PROMOTING HEALTHIER LIVING FOR ALL AGES AND FAMILIES

The Ministry of Health (MOH) will lay the foundations for healthier residents with the launch of Healthier SG. We will continue efforts to promote healthier choices, empower residents to lead healthier lifestyles, and integrate social and health support to keep families healthy. 

Updates on Healthier SG

National enrolment

2. Under Healthier SG, residents are encouraged to enrol with a Healthier SG clinic and commit to seeing one family doctor who will support them in developing and adopting a Health Plan. The Healthier SG family doctor will serve as the first point-of-contact to holistically manage residents’ health. 

3. From May 2023, we will start with pre-enrolment for residents with chronic illness, who are aged 40 and above and already seeing a Healthier SG-registered General Practitioner (GP) clinic regularly. To preserve their existing physician-patient relationship, the GP clinic will engage its regular pool of patients with chronic conditions to pre-enrol onsite at the clinic. Healthier SG benefits will commence for pre-enrolled residents from July 2023.

4. From July 2023, the national enrolment programme will begin with Singapore Citizens and Permanent Residents who are aged 60 years and above. We will progressively invite the remaining residents who are aged 40 years and above to choose and enrol with any Healthier SG clinics, including the polyclinics. All residents eligible for Healthier SG enrolment have the flexibility to choose any Healthier SG-registered clinic using the HealthHub app.  

Resident benefits

5. Upon successful enrolment, residents can schedule an appointment for a  face-to-face onboarding Health Plan consultation with their enrolled Healthier SG clinic. The first on-boarding Health Plan consultation will be fully paid for by the Government. 

6. After completing the onboarding health consultation, residents will receive 3,000 Healthpoints, worth $20, through the Healthy 365 app. These can be exchanged for vouchers from participating merchants, such as NTUC FairPrice vouchers or TransitLink credits.  

7. Nationally recommended vaccinations under the National Adult Immunisation Schedule and screenings under the Screen for Life programme will be fully subsidised for enrolled Singapore Citizens when they visit their Healthier SG family doctor.

8. From early 2024, CHAS cardholders enrolled to Healthier SG GP clinics who have  higher chronic medication needs and bills, can opt for a new Healthier SG Chronic Tier subsidy framework, where they can enjoy access to a selected whitelist of chronic medications (e.g. metformin, losartan) similar to those prescribed and subsidised at polyclinics, at prices more comparable to polyclinics. Under the Healthier SG Chronic Tier, CHAS cardholders can receive means-tested subsidies of up to 87.5% for whitelisted medications, with no dollar cap. They will also receive subsidies of up to $360 per year for other components of their chronic care, such as consultation, lab tests and non-whitelisted medications. 

9. Patients who are more likely to benefit from the new Healthier SG Chronic Tier are those with chronic illnesses with higher medication needs and bills which exceed the current CHAS annual subsidy limits. Such patients may wish to consult their family doctors about whether they are suitable to switch to the whitelisted subsidised medications under the Healthier SG Chronic Tier. Other patients, especially those with low medication needs, may be well covered by their existing CHAS chronic subsidies of up to $540 annually, and need not switch to the new Healthier SG Chronic Tier. Patients will be permitted to switch between the existing CHAS Chronic Tier and the new Healthier SG Chronic Tier, to cater for possible changes to their medication needs. Pro-ration of the annual dollar subsidy balance will apply upon switching. More details of the new Healthier SG Chronic Tier can be found in Annex A.  

10. From early 2024, enrolled residents with chronic conditions under the CDMP can use MediSave to pay for their full treatment at their Healthier SG family physician, up to the MediSave500/700 withdrawal limit. They no longer need to co-pay 15% of their bill in cash.

National Diabetes Reference Materials

11. The National Diabetes Reference Materials (NDRM) Tier 2 materials will be published in April 2023. Available in the four official languages, the materials focus on guidelines on physical activities, healthy eating, ways to cope with stress, and support for Type 1 diabetes.

12. First developed and published in 2019, the NDRM aims to empower patients to take charge of diabetes with easy-to-understand tips and knowledge on diabetic care. It also equips care teams with resources to increase patients’ and caregivers’ health literacy and motivate patients for sustained lifestyle changes. The Tier 1 materials in 2019 contain basic information on diabetes, and how patients can manage their condition.

13. Following a series of engagement sessions in 2019 to understand the next tier of diabetes informational needs of the general public, patients with diabetes and their caregivers, the NDRM Tier 2 Workgroup was convened in April 2021, comprising more than 40 experts from various settings (private and public sectors, and covering physicians, dietitians, physiotherapists and psychologists) and patient champions, to develop in-depth Tier 2 content to address feedback from engagement sessions.

14. A total of four topics have been developed under Tier 2 NDRM, with the aim of providing patients and caregivers with deeper knowledge of materials. The topics of focus are:

a) Physical Activity: To educate patients with diabetes on how they can adopt physical activity in their lifestyle, and provide information on blood glucose monitoring tips for their exercise regime, different intensity of exercises and recommended exercises for patients with diabetes, heart diseases and obesity;

b) Healthy Eating: To educate patients with diabetes on how they can adopt healthy eating habits to better manage their condition. The Tier 2 materials will provide details on how to read nutritional labels, monitor calorie intake and glycaemic index, healthier cooking and practical tips;

c) Emotional Well-being: To provide information on how patients can cope with the stresses of living with diabetes. The Tier 2 materials include information on managing stress in diabetes, how diabetes may impact sleep, as well as where to get support; and

d) Type 1 Diabetes: To share practical tips specific to Type 1 diabetes, and how patients with the condition can be supported in their daily lives.

15. Flipcharts and bite-sized infographics on Tier 2 topics such as Healthy Eating and Physical Activity will be made available when the Diabetes Hub on the HealthHub website and app is updated in April 2023. An animation video will also be developed to raise awareness of NDRM Tier 2 materials.

Targeted Measures to Keep Families Healthy

16. MOH announced in March 2021 that we are developing a Child and Maternal Health and Well-being (CAMH) Strategy and Action Plan to provide holistic and comprehensive support, and address health risks and wider determinants of health from the preconception phase to adolescents aged 18 years old.

17. We have adopted a three-pronged approach to enable families to achieve better health outcomes, namely, (i) going upstream to prevent and address issues early; (ii) strengthening integration across health and social domains; and (iii) embracing family-centricity to better support children and their families. 

18. The inter-agency Taskforce set up to oversee the development and implementation of the CAMH Strategy and Action Plan has completed the first of two phases of review and development. It has also embarked on phase 1 implementation, focusing on three key aspects, namely (i) a healthy mother and a healthy child, (ii) a happy mother and a happy child, and (iii) a well-supported mother and an able child.

19. Several new initiatives have been announced and implemented over the last year and more will be put in place over the next few months including plans on Phase 2 review and development.

New universal Mental Health Screening for pregnant women at KKH

20. As part of our efforts to scale up support for the mental well-being of women during and after pregnancy, KK Women’s and Children’s Hospital (KKH) implemented the Psychological Resilience in Antenatal Management (PRAM) programme, which offers universal antenatal mental health screening for all pregnant women receiving outpatient obstetric care at the hospital since December 2022. The new programme will enable early detection and intervention for pregnant women with depressive symptoms.

Guidelines launched for mental health support for mothers

21. In February 2023, KKH and the College of Obstetricians and Gynaecologists Singapore launched a set of Perinatal Mental Health Guidelines for women of child-bearing age in Singapore. With these guidelines, women and their families will be equipped with the relevant know-how to recognise changes in their mental well-being during pregnancy, identify basic signs and symptoms of mental health conditions such as anxiety and depression, and be encouraged to seek help when needed. The set of guidelines will be disseminated to healthcare professionals and the general public. 

New advisory on screen use for children 12 and below

22. MOH has launched a new advisory on screen use for children up to 12 years of age to provide parents with more resources and practical help to support their children on healthy screen and device use. The advisory was developed by an expert panel comprising professionals from healthcare, social and educational agencies under the ambit of the Child and Maternal Health and Well-being Taskforce. The advisory can be downloaded from https://go.gov.sg/moh-screenadvisory.

Family Nexus – integrated hub to support families

23. In March 2022, MOH announced the piloting of Family Nexus at four sites across Singapore to enhance the integration of services across the health and social domains for more holistic support for children and their families. 

24. SingHealth and Families for Life have started operations of the first site at Our Tampines Hub since November 2022, and families with young children residing in Tampines or the East region can now access Family Nexus services and/or sign up for activities. The other three sites at Choa Chu Kang, Punggol and Sembawang will be progressively rolled out over the next few months.

More family-centric service delivery as a mother-child dyad at polyclinics

25. The mother-child dyad services have been implemented at nine polyclinics as of 1 March 2023, including the pilot sites at Punggol and Yishun Polyclinics. 

26. Following good outcomes achieved at Punggol and Yishun Polyclinics, MOH is scaling up the delivery of integrated services through a mother-child dyad service model to 14 polyclinics by 2025. 

27. Under this effort, both mothers and their children can access healthcare services relevant to them in the same visit to the polyclinic. For example, postnatal depression screening and breastfeeding support are provided to the mothers when they bring their child for vaccination and childhood developmental screening at the polyclinics.

More support for fathers and grandparents  

28. We are also exploring more support for fathers and grandparents to aid them in keeping themselves and their children healthy. The National University Hospital (NUH) will be extending its mental health screening and support to fathers of children and husbands of women under its care. The programme allows for early intervention, case management and multidisciplinary treatment. To widen the reach to support fathers, the programme will be made available to clients referred by its social and community partners, including partners for Family Nexus and KidSTART.

Enhanced support for lower-income families 

29. We will also be doing more to help families with lesser means to care for themselves. This will enable children from low-income families to have a good head start in health and well-being in their early formative years. Two regional pilots will be launched to provide more holistic and comprehensive support for preschool children from low-income families. 

30. In the Northeast Region, SingHealth will be working alongside the KidSTART and ComLink teams, to lead cross-domain and multi-agency effort to support children through Project HOME (Holistic Management & Enablement). 

31. NUH will be rolling out a similar pilot in the West through HEADS-UPP (HEAlth and Development SUpport in Preschool Partnerships) programme, working with Care Corner and PCF Sparkletots preschools in the region. 

32. Both pilot programmes will equip preschool educators and social workers with skills to support the health and development screening of preschool children; identify at-risk children and refer them for intervention; and provide multi-disciplinary case management to children and their families. 

33. Please refer to Annex B for details of the various programmes. 

Mental Health Remains a Key Priority 

34. The Interagency Taskforce on Mental Health and Well-being conducted a public consultation between May and August 2022 to gather views and feedback on 12 preliminary recommendations across three focus areas: 

a) Improving accessibility, coordination and quality of mental health services; 
b) Strengthening services and support for youth mental well-being; and 
c) Improving workplace well-being measures and employment support. 

35. The Taskforce received over 950 responses through an online survey on the Government's feedback unit REACH, as well as virtual and in-person small group engagements with key stakeholders, including youths, parents, persons with mental health conditions, service providers, employers, and community agencies. In general, participants were supportive of the preliminary recommendations, and provided useful suggestions on the refinement of implementation details of the recommendations. The Taskforce will incorporate the feedback gathered into the development of a national strategy for mental health and well-being, aimed to be released at the end of 2023. 

Introducing a tiered care model for mental health and well-being

36. To facilitate better access and smoother transitions for users of mental health services in the social and health sectors, the Taskforce recommends implementing a care model with a tiered system of services to reflect the different groups of clients with varying mental health needs and the types of mental health services, providers and para-professionals/ professionals required to meet those needs. For the general public, this care model will help them identify the appropriate level of service required. For service providers, it will serve to guide them on service provision, referrals, and care coordination among agencies. 

Developing a national mental health competency training framework

37. To complement the tiered care model, the Taskforce is also developing a national mental health competency training framework to establish a common set of training standards and clearly defined competencies expected of mental health professionals and para-professionals who support individuals with varying mental health needs. The framework will outline the competencies needed and recommended training programmes available, both for members of the public who are keen to be equipped with skills to serve as peer supporters in the community, as well as mental health para-professionals/professionals, to uplift mental health capabilities across the care continuum. 

Improving awareness and attitudes towards mental health and well-being

38. The Taskforce recognises that stigma and attitudes towards mental health continue to be significant concerns to many. Public education campaigns such as HPB's "It's OKAY to Reach Out" and National Council of Social Service's "Beyond The Label" campaigns have been rolled out to encourage individuals to seek help for mental health and well-being, and destigmatise mental health issues. The Taskforce will continue with efforts to normalise conversations on mental health and well-being in the community, to build our collective resilience as a nation. 

MINISTRY OF HEALTH 
3 MARCH 2023