiableriskfactorsofNCDswhileoverweightandobesity,raisedbloodpressure,raisedbloodglucoseandabnormalbloodlipidsarethecommonmetabolicriskfactors.ScientificknowledgedemonstratesthattheprematuredeathsduetoNCDarelargelypreventablebyenablinghealthsystemstomoreeffectivelyandequitablymeetthehealthcareneedsofpeoplewithNCDs,andbyinfluencingpublicpoliciesinsectorsoutsideofhealththattacklesthesharedNCDriskfactorsdescribedabove.ThisdocumentfollowstheNSP-NCD2010-2014thatwaspublishedinDecember2010.Inlinewiththeearlierdocument,themaingoaloftheNationalStrategicPlanistoprovidearoadmapforallrelevantstakeholdersinMalaysiatoreducethepreventableandavoidableburdenofmorbidity,mortalityanddisabilityduetoNCDsbymeansofmulti-sectoralcollaborationandcooperationatnationalandstatelevels.ItishopedthatourpopulationwouldreachthehighestattainablestandardsofhealthandproductivityateveryageandNCDsarenolongerabarriertoourwell-beingandnegativelyimpactsMalaysia’ssocio-economicdevelopment.ThemainfocusofthisdocumentinonthreetypesofNCDi.e.cardiovasculardiseases,diabetesandcancer,andonfoursharedNCDriskfactorsi.e.tobaccouse,unhealthydiet,physicalinactivityandharmfuluseofalcohol.

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2. NSP-NCD2010-2014

2.1 BACKGROUND

TheNationalHealthandMorbiditySurveys(NHMS)andtheBurdenofDiseaseStudiesprovidetheevidenceoftheincreasingburdenofNCDandNCDriskfactorsinMalaysia.TheNationalStrategicPlanforNon-CommunicableDiseases(NSP-NCD)2010-2014wasdevelopedin2010tostrengthenMalaysia’sresponsetoNCDpreventionandcontrol1.TheCabinetchairedbythePrimeMinisteron17December2010hadapprovedthisdocument.TheNSP-NCDacknowledgesthatnationalpoliciesinsectorsotherthanhealthhaveamajorbearingontheriskfactorsforNCDbecausethebroaddeterminantsofNCDslargelyfalloutsideofthehealthdomain.TosupporttheimplementationofactivitiesundertheNSP-NCD,acabinetlevelcommitteewasestablished,“CabinetCommitteeforAHealthPromotingEnvironment”(JawatankuasaKabinetbagiPersekitaranHidupyangSihatorJKPHS).ThiscommitteeischairedbytheDeputyPrimeMinisterofMalaysiaandcomprisedof11ministers:

1. MinisterofHealth2. MinisterofEducation3. MinisterofHigherEducation4. MinisterofInformation,Communications,Arts&Culture5. MinisterofRural&RegionalDevelopment6. MinisterofAgricultureandAgro-basedIndustry7. MinisterofYouth&Sports8. MinisterofHumanResource9. MinisterofDomesticTrade,Co-operativesandConsumerism10. MinisterofHousingandLocalGovernments11. MinisterofWomen,FamilyandSocialAffairs

ThemaintermsofreferenceofthisCabinetCommitteeistodeterminepoliciesthatcreatesalivingenvironmentthatsupportspositivebehaviouralchangesofpopulationsofMalaysiatowardshealthyeatingandactiveliving.

1NationalStrategicPlanforNon-CommunicableDisease(NSP-NCD)2010-2014.Availableathttp://www.moh.gov.my/index.php/pages/view/115

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2.2 ANALYSISOFTHEIMPLEMENTATIONOFNSP-NCD2010-2014

AnevaluationoftheNSP-NCD2010-2014wasconductedin2014and2015byanexternalconsultantthroughanApprovedProgramofWork(APW)undertheWorldHealthOrganisation(WHO)ProgramBudget2014-2015.2Thefirstpartoftheevaluationin2014wastodevelopthetoolsformonitoringandevaluation,andtoidentifytherequireddatasources.Alogicframeworkwasdevelopedaspartoftheprocess.Thesecondpartoftheevaluationin2015wastoincorporaterelevantdataintothetools.Insummary,theevaluationreportedunevenprogressinachievingthestatedobjectivesoftheNSP-NCD2010-2014.ASWOTanalysisisshowninTable2.1.LackofadditionalanddedicatedfundingfortheimplementationoftheNSP-NCD2010-2014mayalsohavebroughtaboutlimitedprogress.OnlyRM4millionwasapprovedunderMOHDasarBarufortheimplementationofactivitiesundertheNSP-NCD2010-2014.Thisadditionalnewfundingwasallocatedsolelyforanewcommunity-basedNCDriskfactorinterventioninitiativecalledMyNCDP-1M,theprecursortothecurrentKOSPENinitiative(seeSection5).Table2.1SWOTAnalysisofNSP-NCD2010-2014

Strength

a) TheNSP-NCDconsolidatesallprogramsonpreventionofNCDinonedocument.

b) Theunificationof“whole-of-government”andmulti-sectoralinvolvementofotheragenciesonpreventionofNCD.

c) ProvidestheoverallframeworkonstrategiestopreventNCDsinMalaysia.

Weakness

a) Lackofindicatorsandevaluationcriteria.

b) Nospecifictargetforeachstrategyoutlined.

c) Nospecificmeasurableachievementsineachstrategy.

Opportunity

a) Developmentofpublic-privatepartnerships.

b) DocumentrecognisedworldwideandsetasanexamplebyWHO.

c) ProvidedthemandatetoimplementpoliciesandprogramsrelatingtopreventionandcontrolofNCDs.

Threat

a) Lackofsupportfromotheragencies.

b) Politicalchangemayaffectthedirectionoftheoverallagenda.

2ThereportisavailableuponrequestfromtheNCDSection,DiseaseControlDivision,MOH

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2.3 BURDENOFNCDINMALAYSIA

NCDsarealreadythemaincauseofdeathinMalaysiaandthebiggestcontributorintermsofdisabilitylife-years(DALYs)3(Figure2.1)

Figure2.1DALYsattributabletoriskfactors,Malaysia2008

3NoorAzahD,MohdAzahadiO,UmmiNadiahY,TehChienHuey.2014.BurdenofDiseaseStudy:Estimatingmortality&causeofdeathinMalaysia.InstituteofPublicHealth

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TheoverallincreasingorhighprevalenceofNCDriskfactorswillfurtheraddtotheburdenofdiseaseofNCDsinMalaysia.Table2.2showsthetrendofselectedNCDriskfactorsforMalaysianadultsage18yearsandabovefrom2006to20154.Table2.2PrevalenceofselectedNCDriskfactorsinMalaysiaforadultsage18yearsandabove,2006to2015

NCDriskfactors 2006(%) 2011(%) 2015(%)

DiabetesMellitus 11.6 15.2 17.5

Hypertension 32.2 32.7 30.3

Hypercholesterolemia 28.2 43.9 47.7

Overweight 29.1 29.4 30.0

Obesity 14.0 15.1 17.7

PhysicalActivity 56.3 64.3 66.5

Smoking* 21.5 23.1 22.8

Alcohol(Currentdrinker) 11.4 11.6 7.7

*Note:Dataforpopulation15yearsandaboveMOHhasmadeprojectionsontheprevalenceofdiabetesinMalaysiabasedonavailabledatafirstlyin2006,andtheprojectionswerefurtherrevisedin2011and2015asdatafromtheNHMS2011andNHMS2016becameavailable.Figure2.2showsthateachrevisionoftheprojectionpushedtheestimatedprevalenceofdiabetesevenfurtherupwards.Itiscurrentlyestimatedthatbyyear2025,ourdiabetesprevalencewillbeabout31.3%foradultsage18yearsandabove,withanestimatedpopulationof7millionadultswithdiabetes(bothdiagnosedandundiagnosed).

4DatafromtheNationalHealthandMorbiditySurveys2006,2011and2016.Thefullreportsareavailableathttp://www.iku.gov.my/under“OurSurveys”

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Figure2.2ProjectionsontheprevalenceofdiabetesinMalaysiaforyear2025Theimpactofdiabetesonsocietyissubstantial.Thetrueeconomicburdenofdiabetesshouldincorporatenotjustthecosttothehealthcaresystembutalsoeconomiclossesduetolossofproductivityandeventhewellbeingofpatients.AlthoughMalaysiahasaparallelpublicandprivatesystem,themajorityoftreatmentforchronicdiseasesisprovidedbythepublichealthsystemthatisheavilysubsidisedbythegovernment.Thecostofdiabetestothenationissignificantandamacro-economicstudydonein2011showedthecostatapproximatelyRM2billion,potentiallyrepresenting13%ofthehealthcarebudgetfortheyear2011.Thisrepresentsthecostoftreatingdiabetesitselfandalsothatofitscomplications.ThesensitivityanalysisreflectsthatthisnationalcostcouldbeashighasRM3.52billion;oraslowasRM1.44billion.Ifsocietalcostswereincluded,thiscostwouldbeevenhigher.

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Table2.3showstheage-adjustedprevalenceofselectedNCDriskfactorsforthe10ASEANcountries.Japanwasincludedasacomparatorforadevelopedcountry.AsMalaysiaaspirestobeadevelopednationbyyear2020,ourhealthindicesforNCDriskfactorsunfortunatelyisstillfarbehindcomparedtoJapan.AmongtheASEANcountries,Malaysiahasthehighestprevalenceofdiabetesandobesity.Table2.3PrevalenceofselectedNCDriskfactorsforASEANcountriesandJapan5

HighBloodSugar(2014)

RaisedBlood

Pressure(2014)

RaisedTotalCholesterol

(2008)

Obesity(2014)

Smoking(2011)

PhysicalInactivity(2010)

MALAYSIA 9.9 22.1 15.4 13.3 21.9 52.3

Singapore 8.5 14.1 17.4 6.2 - 33.1

Thailand 9.7 21.3 16.7 8.5 23.5 14.8

Indonesia 8.7 23.3 7.7 5.7 34.9 23.7

Philippines 7.5 22.1 10.5 5.1 26.5 15.8

VietNam 6.5 22.2 8.2 3.6 23.1 23.9

Myanmar 7.1 23.7 6.4 2.9 22.0 9.9

Cambodia 8.2 24.4 5.8 3.2 21.8 10.3

Laos 8.6 24.1 6.7 3.5 25.7 10.3

Brunei 11.6 19.3 16.7 18.1 18.1 -

Japan 5.7 16.9 15.8 3.3 21.8 33.8

Note:Thedatadisplayedwerepercentageofage-adjustedprevalencerate(%)

5Global Status Report on Non-Communicable Diseases 2014, World Health Organization

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3. NSP-NCD2016-2025

3.1. BACKGROUND

Atthe65thWorldHealthAssemblyinMay2013,theAssemblyadoptedtheGlobalActionPlanforthePreventionandControlofNon-CommunicableDiseases(GAP-NCD)2013-2020.6Atthesamemeeting,theAssemblyalsoadoptedtheGlobalMonitoringFrameworkforNCD(GMF-NCD)with25indicatorsandninevoluntaryglobaltargets.7ThedevelopmentofthisdocumentreliesheavilyontheGAP-NCD2013-2020andadoptsthefollowingoverarchingprinciples:Ø Life-courseapproach

OpportunitiestopreventandcontrolNCDsoccuratmultiplestagesoflife;interventionsinearlylifeoftenofferthebestchanceforprimaryprevention.Policies,plansandservicesforthepreventionandcontrolofNCDsneedtotakeaccountofhealthandsocialneedsatallstagesofthelifecourse,startingwithmaternalhealth,includingpreconception,antenatalandpostnatalcare,maternalnutritionandreducingenvironmentalexposurestoriskfactors,andcontinuingthroughproperinfantfeedingpractices,includingpromotionofbreastfeedingandhealthpromotionforchildren,adolescentsandyouthfollowedbypromotionofahealthyworkinglife,healthyageingandcareforpeoplewithNCDsinlaterlife.

Ø Empowermentofpeopleandcommunities

PeopleandcommunitiesshouldbeempoweredandinvolvedinactivitiesforthepreventionandcontrolofNCDs,includingadvocacy,policy,planning,legislation,serviceprovision,monitoring,researchandevaluation.

Ø Evidence-basedstrategies

Strategies,programsandactivitiesforthepreventionandcontrolofNCDsneedtobebasedonlatestscientificevidenceand/orbestpractice,cost-effectiveness,affordabilityandpublichealthprinciples,takinglocalsocio-ethnic-culturalconsiderationsintoaccount.

Ø Multi-sectoralaction

ItshouldberecognisedthateffectiveNCDpreventionandcontrolrequireleadership,coordinatedmulti-stakeholderengagementforhealthbothatgovernmentlevelandatthelevelofawiderangeofstakeholders,withsuchengagementandactionincluding,

6http://www.who.int/nmh/events/ncd_action_plan/en/7http://www.who.int/nmh/global_monitoring_framework/en/

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asappropriate,health-in-allpoliciesandwhole-of-governmentapproachesacrosssectorssuchashealth,agriculture,communication,education,employment,energy,environment,finance,food,foreignaffairs,housing,justiceandsecurity,legislature,socialwelfare,socialandeconomicdevelopment,sports,taxandrevenue,tradeandindustry,transport,urbanplanningandyouthaffairsandpartnershipwithrelevantcivilsocietyandprivatesectorentities.

3.2. NCDTARGETSFORMALAYSIA

ThenationaltargetsforMalaysiabyyear2025areshowninTable3.1.Thiswasdevelopedbasedonthecomprehensiveglobalmonitoringframework,including25indicators,andasetofninevoluntaryglobaltargetsforthepreventionandcontrolofNCDs.8Table3.1NCDTargetsforMalaysia2025

Indicator Globaltarget

Malaysia

BaselineTarget(2025)

1. Riskofprematuremortalityfromcardiovasculardiseases,cancer,diabetes,orchronicrespiratorydiseases.

25%relativereduction

20% 15%

2. Prevalenceofcurrenttobaccouseinpersonaged15+years

30%relativereduction

23% 15%

3. Meanpopulationintakeofsodium 30%relativereduction

8.7gm 6.0gm

4. Prevalenceofinsufficientphysicalactivity 10%relativereduction

35.2% 30.0%

5. Harmfuluseofalcohol(prevalenceofHeavyEpisodicDrinking–HED)

10%relativereduction

≤1.2% ≤1.2%

6. Prevalenceofraisedbloodpressure 25%relativereduction

32.2% 26.0%

7 Prevalenceofdiabetesandobesity Halttherise ≤15% ≤15%

8GlobalActionPlanforthePreventionandControlofNCDs2013-2020;Appendix2,availableathttp://www.who.int/nmh/events/ncd_action_plan/en/

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MalaysiahasselectedsevenindicatorswithtargetsasthemajorNCDtargetsfortheNSP-NCD2017-2025,andthetargetshavebeensetinlinewithvoluntaryglobaltargets.Thebaselinedatawasdeterminedasfollows:

Ø Indicator1wasdeterminedbasedonWHOestimatesfor2010.9Ø Indicator2,4,5,6and7wasdeterminedfromtheresultsoftheNationalHealthand

MorbiditySurvey(NHMS)2011.10Ø Indicator3wasbasedonasurveyofaselectedpopulation(healthcareproviders)

using24-hoururineconductedin2011-2012.11

Thetargetsforyear2025wasdeterminedbasedontheglobaltargets;howeversomeofthenumbershavebeenadjusted(orroundedup)soastomakeiteasiertoberemembered.Indicatorsrelatingto“NationalSystemsResponse”toNCDshavenotbeenincludedbecauseingeneralthepopulationisnotfacedwithissuesonaccessibilityandavailabilityonfirstlineclinicalmanagementofNCDs.Malaysiaismorefocusedonissuesrelatingtodeliveryofqualityofcare.

3.3. OBJECTIVESOFNSP-NCD2016-2025

TheNSP-NCD2016-2025hasfivemainobjectives,basedontheGlobalActionPlanforthePreventionandControlofNCDs2013-2020:1. Tostrengthennationalcapacity,leadership,governance,multi-sectoralactionand

partnershipstoacceleratecountryresponseforthepreventionandcontrolofNCDs.2. ToreducemodifiableriskfactorsforNCDsandunderlyingsocialdeterminantsthrough

creationofhealth-promotingenvironments.3. TostrengthenandorienthealthsystemstoaddressthepreventionandcontrolofNCDs

andtheunderlyingsocialdeterminantsthroughpeople-centredprimaryhealthcareanduniversalhealthcoverage.

4. Topromoteandsupportnationalcapacityforhigh-qualityresearchanddevelopmentforthepreventionandcontrolofNCDs.

5. TomonitorthetrendsanddeterminantsofNCDsandevaluateprogressintheirpreventionandcontrol.

9GlobalStatusReportonNCD2014;reportavailableathttp://www.who.int/nmh/publications/ncd-status-report-2014/en/10NHMS2011;reportavailableathttp://www.iku.gov.my/under“OurSurveys”11Rashidahetal.2014.Sodiumintakeamongnormotensivehealthstaffassessedby24-hoururinaryexcretion:Across-sectionalstudy.MalJNutri.20(3):317-26

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4. OPERATIONALISINGNSP-NCD2016-2025

4.1. BACKGROUND

InoperationalisingtheearlierNSP-NCD2010-2014andfollowinguponearlieractivitiespriorto2010,severalspecific“ActionPlan”documentsandinitiativesrelatingtoNCDsandNCDriskfactorsweredevelopedandpublishedbyMOH.Anintegratedapproachisessentialforeffectiveimplementationoftheplan,andthereforetheNSP-NCD2016-2025willover-archthefollowingsevenactionsplansandinitiatives:

1. NationalStrategicPlanforTobaccoControl2015-20202. PolicyOptionstoCombatObesityinMalaysia2016-20253. SaltReductionStrategytoPreventandControlNCDForMalaysia2015-20204. NationalStrategicPlanforActiveLiving2016-20255. MalaysiaAlcoholControlActionPlan2013-20206. NationalStrategicPlanforCancerControlProgram2016-20207. StrengtheningChronicDiseaseManagementAtPrimaryCareLevelthroughthe

EnhancedPrimaryHealthCare(EnPHC)initiative

SpecificallytoPolicyOptionstoCombatObesityinMalaysia2016-2025,theactivitiesareinlinewiththeNationalPlanofActionforNutritionofMalaysia(NPANM)III2016-202512,a10-yearplantoaddressfoodandnutritionchallengesinthecountryusingtrans-andmulti-sectoralapproaches.ThetargetsandstrategiesofNPANMIIIareinaccordancetointernationaltargets,suchasGlobalNutritionTarget2025andvariousplansofactionandframeworkatinternationalandlocallevel.NPANMIIIunderlinestheimportanceofnutritioninenhancingpopulationhealth,preventingandcontrollingdiet-relateddiseasesandstrengtheningfoodandnutritionsecurity.OneofthethreemainobjectivesofNPANMIIIistoreducedietrelatedNCDs,throughanEnablingStrategycalledpreventingandcontrollingobesityanddiet-relatedNCDs.ImplementationoftheactivitiesunderNPANMIIIisspearheadedbyMOHunderthepurviewoftheNationalCoordinatingCommitteeofFoodandNutrition(NCCFN)andalsotheFoodSafetyandNutritionCouncil.Themembersofthesecommitteesarerepresentativesfromrelevantministriesandgovernmentagencies,researchinstitutions,academia,professionalbodies,non-governmentorganisationsandfoodindustries.

12nutrition.moh.gov.my/wp-content/uploads/2016/12/NPANM_III.pdf

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4.2. SUMMARYOFACTIONPLANANDINITIATIVES

4.2.1. NationalStrategicPlanforTobaccoControl2015-2020

AsamembertotheFrameworkConventiononTobaccoControl(FCTC),theNationalStrategicPlanforTobaccoControlhasbeendevelopedtoensurethesmokingissueendswithasmokingprevalencetargetoflessthan5%andisknownastheendofthegame(TheEndGame).Itisinlinewiththecountry'scommitmenttotheFCTC’streatysince2005andtoensurethecountry'sdesiretoachievetheGlobalNCDtargetsby2025andtheEndGame.ThisplanoutlinesthestrategiesaccordingtoMPOWERbyWHO;Monitortobaccouseandpreventionpolicies,Protectpeoplefromtobaccosmoke,Offerhelptoquittobaccouse,Warnaboutthedangersoftobacco,Enforcebansontobaccoadvertising,promotionandsponsorshipandRaisetaxesontobacco.Itdenotestheactiveinvolvementofinter-ministriesandmulti-sectoralinachievingthetarget:ASmokeFreeGeneration.Thedocumentisavailableatwww.moh.gov.my/index.php/pages/view/115.

4.2.2. PolicyOptionstoCombatObesityinMalaysia2016-2025

TheriseintheprevalenceofobesityinthecommunitycallsforimmediateactionstocombatobesityinMalaysia.In2014,theMinisterofHealthrequestedtheformationofanational-leveltaskforce.ThistaskforcewaschairedbytheDeputyDirectorGeneralofHealth(PublicHealth)MOHandmemberscomprisedofvariousexpertsfromthegovernment,universities,professionalbodiesandNGOs.ThisdocumentsoutlinestheprioritiesofthepotentialpolicyoptionstoaddressobesityinMalaysia.Basedonaprioritisationandfeasibilityexercise,thedocumentlists48policyoptionsacrossthreesettings:(i)schools:7policies;(ii)higherlearning&workplace:11policies;and(iii)generalsetting:30policies.Asstatedearlier,thepolicyoptionsareinlinewithNationalPlanofActionforNutritionofMalaysia(NPANM)III2016-202513.FurtherinformationcanbeobtainedfromtheNutritionDivisionMOH.

4.2.3. SaltReductionStrategytoPreventandControlNCDForMalaysia2015-2020

Saltreductionstrategyisthesimplestandmostcosteffectivemeasureforreducingcardiovasculardiseasesbecauseofitshighimpactonhealth,highfeasibilityandlowimplementationcosts.Withoutstrategicinterventionstoreducesaltintake,wewilllikelyseeanincreaseintheprevalenceofhypertensionandpotentiallymorefatalitiesresulting

13nutrition.moh.gov.my/wp-content/uploads/2016/12/NPANM_III.pdf

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fromcardiovasculardiseases.BasedonMalaysia’slatestburdenofdiseasestudy,highbloodpressureisestimatedtocontributeto42.2%ofdeathsand21.6%ofdisabilityadjustedlifeyears(DALY),thelargestcontributorforbothmenandwomen.ThegeneralobjectiveofthisSaltReductionStrategyistopromote,educateandcollaboratewithallrelatedstakeholderstoreducesaltintakeamongtheMalaysianpopulation,workingtowardsachievingthe30%reductionoftheaveragesaltintake(from8.7g/dayto6.0g/day)oftheadultpopulationbyyear2025.Basedonthemajorsourcesofsalt/sodiuminMalaysia,modificationofthepopulation’sbehaviourwouldhavethebiggestimpact,butunfortunatelytheinterventionswouldbethemostchallenging.ThroughtheM-A-Pstrategies(Monitoring-Awareness-Product),Malaysiahopestobuilduponexistingworkinamoresystematicmannertostrengthencurrentinterventions.Thedocumentisavailableatwww.moh.gov.my/index.php/pages/view/115.

4.2.4. NationalStrategicPlanforActiveLiving2016-2025

TheNationalStrategicPlanforActiveLiving(NASPAL)isexpectedtointensifythecontinuityandstructureofNCDpreventionandcontrolprogramsandactivitiesinMalaysia.NASPALprovidesamoreholisticapproachinthephysicalactivitypromotionprogramsandactivitiesgiventhatNASPALoutlinesstrategiesnotonlyforgovernmentandhealthsectorsbutalsoincollaborationofnon-governmentandnon-healthsectors.PublichealthconceptsparticularlyfromtheworkofWHOhavebeenadoptedandutilisedintheformulationofNASPAL.NASPALcontainssixkeythrustsincreatingahealthyandactivecommunity:

(1) Tostrengthenpublicpoliciesthatsupportactiveliving(2) Toexpandappropriateenvironments(3) Toincreasepublicmotivationandunderstandingthroughpubliceducation(4) Tointensifybehaviorchangeprograms(5) Toenhancepartnerships&collaboration(6) Tostrengthenevaluation,monitoring&research

Thesixkeythrustswillfocusonstrategiesinvolvingmulti-sectorssuchasFederalGovernment,corporate/businessindustries,learninginstitutions,transportation,healthsectorsaswellasmedia.Theevidence-basedstrategiesareoutlinedtopromotephysicalactivitythroughimplementationandmonitoringinamoreefficientmannerinfourkeysettings:education,community,workplaceandhealthcare.Thedocumentisavailableatwww.moh.gov.my/index.php/pages/view/115.

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4.2.5. NationalActionPlan:PreventionandHarmfulUseofAlcohol2013-2020

ThemainobjectiveofthisNationalActionPlan:PreventionandHarmReductionofAlcoholism(PeTA)2013-2020istoraisepublicawarenessabouttheharmofalcohol,toberesponsiblefortheirownhealth,andtopreventandreduceharmfuluseofalcohol.PeTAstrategiesarebasedonpublichealthprinciples:

(1) Strengtheninghealthcampaigns"healthywithoutalcohol"(2) Reducingtheriskofharmfuluseofalcohol(3) Reducingtheimpactofharmfuluseofalcohol(4) Limitingtheavailabilityofalcoholicbeverages(5) Sustainabilityofthepreventionandharmfuluseofalcoholprograms

Thedocumentisavailableatwww.moh.gov.my/index.php/pages/view/115.

4.2.6. NationalStrategicPlanforCancerControlProgram2016-2020

TheNationalStrategicPlanforCancerControlProgramme(NSPCCP)2016-2020aimstoreducethenegativeimpactofcancerbydecreasingthemorbidity,mortalityandtoimprovethequalityoflifeofcancerpatientsandtheirfamilies.TheNSPCCPhasidentifiednineareasoffocus,wheretheirrespectiveobjectives,targetsandstrategicactionessentialforinstitutingtotalcancercareinthecountrytill2020.TheNSPCCPaddressedthecancercareandmanagementfromaholisticviewpointthatspansacrossprimaryprevention,screening,earlydetection,diagnosis,treatment,rehabilitation,palliativecareaswellastraditionalandcomplementarymedicine(T&CM)andresearch.TheNSPCCPcallsforthesupportandcommitmentfromallstakeholders,strengtheningofexistingnetworksandbettercollaborationbetweenthepublicandprivatesectoragencies,andinparticular,privatecancercenters,professionalbodiesandNGOstoaddresscancerburdenandmanagementissuesinthecountry.ContinuousmonitoringandevaluationofthevariousinitiativesisveryimportantinensuringthesuccessfulimplementationoftheNSPCCP2016-2020.Thedocumentisavailableatwww.moh.gov.my/index.php/pages/view/115.

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4.2.7. StrengtheningChronicDiseaseManagementAtPrimaryCareLevelthroughtheEnhancedPrimaryHealthCare(EnPHC)initiative

TheproposedEnPHCmodelfocusesinitiallyonimprovingthemanagementofthreemajorNCDsthatcontributetoaveryhighburdenofdiseaseandprematuremortalityinMalaysia,highbloodpressure,Type2diabetesmellitus,andischemicheartdisease,andtheirriskfactors.Initialintroductionwillbefollowedbyarapidscale-upoftheEnPHCmodelintermsofdiseasesmanagedandnumberofpublicandprivateprimaryhealthcentersimplementingthenewcaremodel.EnPHCwill involvethedevelopmentofanewcaremodelintensivelytargetingthesethreeNCDsandriskfactorsthroughsixmajorinterlinkedcomponents:

(1) populationenrollment(2) riskprofiling(3) integrated care pathways for a cardiovascular care bundle, underpinned by digital

healthinformationtechnology(4) ClinicalandPrescribingAudit(5) informationsystems,analytics,andmonitoring(6) organisationalchange–includingthedevelopmentofFamilyHealthTeams

FurtherinformationcanbeobtainedfromtheFamilyHealthDevelopmentDivisionMOH.

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4.3. MAINACTIVITIESUNDEREACHOBJECTIVEOFNSP-NCD2016-2025

4.3.1. Objective1:Tostrengthennationalcapacity,leadership,governance,multi-sectoralactionandpartnershipstoacceleratecountryresponseforthepreventionandcontrolofNCDs

(1) Enhancegovernance(2) Mobilisesustainedresourcesincoordinationwithrelevantministriesand

organisations(3) StrengthenNationalNCDProgrammes(4) Conductneedsassessmentandevaluation(5) Strengthenmulti-sectoralaction(6) Improveaccountability(7) Strengtheninstitutionalcapacityandtheworkforce(8) Forgepartnerships(9) Empowercommunitiesandpeople,throughtheKOSPENprogram(seeSection5)

4.3.2. Objective2:ToreducemodifiableriskfactorsforNCDsandunderlyingsocialdeterminantsthroughcreationofhealth-promotingenvironments

(1) Implementationofactivitiesunderthe:(a) NationalStrategicPlanforTobaccoControl2015-2020(b) PolicyOptionstoCombatObesityinMalaysia2016-2025(c) SaltReductionStrategytoPreventandControlNCDForMalaysia2015-2020(d) NationalStrategicPlanforActiveLiving2016-2025(e) MalaysiaAlcoholControlActionPlan2013-2020

(2) ImplementationofrelevantactivitiesundertheNationalPlanofActionforNutritionofMalaysia(NPANM)III2016-2025

4.3.3. Objective3:TostrengthenandorienthealthsystemstoaddressthepreventionandcontrolofNCDsandtheunderlyingsocialdeterminantsthroughpeople-centredprimaryhealthcareanduniversalhealthcoverage

(1) ImplementationoftheEnhancedPrimaryHealthCare(EnPHC)initiative(2) ImplementationofactivitiesundertheNationalStrategicPlanforCancerControl

Program2016-2020

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4.3.4. Objective4:Topromoteandsupportnationalcapacityforhigh-qualityresearchanddevelopmentforthepreventionandcontrolofNCDs

(1) Investmentinresearch(2) Capacitystrengtheninginresearchanddevelopment(3) Evidencetoinformpolicy(4) Accountabilityforprogressinresearch

4.3.5. Objective5:TomonitorthetrendsanddeterminantsofNCDsandevaluateprogressintheirpreventionandcontrol

(1) Monitoring(2) Diseaseregistries(3) Surveillance(4) Capacitystrengtheninginsurveillanceandmonitoring(5) Disseminationanduseofresults

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5. EMPOWERINGMALAYSIANSTHROUGHKOSPEN

5.1. BACKGROUND

ThebrainchildofDatukSeriDrS.Subramaniam,theHealthMinisterofMalaysia,thisMOHflagshipinitiativeisanNCDriskfactorcommunity-basedinterventionprogramdevelopedinresponsetotheincreasingprevalenceofNCDriskfactors,particularlyonthehighproportionofthoseundiagnosed.ThereisastrongneedtoempowertheMalaysianpopulationtotakemoreresponsibilityontheirownhealthstatus.KnownasKOmunitiSihatPErkasaNegara(orKOSPEN),theprogramaimsatbringingtheNCDriskfactorinterventionstothecommunitylevelbycreatingtrainedhealthvolunteers,whowillfunctionas“agentsofchange”orhealthenablers,whowillintroduceandfacilitatehealthylivingpracticesamongsttheirrespectivecommunity.ThemainobjectivesofKOSPENaretoempowerthecommunityinadoptingandpracticinghealthylifestylesandenhancetheirparticipationandinvolvementinprogramsaimingatpreventingandcontrollingNCDinMalaysia.KOSPENhasfivemainscopes,promoting:

(1) healthydiet(2) activeliving(3) smoke-free(4) weightmanagement(5) routinecommunityNCDriskfactorscreening.

Launchedin2014,theMinistryofHealth(MOH)iscurrentlycollaboratingwiththeMinistryofRuralandRegionalDevelopment(throughtheDepartmentofCommunityDevelopmentorKEMAS)inimplementingKOSPENinruralareas,andcollaboratingwiththeDepartmentofNationalUnityandIntegration(throughRukunTetangga)forurbanandsub-urbanareas.Agroupofhealthvolunteerswithintheidentifiedresidencesorcommunityregisteredunderbothcollaboratingagenciesareprovidedwithtrainingthatwillenablethemtopromotehealthybehaviours,advocateforhealthypolicyadoptionandfacilitateenvironmentalchangeswithinthelocalcommunitythatsupporthealthypractices.Thesetrainedvolunteersarealsocapableofconductingbasichealthscreeningconsistingofmeasuringbloodpressure,bloodglucoselevelsandbodymassindex(BMI).Thevolunteersalsoconductsemi-structuredinterventions,andthoseofhighriskwouldbereferredtonearbyhealthclinicsforfurtherinvestigationandmanagement.

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5.2. EVALUATIONOFPHASE1IMPLEMENTATION

MOHhaveconductedanevaluationoftheeffectivenessofimplementationofKOSPENPrograminMalaysia:Phase114.ThestudyrevealedthatmostimplementerswereawareoftheirroleinimplementingtheKOSPENprogramandunderstoodtheobjectivesoftheprogram.Morethan90%ofimplementersperceivedKOSPENasagoodcommunityinterventionprogram.However,implementationwise,inadequatefunding,trainingandquantityofscreeningequipmentwereissueshighlightedbytheimplementers.ThemajorityofthevolunteershadpositiveperceptionofKOSPEN.MostofthemwereawareoftheirrolesandfunctionsinimplementingKOSPENprogram.AlmostallofthevolunteersknewoftheirresponsibilitiesinconductinghealthscreeningamongthecommunityandtoreferthosewithriskofNCDstothenearesthealthclinic.Apartfromthescreening,thevolunteersalsoknewoftheirroleinadvocatingthecommunitytoparticipateinhealthylifestylesactivities.AlmosttwothirdsofthecommunitiesfromthestudyareawereawareoftheexistenceoftheKOSPENprogram,inwhichmajorityofthemunderstoodthathealthscreening,physicalactivityandnon-smokingwerethecoreactivitiesofKOSPEN.Allofthemhadpositiveperceptionsabouttheprogramanditsbasicelementsandtheyagreedwiththepracticeofdrinkingplainwaterandconsumingmorefruitsandvegetables.Nevertheless,only45.2%ofthemparticipatedinKOSPENactivitiesand41.1%reporteddifficultiesinparticipatingduetotimeconstraints.

5.3. STATUSOFIMPLEMENTATION

AsofDecember2016,5,900KOSPENlocalitiesorsiteshavebeenestablishedthroughoutMalaysia,withmorethan36,000volunteerstrained.Withinthelocalities,almost400,000adultresidentshavebeenscreenedforNCDriskfactors;about75%havebeenreferredfordiabetesconfirmatorytests,35%forhypertensionand9%duetoobesityclass2(BMI≥35kg/m²)Todate,KOSPENvolunteershaveconductedweightmanagementprogramsin200KOSPENlocalities.Initialanalysisindicatesthat90%oftheprogramshadsuccessfullyachieveditstargets.In2017,furtherworkwillbeputintofurtherstrengthentheNCDriskfactorinterventioncomponentsaswellasexploringoptionsinensuringthesustainabilityoftheKOSPENprogram.Inaddition,2017willseetheimplementationofKOSPEN-plus,aworkplace-basedNCDriskfactorinterventionprogram.

14LimKH,MFadhliY,OmarM,RosnahR,M.NazaruddinB,SumarniMGetal.TechnicalReport:EvaluationofeffectivenessofimplementationofKOSPENprogrammeinMalaysia:Phase1

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6. MONITORINGANDEVALUATION

6.1. GLOBALLEVEL

FollowingthePoliticalDeclarationonNCDsadoptedbytheUNGeneralAssembly(UNGA)in2011,WHOdevelopedaglobalmonitoringframeworktoenableglobaltrackingofprogressinpreventingandcontrollingmajorNCDsandtheirkeyriskfactors.Theframeworkcomprisesnineglobaltargetsand25indicators,adoptedbytheWorldHealthAssemblyinMay2013.SeveraloftheseindicatorshavealsobeenincorporatedintotheSustainableDevelopmentGoals(SDGs)underStrategy#3:GoodHealthandWell-being.ItisbasedonthisglobaltargetthatMalaysiahassetherowntargetsasshowninTable3.1(Section3.2).Inaddition,severaltime-boundindicatorswerealsoagreeduponduringtheNCDUNGAfollow-upmeetingin201415.WHOalsoconductsperiodicassessmentofnationalcapacityforNCDpreventionandcontrolthroughtheuseofaglobalsurveytoallMemberStatesknownastheNCDCountryCapacitySurvey(NCDCCS)16.SuchperiodicassessmentallowscountriesandWHOtomonitorprogressandachievementsinexpandingcapacitiestorespondtotheepidemicofNCDs.Thequestionnaire,whichcoversthefollowingtopics:healthsysteminfrastructure;funding;policies,plansandstrategies;surveillance;primaryhealthcare;andpartnershipsandmultilateralcollaboration,iscompletedbynationalNCDfocalpoints.NCDCCShavebeencarriedoutin2000,2005,2010,2013and2015.

6.2. NATIONALLEVEL

Twointer-agencycommitteeshavebeencreatedtosupporttheworkofthe“CabinetCommitteeforAHealthPromotingEnvironment”chairedbytheDeputyPrimeMinister.ThemembershipsofthesetwocommitteesmirrorthemembershipoftheCabinetlevelcommittee.

(1) “Inter-AgencySteeringCommitteeforaHealthPromotingEnvironmentandHealthyLifestyle”chairedtheSecretaryGeneraloftheMinistryofHealth.ThemaintermsofreferencefortheSteeringCommitteeistoprovideguidanceonstrategicplanningandimplementationofpoliciesandinitiativestoreducetheburdenofNCDinMalaysia.

15http://www.who.int/nmh/events/2014/a-res-68-300.pdf16http://www.who.int/chp/ncd_capacity/en/

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(2) “Inter-AgencyTechnicalCommitteeforaHealthPromotingEnvironmentandHealthyLifestyle”chairedbytheDeputyDirectorGeneralofHealth(PublicHealth),MinistryofHealth.ThemaintermsofreferencefortheTechnicalCommitteeistoprovidetechnicalinputonstrategicplanningofpoliciesandinitiatives,coordinateimplementationandmonitortheprogressofplanningandimplementationofpoliciesandinitiativestoreducetheburdenofNCDsinMalaysia.

AttheMOHlevel,the“PublicHealthSteeringCommitteeforNon-CommunicableDiseases”(JawatankuasaPemanduKesihatanAwamuntukPenyakitNCD–JKPKA-NCD)chairedbytheDeputyDirectorGeneralofHealth(PublicHealth)MOH,coordinatesandmonitorstheimplementationoftheagreedpoliciesandinitiatives.FortheotherMinistriesinvolved,theyeitherhavespecificCommitteesoruseexistingCommitteestocoordinateandmonitorimplementationattheirrespectiveMinistries.SpecialarrangementshavebeenmadetoincludearepresentativefromMOHtobeamemberofthesespecificorexistingCommittees.

6.3. NATIONALINDICATORSANDTARGETS

Asindicatedearlier,theNationaloutcomeindicatorsandtargetsareshowninTable3.1(Section3.2).MostofthemechanismsforsurveillancearecurrentlyinplaceandsomearebeingstrengthenedtoenableMalaysiatohavemoreaccuratedata.MOHiscurrentlyfinalisingaverbalautopsymethodologytoimprovetheaccuracyofdataoncauseofdeathinMalaysia,plannedfornationwideimplementationbyendof2017.Forindicatorsontobaccouse,physicalinactivity,harmfuluseofalcohol,raisedbloodpressure,diabetesandobesity,thedatawillbefromtheNationalHealthandMorbiditySurvey(NHMS)forNCDriskfactors,tobeconductedeveryfouryearsstartingfrom2011.Thenextsurveyswillbeinyear2019and2023.Formeanpopulationintakeofsodium,MOHwillembarkonapopulation-basedsurveyin2017using24-hoururinecollectiontohaveamoreaccuratepictureofthesodiuminMalaysia.

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Asmentionedearlier,NSP-NCD2016-2025willbeinline,includesorover-achesseveralotherrelevantactionplansandinitiatives:

1. NationalPlanofActionforNutritionofMalaysia(NPANM)III2016-20252. NationalStrategicPlanforTobaccoControl2015-20203. PolicyOptionstoCombatObesityinMalaysia2016-20254. SaltReductionStrategytoPreventandControlNCDForMalaysia2015-20205. NationalStrategicPlanforActiveLiving2016-20256. MalaysiaAlcoholControlActionPlan2013-20207. NationalStrategicPlanforCancerControlProgram2016-20208. StrengtheningChronicDiseaseManagementAtPrimaryCareLevelthroughthe

EnhancedPrimaryHealthCare(EnPHC)initiative9. KOmunitiSihatPErkasaNegara(KOSPEN)initiative

Eachoftheaboveactionplansandinitiativeshastheirownrespectivesetofindicatorsandtargetsoveraspecifiedtime-frame.Theseprocess,outputsandshort-termoutcomeindicatorswillbeusedtomonitortheprogressofNSP-NCD2016-2025.Atthebeginningofeachyear,afewselectedkeyindicatorswillbeselectedfromalloftheaboveactionplansandinitiativestobemonitoredattheendoftheyear.

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7. CONCLUSIONMostoftheprematuredeathsduetoNon-CommunicableDiseases(NCDs)arelargelypreventablebyinfluencingpublicpoliciesinsectorsoutsideofhealththattacklethesharedriskfactors,namelytobaccouse,unhealthydiet,physicalinactivityandharmfuluseofalcohol.NCDsarenotwell-studiedandunderstood.Manystudieshavebeenpublishedontheimpactofvariouspopulation-basedinterventionstoreducetheburdenofNCDsinmanycountries.Inaddition,manycasestudieshavebeenpublishedthatdemonstratestheeffectivenessvariousinterventionstoreducetheexposureofpopulationstoNCDriskfactors.ThemaingoaloftheNSP-NCD2016-2025istoprovidearoadmapforallrelevantstakeholdersinMalaysiatoreducethepreventableandavoidableburdenofmorbidity,mortalityanddisabilityduetoNCDsbyyear2025.Thiscanbeachievedbymeansofmulti-sectoralcollaborationandcooperationatnationalandstatelevels.ItishopedthatourpopulationwouldreachthehighestattainablestandardsofhealthandproductivityateveryageandNCDsarenolongerabarriertoourwell-beingandnegativelyimpactsMalaysia’ssocio-economicdevelopment.