kospen: challenges in empowering the community
TRANSCRIPT
![Page 1: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/1.jpg)
KOSPENchallenges in empowering the
community
DR ROSNAH RAMLY
PUBLIC HEALTH PHYSICIAN AND SENIOR PRINCIPAL ASSISTANT DIRECTOR (KOSPEN)
MINISTRY OF HEALTH
![Page 2: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/2.jpg)
Increasing Burden of Non-Communicable Diseases
![Page 3: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/3.jpg)
• 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
![Page 4: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/4.jpg)
≥ 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?
![Page 5: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/5.jpg)
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
![Page 6: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/6.jpg)
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
![Page 7: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/7.jpg)
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
![Page 8: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/8.jpg)
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
%
![Page 9: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/9.jpg)
- 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
![Page 10: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/10.jpg)
- 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
![Page 11: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/11.jpg)
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
![Page 13: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/13.jpg)
BUT … If we want people to make healthy choices we have to make healthy choices available, accessible and affordable
![Page 14: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/14.jpg)
KOSPENEmpowering Communities, Strengthening the Nation
A Community-Based Intervention for NCD Risk Factors
![Page 15: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/15.jpg)
- 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
![Page 16: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/16.jpg)
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
![Page 17: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/17.jpg)
• 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
![Page 18: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/18.jpg)
• 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
![Page 19: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/19.jpg)
• 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
![Page 20: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/20.jpg)
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
![Page 21: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/21.jpg)
• 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
![Page 22: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/22.jpg)
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
![Page 23: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/23.jpg)
• 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
![Page 24: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/24.jpg)
BY YEAR 2022
• 10,000 KOSPEN localities• 50,000 volunteers trained• 1.5 adults screened by 2022
TARGETS
![Page 25: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/25.jpg)
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)
![Page 26: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/26.jpg)
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.
![Page 28: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/28.jpg)
70 % for Diabetic confirmatory test
36.2% BP ≥ 140/90mmHg
6.5 % for BMI ≥35kg/m²
REFERRALS
![Page 32: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/32.jpg)
Healthy Eating
Separation of sugare from hot
drinks
Eating fruits and vegetables
Drinking plain water
Food Callorie
information
32
![Page 35: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/35.jpg)
Screening equipments• Glucostrip dan Glucometer• Digital BP measurement set• Stadiometer dan weighing machine• Health Diary
SCREENING EQUIPMENTS
![Page 38: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/38.jpg)
REFERRALS CRITERIA
RBS ≥ 5.6mmol/L
BP Sistolic ≥ 140 and/or Diatolic ≥190mmHg
BMI ≥ 35kg/m²
REFERRALS OF RISK CASES
![Page 40: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/40.jpg)
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
![Page 41: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/41.jpg)
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
41
![Page 42: KOSPEN: Challenges in empowering the community](https://reader030.vdocuments.us/reader030/viewer/2022021507/587bbd021a28abb8258b6a89/html5/thumbnails/42.jpg)
Thank you for your kind attention