The document discusses non-communicable diseases (NCDs) planning in Malaysia and opportunities for stroke prevention. It summarizes the 2014 UN General Assembly outcome document on NCDs which outlines national commitments and global assignments between 2014-2018. These include setting national NCD targets and developing multisectoral policies and plans. It also discusses Malaysia's national strategic plan for NCDs from 2010-2014 and efforts to strengthen chronic disease management at the primary care level through multidisciplinary care teams and clinical practice guidelines. Availability of essential medicines for NCDs and lessons learned from working with other sectors are also covered.

1. Ministry of Health
Malaysia
NCD Planning:
Current Status & Opportunities
for Stroke
Feisul Idzwan Mustapha MBBS, MPH, AM(M)
Public Health Physician, NCD Section, Disease Control Division
Ministry of Health, Malaysia
Asia Pacific Meeting
18 October 2014
Kuala Lumpur
dr.feisul@moh.gov.my

2. Outcome Document of the 2014 UN
General Assembly High-level Meeting
on NCDs
First High-level Meeting on NCDs (New York,
19-20 September 2011)
2011
Second high-level Meeting on NCDs (New York, 10-11
July 2014) to take stock of the progress made since
2011
2014
Third High-level Meeting on NCDs
to report on progress achieved
since 2014
2018
2

3. 2014 UN Outcome Document on NCDs
(resolution A/RES/68/300)
• Bottom line:
Governments committed themselves to
intensify their efforts towards a world free of
the avoidable burden of NCDs
• Moving forward:
Maps out a set of concrete national
commitments to be implemented between
2014 and 2018, and
provides 3 new global assignments
• Towards the world we want:
Next milestone in 2018
3

4. National commitments included in the
2014 UN Outcome Document on NCDs
By 2015, consider setting national targets for NCDs
By 2015, consider developing national multisectoral
policies and plans
Integrate NCDs into health-planning and national
development plans
By 2016, implement "best buys" to reduce risk factors
for NCDs
By 2016, implement "best buys" to enable health
systems to respond
Strengthen national surveillance systems
4

5. Global assignments included in the
2014 UN Outcome Document on NCDs
By 2015, WHO to develop an approach to register and
publish contributions of non-State actors towards the 9
global NCD targets
WHA68: Framework for country action to mobilize
sectors beyond health
OECD/DAC: Purpose code to track development
assistance for NCDs
By 2017, WHO to submit a progress report to UN
General Assembly
By 2018, UN General Assembly to convene a third High-level
Meeting
5
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

6. Global accountability framework for NCDs:
Milestones during the next three years
• WHO publishes global baseline
• WHO conducts third survey on national capacities
• WHO generates data
2015
• Progress report to WHA on 25 outcome indicators
• Progress report to WHA on 9 progress indicators 2016
• Independent evaluation (Global Action Plan)
• Progress report to the UN General Assembly 2017 6
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

7. NCDs in the post-2015 development
agenda: Towards the world we want
• 10 September 2014: Member States
welcomed the report of the Open Working
Group of the UN General Assembly on
Sustainable Development Goals
• Next 12 months: Proposal shall be the
main basis for integrating sustainable
development goals into the post-2015
development agenda
• Target 3.4: By 2030 reduce by one-third
pre-mature mortality from NCDs through
prevention and treatment, and promote
mental health and well-being
7
Slide courtesy of Dr Shin Hai-rim, WHO Western Pacific Region Office

8. 8

9. Cost effective interventions to address
NCDs
Population-based
interventions
addressing
NCD
risk factors
Tobacco use - Excise tax increases
- Smoke-free indoor workplaces and public places
- Health information and warnings about tobacco
- Bans on advertising and promotion
Harmful use
of alcohol
- Excise tax increases on alcoholic beverages
- Comprehensive restrictions and bans on alcohol marketing
- Restrictions on the availability of retailed alcohol
Unhealthy
diet and
physical
inactivity
- Salt reduction through mass media campaigns and reduced salt
content in processed foods
- Replacement of trans-fats with polyunsaturated fats
- Public awareness programme about diet and physical activity
Individual-based
interventions
addressing
NCDs in
primary care
Cancer - Prevention of liver cancer through hepatitis B immunization
- Prevention of cervical cancer through screening (visual
inspection with acetic acid [VIA]) and treatment of pre-cancerous
lesions
CVD and
diabetes
- Multi-drug therapy (including glycaemic control for diabetes
mellitus) for individuals who have had a heart attack or stroke,
and to persons at high risk (> 30%) of a cardiovascular event
within 10 years
- Providing aspirin to people having an acute heart attack
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10. Cost effective NCD interventions…
• What works, what can we afford, and what should we
adopt?
• The challenge? Identify interventions that:
• are effective;
• can lead to measurable declines in NCD death rates
quickly (e.g. over 10 years);
• are affordable; and
• can easily be implemented and sustained.
The Lancet. December 8, 2007 Volume 370:
Gaziano T, Galea G and Reddy K. Scaling up interventions for chronic disease prevention: the evidence.
pp 1939-1946.
The Lancet. December 15, 2007. Volume 370:
Asaria P, Crisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and
financial costs of strategies to reduce salt intake and control tobacco use. pp 2044-2053.
Lim S, et. al. Prevention of cardiovascular disease in high-risk individuals in low-income and middle-income
countries: health effects and costs. pp 2054-2061.
10

11. Cost effective NCD interventions…
• What is effective? The intervention must:
• targets behaviours or risk factors that are causally
associated with NCDs; and
• is proven, through evidence, to lead to favourable
changes in behaviours/risk factors, thereby reducing
risk of death from NCDs.
11

12. 12
Global NCD
Targets
Source of icons: World Heart Federation Champion Advocates Programme

13. Proportional mortality, Malaysia
(% of total deaths, all ages, both sexes)
13

14. Premature mortality due to NCDs,
Malaysia
14
The probability of dying between ages 30 and 70 years
from the 4 main NCDs is 20%

15. DALYs attributable to risk factors
15
Poor Water & Sanitation
Underweight
Physical Inactivity
Alcohol
High Cholesterol
High BMI
Diabetes Mellitus
10.7%
10.8%
8.3%
9.0%
3.1%
4.3%
5.2%
0.1%
0.7%
12.1%
10.8%
0.1%
0.7%
11.4%
5.1%
0.9%
4.3%
0.7%
Tobacco
High BP
15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0%
Male Female
Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

16. Deaths attributable to risk factors
Poor Water & Sanitation
Underweight
Alcohol
Physical Inactivity
High BMI
High Cholesterol
Diabetes Mellitus
19.4%
15.7%
7.0%
7.3%
8.5%
5.0%
2.3%
0.1%
0.2%
22.8%
0.1%
0.2%
1.2%
7.1%
8.2%
8.1%
9.1%
0.3%
Tobacco
High BP
25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%
Male Female
Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health
16

17. 17

18. National Systems Response to
NCDs – ASEAN Countries
BRN
CAM
IND
LAO
MAL
MYN
PHI
SIN
THA
VIET
Has an operational NCD unit/branch or department
within MOH ✓ ✓ ✓ ✗ ✓ ✗ ✓ ✓ ✓ ✗
Has an operational multisectoral & integrated national
policy, strategy or action plan ✗ ✗ ✓ ✗ ✓ ✓ ✗ ✗ ✗ ✗
Has an operational policy, strategy or action plan to
reduce the harmful use of alcohol ✓ ✓ ✓ ✗ ✗ ✓ ✓ ✗ ✓ ✗
Has an operational policy, strategy or action plan to
reduce physical inactivity ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✗
Has an operational policy, strategy or action plan to
reduce the burden of tobacco use ✗ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Has an operational policy, strategy or action plan to
reduce unhealthy diet and/or promote healthy diets ✗ ✓ ✓ ✗ ✓ ✓ ✓ ✓ ✓ ✓
Has evidence-based national guidelines for the Mx of
major NCDs through a primary care approach ✓ ✗ ✓ ✗ ✓ ✓ ✗ ✓ ✓ ✗
Has an NCD surveillance and monitoring system in
place to enable reporting for the GMF ✗ ✓ ✗ ✗ ✓ ✗ ✗ ✓ ✓ ✓
Has a national, population-based cancer registry ✓ ✗ ✗ ✗ ✗ ✗ ✗ ✓ ✗ ✗
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19. Global Action Plan for the Prevention
and Control of NCDs 2013-2020
Has six (6) objectives:
1. To raise the priority accorded to the prevention and control of NCDs
in global, regional and national agendas and internationally agreed
development goals, through strengthened international cooperation
and advocacy.
2. To strengthen national capacity, leadership, governance, multi-sectoral
action and partnerships to accelerate country response for
the prevention and control of NCDs.
3. To reduce modifiable risk factors for NCDs and underlying social
determinants through creation of health-promoting environments.
4. 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.
5. To promote and support national capacity for high-quality research
and development for the prevention and control of NCDs.
6. To monitor the trends and determinants of NCDs and evaluate
progress in their prevention and control.
19

20. National Strategic Plan for
Non-Communicable Diseases
(NSP-NCD) 2010-2014
• Presented and approved by the Cabinet on 17
December 2010.
• Provides the framework for strengthening NCD
prevention & control program in Malaysia.
• Adopts the “whole-of-government” and
“whole-of-society approach”.
• Diabetes & obesity are used as the entry
points.
Seven Strategies:
1. Prevention and
Promotion
2. Clinical Management
3. Increasing Patient
Compliance
4. Action with NGOs,
Professional Bodies &
Other Stakeholders
5. Monitoring, Research
and Surveillance
6. Capacity Building
7. Policy and Regulatory
interventions
20

21. Strengthening Chronic Disease
Management at the primary care level
Multi-disciplinary
care team
Post-basic
training for
paramedics
Clinical practice
guidelines
Quality
improvement
programs
Community
empowerment
Patient
resource
centres
Clinical
information
systems
21

22. Availability of essential medicines
The challenges of access to essential medicines for NCDs:
1. generic oral medicines available cheaply on the international
market but intermittently available in countries and of
uneven quality;
2. asthma inhalers and insulin available at high cost, and
quality assessment being highly challenging;
3. NCD medicines still under patent and accessible only
through expanded access programmes; and
4. opioid analgesics for palliative care often limited by
excessive regulation.
22
David Beran, Christophe Perrin, Nils Billo, John S Yudkin. 2014. Improving global access to
medicines for non-communicable diseases. The Lancet Global Health. Volume 2, Issue 10

23. Availability of essential medicines
• Global initiatives have shown that it is possible to deliver care and
medicines for a complex chronic disease in low-income and middle-income
countries, for AIDS and TB.
• Two NCD schemes might provide pointers for future directions.
• The Global Task Force on Expanded Access to Cancer Care and
Control helps with delivery of affordable cancer drugs, vaccines, and
services through assistance with finance and procurement.
• The Asthma Drug Facility established and run by International Union
Against Tuberculosis and Lung Disease has assisted low- and middle-income
countries to reduce by half the cost of quality-assured
asthma inhalers through a quality assurance system based on WHO
standards and a transparent tendering process.
• Combining these initiatives as a basis for an NCD Drug Information
Facility might offer an attractive route to improve the international
availability and affordability of quality generic medicines for NCDs. 23
David Beran, Christophe Perrin, Nils Billo, John S Yudkin. 2014. Improving global access to
medicines for non-communicable diseases. The Lancet Global Health. Volume 2, Issue 10

24. Lessons learned from the past and current
attempts to work with other sectors
• Go for the path of least resistance.
• Perhaps less impact, but at least establish the link and develop
trust.
• Compromise, find the “middle path”
• You cannot force the other sectors to go 100% your way.
• Be creative – think “out-of-the-box”
• Use other existing mechanisms not previously used to move the
NCD prevention and control agenda forward.
• Be sensitive to current global/national trends.
• Use any opportunity to move the NCD prevention agenda
forward.
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25. threesteps
sir george
alleyne
mutuality of interest
specificity of purpose
identification of specific resources
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26. Thank you
dr.feisul@moh.gov.my
Facebook: Feisul Mustapha
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