MATERIALIZING SUSTAINABLE DEVELOPMENT GOALS FOR

HEALTH TIME FOR ACTION

SHA’ARI BIN NGADIMANMD, MPH, EIPM, FAMM

Ministry of Health Malaysia

SUSTAINABLE DEVELOPMENT GOALS (SDGs)

United Nations General Assembly Sustainable Development Summit, 25 September 2015, World leaders adopted the 2030 Agenda for Sustainable Development,

includes a set of 17 Sustainable Development Goals (SDGs) and 169 targets

• to end poverty, • fight inequality and injustice, and • tackle climate change, • all by 2030.

SDG - 3

Health related SDGAspires to ensure healthy

live & promote well-being for all at all ages

Effective on 1 January 2016 – to reach target by 2030

FRAMEWORK OF ACTION AGENDA

1. WHAT ARE COUNTRIES AIMING TO ACHIEVE, AND HOW WILL THEY KNOW?

• 1.1 Country-led selection of health goals, targets and indicators• Develop a country-based monitoring framework• Ensure indicators are fit for purpose• Make best use of existing data collections

• 1.2 Robust monitoring and review process• Conduct equity-focused national and local level reviews• Use evidence to inform policy development and evaluation

• 1.3 Adequate information capacity• Strengthen links between information systems within & beyond health sectors• Build capacity to gather and use information• Standardize information and harness communication technologies

2. WHAT ARE THE POLICY AND PROGRAMME PRIORITIES FOR LEAVING NO ONE BEHIND?

• 2.1 Equity in health services• Minimize access barriers• Health programme collaboration on shared social determinants

• 2.2 Realising win-wins through collaboration across sectors• Stimulate social development• Promote health urbanization• Protect the health of the environment

• 2.3 Financing strategies for promoting equity• Strengthen public financing for the social sector• Improve access to social protection

3. HOW WILL COUNTRIES PUT THESE PRIORITIES INTO EFFECT?

• 3.1 Collaboration across government• Create enabling conditions for inter-sectoral action• Structure institutional arrangements to support inter-sectoral action• Embed measures of health equity within planning and reporting• Shape international relation to enable action on health

• 3.2 Engagement of stakeholder beyond government• Sustain constructive engagement with stakeholder beyond government• Strengthen health programme & service delivery in partnership with stakeholder beyond

government• Improve health through action on the social determinants of health in collaboration with

stakeholders beyond government

• 3.3 Participation of affected communities• Include affected communities in policy consultations• Enable participation of affected communities

4. HOW CAN THE HEALTH SECTOR DRIVE THE AGENDA?

• 4.1 capabilities for knowledge exchange• Build the knowledge base on social determinants• Understand the priorities and processes of other sectors• Understand the perspectives and needs of communities

• 4.2 Leadership skills for policy making• Strengthen the capability to:

• engage other sectors in policy-making• Mobilize political and financial support• Use policy levers effectively

• 4.3 Institutional capacity for present and future challenges• Raise the priority of health in the national development agenda• Establish rules and incentives for improving performance and sustaining progress • Train a health workforce to collaborate across sectors and professions

EXAMPLE IN MATERIALIZING SDG……….

Part of SDG 3.3ENDING AIDS IN MALAYSIA BY 2030

10-Feb-16

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Chronology National Strategic Plans 1988 - 2016

Year Commitment1988 1st National Plan of Action on AIDS 1998 Revised National Plan of Action on AIDS2006 – 2010 1st National Strategic Plan on HIV and AIDS2011 – 2015 2nd National Strategic Plan on HIV and AIDS2016 – 2030 3rd National Strategic Plan on HIV and AIDS – Ending AIDS

(NSPEA)

10-Feb-16

14

The making of NSPEA 2016-203020152014

Oct. April May Jun

Data consolidation

3rd W/ShopImpact analysis–5 scenarios

Briefing on Ending AIDS – JKEDKA (11th May)

March

NSPEA preparatory work – formation of TWG (14-15th May)

1st Consult. (9-11th June); 86pax

Aug

2nd Consult. (10-11th Aug.); 58pax

1st W/ShopDeveloping Baseline

2nd W/ShopIntervention model

Oct

3rd Consult. (22 - 23rd Oct)

Nov

Draft NSPEA 2016 -2030 (23rd Oct)

Dec

WAD – Launching of NSPEA (5th Dec)

1st consultation:- Input: gaps,

challenges. Initiatives

- 86 pax: 33MOH + 12Gov+ 39NGOs + 2others

2nd consultation:- Consolidate: Nat.

Strategies, Nat. POA, Nat. M&E framework

- 58pax: 29MOH+ 7Gov + 21NGOs + 1others

TWG:- Setting priorities

based on AEM- 5 focus areas: Testing

& treatment, Harm Reduction, Mitigating Sexual transmission, eMTCT, Young Key Populations

Data consolidation:-develop 5 best scenarios for Ending AIDS

3rd consultation:- Final

consolidation and review by key stakeholders : finalize indicators

Final Draft- Endorsed

by DG of MOH

10-Feb-16

15

NATIONAL STRATEGIC PLAN FOR ENDING AIDS

(NSPEA) 2016-2030

http://www.moh.gov.my/images/gallery/Report/MalaysiaNSPE

A2016-20302.3(Final_27Nov)_printed%20version.pdf

What the model (AEM) tells us:Where we are now and where we are heading to

[Ending AIDS = Reduction of new infection by 90% from 2010 (UNAIDS)]

198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015

0

2000

4000

6000

8000

0

5

10

15

20

25

30

35

40

45

50HIV epidemic based on surveillance system

HIVAIDSHIV/AIDS related deathsHIV Notification rate

Repo

rted

HIV

cas

es

Noti

ficati

on ra

te (p

er 1

00 0

00 p

op.)

19861988

19901992

19941996

19982000

20022004

20062008

20102012

20142016

20182020

20222024

20262028

20300

20000

40000

60000

80000

100000

120000

0

5000

10000

15000

20000

25000

30000HIV epidemic as projected using AEM

Est. PLHIV (15+)

Est. New infections (15+)

Est. Death (15+)

Ending AIDS

The model was validated against National Surveillance DataTotal reported PLHIV (Dec 2015) - 90,603 (Estimated PHLIV : 89,643)

What the model (AEM) tells us:Who are the Key Populations?

Maintaining similar interventions and resources as before (2013):PWID remain as key driven factor for the country’s epidemic and continue posing a threat to achieving ending AIDSProportion of other key populations expected to reduce except for MSM

2000 2010 2013 2020 20300%

20%

40%

60%

80%

100%

Clients MSM1 TG FSW1LRM LRF Male IDU

Est. Proportion of HIV new infection by Mode of Transmission, Malaysia 2000 - 2030

19861988

19901992

19941996

19982000

20022004

20062008

20102012

20142016

20182020

20222024

20262028

20300

5000

10000

15000

20000

25000

Clients MSM1 TG FSW1 LRM LRF Male PWID

No. o

f cas

es

Estimated and projected number of cases by Mode of Transmission, Malaysia 1986 – 2030

Yesterday Today Tomorrow

Materializing SDG3 on AIDS:National Strategic Plan for Ending AIDS (NSPEA) 2016 – 2030What we already have and what we need ?

1. Best option to “End AIDS’– Combination of Prevention and Treatment; focusing on Key Pop.

2. What works (evidence-based)– NSEP; OST

– PMTCT

– Condom use program

– Treatment as Prevention (TasP)

– Pre-Exposure Prophylaxis (PrEP) & Post-Exposure Prophylaxis (PEP)

– circumcision

3. The 4 ‘P’s (Policy, Participation, Political will, Perseverance)10-Feb-16

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What the model (AEM) tells us:What investment options do we have?

OPTIONS MMT NSEP FSW MSM TG CD4 ART

Business as usual (Base-line 2013) 31% 21% 52% 38% 49% 350 44%Scenario 1: Accelerate treatment only 31% 21% 52% 38% 49% ALL 95%Scenario 2: Scale-up prevention only 80% 15% 80% 80% 80% 350 44%Scenario 3: Scale-up Harm Reduction and treatment CD4<350

80% 15% 52% 38% 49% 350 80%

Scenario 4: Scale-up Harm Reduction and treatment CD4<500

80% 15% 52% 38% 49% 500 80%

Scenario 5: Ending AIDS 80% 15% 80% 80% 80% ALL 95%

[Note: Ending AIDS = Reduction of new infection by 90% from 2010 (UNAIDS)]

Prevention Treatment

Investment impact : Epidemic

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

20182019

20202021

20222023

20242025

20262027

20282029

20300

20000

40000

60000

80000

100000

120000Current HIV infection (Total), Malaysia 2000-2030

Accelerate treatment only regardless of CD4Scale-up prevention onlyScale-up Harm Reduction for PWID and scale-up treatment CD4<350 Scale-up Harm Reduction for PWID and scale-up treatment CD4<500 Ending AIDS (scale-up both prevention and treatment regardless of CD4)Baseline -Business as usual

Num

ber o

f cas

es

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20142015

20162017

20182019

20202021

20222023

20242025

20262027

20282029

20300

2000

4000

6000

8000

10000

12000

14000 New HIV infection (Total), Malaysia 2000-2030

Num

ber o

f cas

es

2021: 7512010: 7936

90% reduction

Malaysia will reach 90% reduction by 2021 if we embark on ‘Ending AIDS’ scenario. Other options will never end AIDS!

‘Ending AIDS’ averts 5,022 infections in 2021

Ending AIDS

National Strategic Plan for Ending AIDS (NSPEA) 2016 - 2030

REALIZING ‘ENDING AIDS’ IN MALAYSIA

Invest now, optimize national responses, Malaysia can “End AIDS” in less than 10 years!

Priority 1 : ‘Test and Treat’ Scale-up test and treatment for key populations : Health Facilities testing including at K1M, Community based testing, NGO at health facilities etc

90%

Diagnosed

90%

On treatment

90%

Virally suppressed

95%

Diagnosed

95%

On treatment

95%

Virally suppressed

Global target: By 2020 By 2030

Malaysia target By 2021 10-Feb-16

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REALIZING ‘ENDING AIDS’ IN MALAYSIA

Priority 2 : Scale-up Harm Reduction for PWID to cover 80% MMT and 15%NSEP, >MMT Clinics, beyond government partnership with NGO, Privates, Religious group, etc

Priority 3 : Mitigate sexual transmission of HIV through scaling up prevention to cover 80% FSW, 80% TG and 80% MSM, working with other through partnership with NGO, Privates, Religious group, improving T&T, PreP, PEP, etc

10-Feb-16

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2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 20300

2000

4000

6000

8000

10000

12000

14000 New HIV infection (Total), Malaysia 2000-2030

Num

ber o

f cas

es

2021: 7512010: 7936

90% reduction

Malaysia will reach 90% reduction by 2021 if we embark on ‘Ending AIDS’ scenario.

‘Ending AIDS’ averts 5,022 infections in 2021

MALAYSIA – Realizing SDGs…• Full operationalization & effective implementation of national, sub-

national and local development plans• Mobilize resources through innovative mechanism :

Ensure effectiveness and efficiencyPeople engagement at various levelEffective development cooperation at government, civil society,

private sector, international institution and individual

THANK YOU