Paper presented at 8th National Public Health Conference. Hotel Equatorial, Melaka. 2-4th August

1. MATERIALIZING
SUSTAINABLE DEVELOPMENT GOALS FOR HEALTH
TIME FOR ACTION
SHA’ARI BIN NGADIMAN
MD, MPH, EIPM, FAMM
Ministry of Health Malaysia

2. 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.

4. SDG - 3
Health related SDG
Aspires to ensure healthy
live & promote well-being
for all at all ages
Effective on 1 January 2016
– to reach target by 2030

7. FRAMEWORK OF ACTION AGENDA

8. 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

9. 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

10. 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

11. 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

12. EXAMPLE IN MATERIALIZING SDG……….
Part of SDG 3.3
ENDING AIDS IN MALAYSIA BY 2030

13. 10-Feb-16
13

14. Chronology
National Strategic Plans 1988 - 2016
Year Commitment
1988 1st National Plan of Action on AIDS
1998 Revised National Plan of Action on AIDS
2006 – 2010 1st National Strategic Plan on HIV and AIDS
2011 – 2015 2nd National Strategic Plan on HIV and AIDS
2016 – 2030 3rd National Strategic Plan on HIV and AIDS – Ending AIDS
(NSPEA)
10-Feb-16
14

15. The making of NSPEA 2016-2030
20152014
Oct. April May Jun
Data consolidation
3rd W/Shop
Impact
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/Shop
Developing
Baseline
2nd W/Shop
Intervention
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

16. NATIONAL STRATEGIC
PLAN FOR ENDING AIDS
(NSPEA) 2016-2030

17. 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)]
0
5
10
15
20
25
30
35
40
45
50
0
2000
4000
6000
8000
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Notificationrate(per100000pop.)
ReportedHIVcases
HIV epidemic based on surveillance system
HIV
AIDS
HIV/AIDS related deaths
HIV Notification rate
0
5
10
15
20
25
30
0
20
40
60
80
100
120
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 2026 2028 2030
Thousands
Thousands
HIV epidemic as projected using AEM
Est. PLHIV (15+)
Est. New infections (15+)
Est. Death (15+)
Ending AIDS
The model was validated against National Surveillance Data
Total reported PLHIV (Dec 2015) - 90,603 (Estimated PHLIV : 89,643)

18. 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 AIDS
 Proportion of other key populations expected to reduce except for MSM
0%
20%
40%
60%
80%
100%
2000 2010 2013 2020 2030
Clients MSM1 TG FSW1 LRM LRF Male IDU
Est. Proportion of HIV new infection by Mode of
Transmission, Malaysia 2000 - 2030
0
5
10
15
20
25
No.ofcasesThousands
Clients MSM1 TG FSW1 LRM LRF Male PWID
Estimated and projected number of cases by Mode of Transmission,
Malaysia 1986 – 2030
Yesterday Today Tomorrow

19. Materializing SDG3 on AIDS:
National Strategic Plan for Ending AIDS (NSPEA) 2016 – 2030
What 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
19

20. 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

21. Investment impact : Epidemic
0
20
40
60
80
100
120
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
2030
NumberofcasesThousands
Current HIV infection (Total), Malaysia 2000-2030
Accelerate treatment only regardless of CD4
Scale-up prevention only
Scale-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
0
2
4
6
8
10
12
14
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
2030
NumberofcasesThousands
New HIV infection (Total), Malaysia 2000-2030
2021: 751
2010:
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

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

23. 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
23

24. 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
24

25. 0
2
4
6
8
10
12
14
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 2030
NumberofcasesThousands
New HIV infection (Total), Malaysia 2000-2030
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

26. MALAYSIA – Realizing SDGs…
• Full operationalization & effective implementation of national, sub-
national and local development plans
• Mobilize resources through innovative mechanism :
Ensure effectiveness and efficiency
People engagement at various level
Effective development cooperation at government, civil society,
private sector, international institution and individual
THANK YOU