ENHANCING PREVENTIVE HEALTH AND AGED CARE

        To keep healthcare cost in check, healthcare capacity adequate, and protect the wellbeing of Singaporeans, we will continue to invest in prevention care through primary care, and reshape the health habits of a people. In addition to making strides in our Healthier SG strategy, we are supporting seniors to age well in the community and strengthening support for families and children.

Updates on Healthier SG

2.    The Ministry of Health (MOH) launched Healthier SG in July 2023 as a major transformation of our healthcare system, to strengthen our focus on preventive care. To date, more than 700,000 residents have enrolled in Healthier SG, and more than 1,000 GPs are participating in Healthier SG.

3.    More residents are taking steps to adopt healthier lifestyles, with over 154,000 participants engaging in HPB’s exercise sessions in 2023, a 16% increase from 133,000 participants in 2022. The number of participants in PA’s programmes has also increased by 12%, from around 401,000 participants in 2022 to over 449,000 participants in 2023.

4.    In February 2024, the Healthier SG Chronic Tier subsidy framework was implemented to provide eligible Singaporeans with more subsidies at their enrolled Healthier SG general practitioner (GP) clinic. Under this framework, eligible Singaporeans with higher medication needs can get selected common medications for chronic conditions at prices that are comparable to those at polyclinics.

5.     Since February 2024, enrolled residents with chronic conditions under the Chronic Disease Management Programme are able to use MediSave to fully pay for their treatment at their enrolled Healthier SG clinics, up to the MediSave 500/700 withdrawal limit.

Empowering residents to lead healthier lifestyles

6.    Under Healthier SG, residents are supported by their enrolled family doctor to co-develop a personalised Health Plan based on their health conditions. The Healthier SG Health Plan serves as a living reference document to support the doctor-patient relationship, and will be updated based on residents’ health outcomes, care preferences and action plan. It will be continuously enhanced to better support the needs of both residents and family doctors. For example, more specific lifestyle recommendations will be included in the Health Plan over time. This is to support residents to take action towards achieving their health goals. The Health Plan is digitally available via the HealthHub app and on hard copy (i.e. the Health Plan booklet).

7.    Residents can access the Healthy 365 app to get information on suitable healthy lifestyle activities and programmes as part of their Healthier SG journey. The Healthy 365 app will be progressively enhanced to list a wider range of community-based activities and programmes by HPB, PA, SportSG and Active Ageing Centres, and reflect the intensity levels of these physical activities.

8.    In addition, Healthy 365 provides a comprehensive suite of tracking functions for healthy lifestyle behaviours, such as step count, moderate- to vigorous-intensity physical activity, sleep, and diet (e.g. calorie, sodium, and sugar intake tracked through meal logging).

Supporting GPs in delivering evidence-based and quality care

9.    Family doctors delivering preventive and chronic care are a central pillar of Healthier SG. Under Healthier SG, additional support is provided to family doctors through Care Protocols. These provide clear and concise guidance on clinical management based on evidence, as well as information on support available for primary care providers in managing these conditions, such as community resources and activities, and available subsidy schemes. With the Care Protocols, residents can be assured that care will be delivered in a consistent and coordinated manner, regardless of which Healthier SG clinic they choose to visit.

10.    To date, 12 Care Protocols focusing on preventive care and management of common chronic conditions such as diabetes, hypertension and lipid disorders, are in place. The full list of Care Protocols can be found in the Annex. Other care protocols are currently being developed for chronic conditions under the Chronic Disease Management Programme.

11.    We have also enhanced team-based support for Healthier SG GPs through the Primary Care Networks (PCNs). Set up in 2018, PCNs organise nursing, care coordination and ancillary services such as diabetic foot and eye screening for their partner GPs. These services allow small-practice GPs to have access to multi-disciplinary care team support for better disease detection, prevention and chronic care management. These primary care teams are now being scaled up to support Healthier SG GPs. They will adopt different modalities to make care more accessible for patients, including video consultations where appropriate.

Enabling our seniors to age well

12.    Age Well SG aims to help our seniors age well in the community by proactively caring for their needs and pre-empting social isolation. Over the next decade, the government will dedicate $3.5 billion to support the implementation of Age Well SG, of which $1.9 billion will be dedicated to MOH’s initiatives.

Encouraging active ageing

13.    Anchoring ageing in the community is an important aspect of Age Well SG. Active Ageing Centres (AACs) will serve as key nodes for seniors to remain socially engaged and physically active. MOH will expand our network of AACs from 157 today to 220 island-wide by 2025. With this expansion, eight in 10 seniors will have access to an AAC near their home.

14.    Beyond expanding our network of AACs, we will continue to improve the quality of programmes at the AACs. We will also encourage seniors to remain meaningfully engaged by volunteering at AACs.

Strengthening support for seniors with care needs

15.    To strengthen support for frailer seniors and provide greater reassurance to family members, we are developing more options for seniors to receive timely and appropriate care right where they are. For instance, seniors who face mobility issues but lack family support will soon be able to benefit from enhanced Home Personal Care (HPC+).

16.    Currently, the Home Personal Care service provides services to support seniors with their activities of daily living (such as showering and feeding) as well as housekeeping services. The new HPC+ will include a 24/7 technology-enabled monitoring and response element to detect falls and incidents, so that family members can be assured that their loved ones will receive timely help when they need it. Caregivers who require respite care services can also tap on HPC+ for extended durations to support senior’s care at home. Currently the HPC+ service has been rolled out as a pilot at 11 sites. MOH will evaluate the HPC+ pilot by end-2024 before considering to expand it islandwide.

17.    We are also working with the Ministry of National Development (MND) and Housing and Development Board (HDB) to offer more options for seniors to age in the community through the Community Care Apartments (CCA). The first CCA project, Harmony Village @ Bukit Batok will be ready for residents to move in by the end of this year. Together with MND and HDB, we will launch up to 30 CCAs by 2030, if the model of care provision proves to be effective and scalable.

Seamless delivery of care

18.    Today, seniors and their families may have to interact with multiple care providers and undergo repeated assessments from each provider. To provide a more seamless care journey for seniors and their caregivers, we will enhance coordination with care providers. Within each sub-region, we will appoint a single provider to coordinate and deliver the services needed for each senior. These changes will be made progressively starting from the second half of 2024.

Strengthening Support for the Health and Well-being of Children and Families

19.    The inter-agency taskforce led by MOH has completed the development of the Child and Maternal Health and Well-being (CAMH) Strategy and Action Plan to strengthen holistic support for the health and well-being of children and their families. The taskforce was chaired by Mr Masagos Zulkifli, Second Minister for Health, with support from more than 20 agencies across the health, social and education domains.

20.    The taskforce conducted its review over two phases. Phase 1 (from 2021 to 2022) focused on recommendations and initiatives that supported mothers and their children from pre-conception to 12 years old. The Taskforce completed the Phase 2 review in 2023 with a focus on supporting adolescents up to 18 years old and their families.

21.    A budget of $65 million has been allocated for the implementation of the CAMH Action Plan from 2022 to 2027, in addition to ongoing funding by agencies. 28 out of 48 initiatives in the Action Plan have been implemented to date and the remainder will be progressively implemented.

Greater support for couples in their parenthood journey

22.    Couples will receive greater support throughout their parenting journey starting as early as pre-conception, through pregnancy and parenthood.

a. The Taskforce and supporting agencies will provide access to more online evidence-based resources on a one-stop point via Parent Hub to help them prepare for parenthood, manage lifestyle risks and keep healthy before starting a family. Examples include quick guides on managing gestational diabetes, handling mental and psycho-emotional issues during and after pregnancy. Since its launch, ParentHub has garnered over three million views, with over 100,000 page views monthly.

b. Pregnant women and their spouses can receive enhanced support for mental health screening and follow-up care at public hospitals during the antenatal and postnatal stages.

i. At the KK Women’s and Children’s Hospital (KKH), mental health screening has been extended to all pregnant women receiving outpatient obstetrics and gynaecological care since February 2023 to facilitate identification of women with high risk of antenatal depression so that early treatment can be offered.

ii. At the National University Hospital (NUH), the Women’s Emotional Health Service Plus programme has extended its services to include spouses, as well as parents or parents-to-be with higher risks of significant anxiety and/or depressive symptoms who are referred by its community health programmes and partners for mental health support. Women receiving care at NUH are also now supported up to six years after their children are born, up from the previous period of one year.

Leverage touchpoints to forge healthy habits from young

23.     We will also continue to support parents to raise happy children with healthy habits during their formative years. The local study on Growing Up in Singapore Towards Healthy Outcomes (GUSTO) showed that children’s eating behaviours, such as portion size, speed of eating and food choices are key risk factors for childhood obesity.

24.    Online interactive resources on good eating habits and balanced meals will be offered to students through the Ministry of Education's (MOE) Student Learning Space this year. Evidence-based resources have also been made available for parents on Parent Hub to empower them to nurture healthier eating habits among children. These resources are designed to provide bite-sized information with small actionable steps to make it easy for parents to act on. We will continue to improve access to easy-to-use resources across schools and families.

25.    We will also work with partners to set out relevant guidance to parents and caregivers from time to time. In February 2024, KKH and the College of Paediatrics and Child Health Singapore launched the Guidelines for Feeding and Eating in Infants and Young Children. The guidelines provide healthcare professionals, parents and caregivers of children aged up to 2 years old with recommendations to help their children form healthy eating habits from infancy, with specific nutrition goals and feeding milestones. This complements ongoing effort to provide guidance on the key modifiable factors for childhood obesity, such as the introduction of the Singapore Integrated 24-hour Activity Guidelines for Children and Adolescents in 2021 by CPCHS and guidelines for early childhood in 2022 led by KKH.

More care options in the community for families

26.    Antenatal care and education play a pivotal role in preparing parents-to-be for the physical, emotional, and practical aspects of pregnancy, childbirth, and parenthood. Antenatal classes are typically offered at the hospitals. To increase accessibility, we will explore offering antenatal education programmes for couples at community touchpoints.

27.    The National University Health System (NUHS) will be rolling out a new series of community antenatal classes based on a combination of online lectures, videos and hands-on classes in key community touchpoints, starting in Choa Chu Kang. This would reduce the need for couples staying in the region to travel to NUH for antenatal education. These classes will be offered to lower-income families at highly subsidised rates to encourage participation.

28.    Likewise, SingHealth will be offering antenatal education programmes at the Family Nexus pilot site at Our Tampines Hub later this year.

Greater convenience in accessing cross-domain services

29.    We have launched the Family Nexus pilot across four sites to enhance the integration of health and social services and provide one-stop health and parenting services across Singapore for families. The four sites are Our Tampines Hub (November 2022), Choa Chu Kang Polyclinic with satellite site at Keat Hong ServiceSG office (September 2023), Punggol Polyclinic (October 2023) and Sembawang Polyclinic at Bukit Canberra (November 2023).

Multi-agency effort to step up anti-vaping enforcement and education efforts

30.    Singapore adopts a multipronged tobacco control strategy to keep our smoking prevalence low. To date, our key efforts include a ban in 2018 on the use of imitation tobacco products, such as electronic vaporisers (e-vaporisers), introduction of standardised packaging and enhanced graphic warnings for tobacco products in 2020, and an increase in the minimum legal age for smoking to 21 years old since 2021. MOH has also been working with government agencies to step up anti-vaping enforcement and education efforts in Singapore.

31.    Upstream on the sales and supply of e-vaporisers, MOH and the Health Sciences Authority (HSA) are working with the Ministry of Communications and Information and the Infocomm Media Development Authority to improve the detection and removal of sales and advertisements of e-vaporisers online.

32.    To prevent the entry of e-vaporisers into Singapore at the borders, HSA is working with the Immigration and Checkpoints Authority on joint operations at Changi Airport and land checkpoints, with plans to extend these to the sea checkpoints.

33.    In the community, HSA is working closely with agencies such as the National Environment Agency and National Parks Board to step up enforcement against the possession and use of e-vaporisers at public places.

34.    In schools and Institutes of Higher Learning (IHLs), MOE is working closely with MOH and HSA to strengthen detection and enforcement efforts against vaping. When students are caught using or in possession of e-vaporisers, the prohibited product will be confiscated and their parents will be informed. The schools and IHLs will report the offender to HSA and continue to manage vaping-related offences through their existing disciplinary frameworks, including school-based disciplinary actions, such as suspension or caning for boys. Students caught vaping will also be referred to cessation support programmes.

35.    The Health Promotion Board (HPB) will continue to raise awareness of the harms and illegality of smoking and vaping at the population-level. In schools and IHLs, HPB works closely with MOE to amplify anti-vaping messages in education materials and preventive programmes, raise awareness about the harms of smoking and vaping, and provide vaping cessation support for students who are caught vaping.

Review of penalties for e-vaporisers-related offences

36.    Under the Tobacco (Control of Advertisements and Sale) Act, the possession, use or purchase of e-vaporisers carries a maximum fine of $2,000. It is also an offence to import, distribute, sell or offer for sale e-vaporisers and their components. Any person convicted of an offence is liable to a fine of up to $10,000, or imprisonment of up to six months or both for the first offence, and a fine of up to $20,000, or imprisonment of up to 12 months or both for the second or subsequent offence. All prohibited tobacco items will also be seized and confiscated.

37.    Concurrent to the stepping up in enforcement and education efforts, MOH will review the penalties for e-vaporisers-related offences under the Tobacco (Control of Advertisements and Sale) Act to ensure continued strong deterrence against such offences.

MINISTRY OF HEALTH
6 MARCH 2024