We are generating evidence that will help shape the expansion of this pilot program and eventually inform noncommunicable disease policies in Malaysia and beyond.  Noncommunicable diseases (NCDs) such as diabetes and cardiovascular disease pose a threat to well-being and economic development worldwide. Obesity increasingly and disproportionately affects the poor in middle-income countries around the globe, elevating people’s risk of devastating NCD treatment costs, lost productivity, and premature death. An effective response depends on addressing the local social and structural factors that increase NCD risk.

Funded by the United Kingdom Prosperity Fund, the Global Better Health Programme (BHP) strives to cultivate a healthier and more productive workforce by reducing the burden of NCDs in eight middle-income countries. Fijishi is implementing the Better Health Programme Malaysia in close partnership with the Ministry of Health.

Obesity prevalence has risen sharply in Malaysia in recent decades, and today over half of the adult population is considered either overweight or obese. People of low socio-economic status are disproportionately affected. Today, diabetes is most prevalent among individuals in the bottom 40 percent of the Malaysian population (B40). BHP Malaysia focuses on serving the B40 in recognition of this inequitable disease burden.

BHP Malaysia is collaborating with community health volunteers to improve the food and physical activity environment for the urban poor in Kuala Lumpur. Equipped with digital tools, community health volunteers are well positioned to engage with local businesses and other community stakeholders to address community priorities, such as the availability of healthier food options or physical activity.

The program is implementing evidence-based interventions for obesity prevention, drawn from global best practice guidelines, and adapted to the local context. During our 9-month pilot phase, BHP Malaysia will assess impact by comparing intervention and control communities. Baseline assessments with community members and community health volunteers will help determine knowledge, attitudes, and practices related to health and NCDs, as well as inform the design of our training curriculum, digital health tools, and program interventions. We are also surveying community health volunteers regarding their access to and use of digital technologies.

Social distancing measures in response to the COVID-19 pandemic have accelerated recent trends toward the use of digital tools for health care and health promotion activities. Digital health solutions, such as a mobile phone app, will provide eLearning for community health volunteers to support the delivery of program interventions and offer community education opportunities via a gamified community health reward model.

Fijishi is working with community stakeholders to determine which evidenced-based interventions should be prioritized. We are conducting a discrete choice experiment in each community participating in the pilot, asking community members to make tradeoffs between potential interventions. This approach will allow us to quantify preferences and understand a community’s relative preference for interventions, such as physical activity classes, rewards to make healthier foods more available, or partnerships with local food vendors. This approach will enable us to apply global best practices for evidence-based obesity prevention in a way that is locally relevant and consistent with community priorities.

Lessons from the BHP Malaysia pilot will inform the expansion of work to new areas. Using rigorous research methods, we expect that the program will serve to generate evidence to inform NCD policies in Malaysia and beyond. We hope that BHP Malaysia models the engagement and empowerment required to translate national and global NCD strategies into sustainable approaches that meet the needs of local communities.