1) Non-communicable diseases (NCDs) like diabetes and hypertension are increasing in Malaysia, with over 50% of cases being undiagnosed and placing a large burden on the country's health system. 2) KOSPEN is Malaysia's community-based intervention program aimed at empowering communities to prevent and control NCDs and their risk factors. It uses health volunteers to promote healthy behaviors and screen for early detection of NCD risk factors. 3) The challenges of KOSPEN implementation include increasing community prioritization of health, motivating volunteers, and ensuring adequate support from the health sector and collaborating agencies for large-scale nationwide implementation.

1. KOSPEN
challenges in empowering the
community
DR ROSNAH RAMLY
PUBLIC HEALTH PHYSICIAN AND SENIOR PRINCIPAL ASSISTANT
DIRECTOR (KOSPEN)
MINISTRY OF HEALTH

2. Increasing Burden of Non-
Communicable Diseases

3. • 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 OF
HIPERTENSION
2011 - 2015
UndiagnosedDiagnosed

4. ≥ 18 tahun
NHMS (1996) NHMS (2006) NHMS (2011) NHMS (2015)
Age Group ≥ 18 tahun ≥ 18 tahun ≥ 18 tahun ≥ 18 tahun
Overweight
and Obesity
21.0% 43.1% 44.5% 47.7%
Diabetes 8.3% 11.6% 15.2% 17.5%
Undiagnosed
DM
1.8% 4.5% 8.0% 9.2%
Hypertension 29.9% 32.2% 32.7% 30.3%
Undiagnosed
HPT
NA NA 19.8% 17.2%
Smoking 24.8% 21.5% 23.1%
(GATS 2011)
22.8%
OUR NCD STATUS?
drrosnah.ramly@moh.gov.my

5. 11.6
15.2
17.5
7.0 7.2
8.3
4.5
8.0
9.2
4.2
4.9 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
Prevalence(%)
Prevalence of Diabetes, ≥18 years
(NHMS 2006, 2011, 2015)
Total diabetes Known Undiagnosed IFG
drrosnah.ramly@moh.gov.my

6. 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
Prevalence(%)
Prevalence of Hypertension, ≥18 years
NHMS 2006, 2011, 2015
Total HPT
Known
Undiagnosed
drrosnah.ramly@moh.gov.my

7. Prevalence of obesity and overweight, ≥18 years
(NHMS 1996, 2006, 2011,2015)
4.5
14 15.1
17.7
16.6
29.1 29.4
30
0
5
10
15
20
25
30
35
1996 2006 2011 2015
Prevalence(%)
obesity
overweight
drrosnah.ramly@moh.gov.my

8. 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
National
Prevalence
Male Female Non-smoking
1996 2006 2011 2015
%
drrosnah.ramly@moh.gov.my

9. - 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
drrosnah.ramly@moh.gov.my

10. - 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
drrosnah.ramly@moh.gov.my

11.  Health promotion and education will increase
awareness and knowledge
 However changes in behaviour is strongly influenced by
our living environment
Awareness Knowledge
Behavioural
Change
Supportive living
environment
Health promotion & educations
OUR CHALLENGES
drrosnah.ramly@moh.gov.my

12. Personal Choice is Important
drrosnah.ramly@moh.gov.my

13. BUT …
If we want people to make healthy choices we
have to make healthy choices available,
accessible and affordable
drrosnah.ramly@moh.gov.my

14. KOSPEN
Empowering Communities,
Strengthening the Nation
A Community-Based Intervention for NCD
Risk Factors
drrosnah.ramly@moh.gov.my

15. - 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
drrosnah.ramly@moh.gov.my

16. 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
drrosnah.ramly@moh.gov.my

17. • 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
drrosnah.ramly@moh.gov.my

18. • 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
drrosnah.ramly@moh.gov.my

19. • Bringing the NCD prevention and control program to the
community by:
Establishing Health Volunteers
Strategic collaboration with agencies that have established
community organizations/program/networkings (KEMAS dan
Rukun 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
drrosnah.ramly@moh.gov.my

20. 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 members
as agent of change
Target:
10,000 KOSPEN by
localities with 50,000
trained volunteers by
2022
Basic concept of KOSPEN
drrosnah.ramly@moh.gov.my

21. • 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
drrosnah.ramly@moh.gov.my

22. Increasing awareness &
knowledge
Health Policy adoption
and Health-promoting
environment
Translation of knowledge into
sustainable actions
Implementation Strategies
1. Healthy eating
2. Active living
3. Smoke-free
4. Weight
management
5. Early detection of
NCD risk factors
The Scopes
22drrosnah.ramly@moh.gov.my

23. • 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
drrosnah.ramly@moh.gov.my

24. BY YEAR 2022
• 10,000 KOSPEN localities
• 50,000 volunteers trained
• 1.5 adults screened by 2022
TARGETS
drrosnah.ramly@moh.gov.my

25. 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)
drrosnah.ramly@moh.gov.my

26. 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.
drrosnah.ramly@moh.gov.my

27. CURRENT STATUS
drrosnah.ramly@moh.gov.my

28. 70 % for Diabetic confirmatory test
36.2% BP ≥ 140/90mmHg
6.5 % for BMI ≥35kg/m²
REFERRALS
drrosnah.ramly@moh.gov.my

29. TARGETS 2022
drrosnah.ramly@moh.gov.my

30. drrosnah.ramly@moh.gov.my
30
KOSPEN LOCALITIES

31. drrosnah.ramly@moh.gov.my
31
IEC MATERIALS

32. Healthy
Eating
Separation of
sugare from hot
drinks
Eating fruits
and vegetables
Drinking plain
water
Food
Callorie
information
32
drrosnah.ramly@moh.gov.my

33. Active
Life
Style
Establishment
of 10,000 steps
trek
Regular Physical
Program
33
drrosnah.ramly@moh.gov.my

34. Weight
Management
BMI
Measurement
Corner
34
Weight
Management
Program
drrosnah.ramly@moh.gov.my

35. drrosnah.ramly@moh.gov.my
Screening equipments
• Glucostrip dan Glucometer
• Digital BP measurement set
• Stadiometer dan weighing machine
• Health Diary
SCREENING EQUIPMENTS

36. drrosnah.ramly@moh.gov.my
36
KOSPEN SCREENING CENTER

37. drrosnah.ramly@moh.gov.my
37
HOME-BASED SCREENING

38. REFERRALS CRITERIA
 RBS ≥ 5.6mmol/L
 BP Sistolic ≥ 140 and/or
Diatolic ≥190mmHg
 BMI ≥ 35kg/m²
REFERRALS OF RISK CASES
drrosnah.ramly@moh.gov.my

39.  MOVeS KOSPEN
 Online system
 Data entry by the volunteers
drrosnah.ramly@moh.gov.my
39
MONITORING SYSTEM

40. 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
drrosnah.ramly@moh.gov.my

41. Source of icons: World Heart Federation Champion Advocates Programme
Global NCD
Targets
20%15
%
22.8%15%
HED* <1.2%
33.5%30.0%
8.76.0gm
30.3%24.0%
17.5%  <15.0%
Targets for
Malaysia
* Heavy episodic
drinking
41

42. Thank you for your kind attention