Launch Of ‘WHO Regional Meeting On Strengthening Health Systems To Improve Chronic Disease Prevention Control’

05 Nov 2007

By Mr Heng Chee How

Dr Shigeru Omi

Regional Director, WPRO

Distinguished Ministry representatives and guests from the Western Pacific Region,

Ladies and Gentlemen

I am delighted to be with you at this opening of the WHO Regional Meeting on Strengthening Health Systems to Improve Chronic Disease Prevention and Control. To our overseas delegates, I warmly welcome you to Singapore and wish you a most pleasant stay here. It is a privilege for Singapore to be hosting this event and it reaffirms our commitment to chronic disease prevention and control.

The Challenge of Chronic Diseases

Singapore, like many other countries, is searching for ways to rise to the challenge of chronic diseases. According to one study using the concept of Disability-Adjusted Life Years (DALY), "Health" was reduced from its potential maximum by 10.4% among Singaporeans in the year 2004 . The key causes were chronic diseases. Top amongst these were diabetes, ischemic heart disease, stroke, anxiety and depression, and cancers. The aging population will further add to this burden. While Singapore has made progress in moderating risk factors like smoking rates, it is still a long battle to wage.

Singapore’s contribution: Chronic Disease Management Programme

I understand that the key objective of this meeting is to review evidence and best practices, as well as identify barriers and critical success factors in the strategy for chronic disease prevention and control. Singapore may be able to contribute to this learning process by sharing our experience on the Chronic Disease Management Programme or CDMP. It was launched in January 2007 and covers 4 key diseases which contribute significantly to the disease burden. They are diabetes, hypertension, high lipids and stroke. Let me elaborate on three aspects of this programme.

Financing

First, on financing. The CDMP leverages on Medisave, with is part of our 3M healthcare framework that forms the backbone of our country’s healthcare financing.  Medisave is a compulsory savings scheme that was first set up for inpatient use. With CDMP, my Ministry has allowed Medisave to be used for outpatient treatment for patients with any of the 4 key diseases. This is a big step forward for us in Medisave policy. We do this because we recognise that chronic disease is best managed outside of hospital and early rather than wait for complications to happen which then necessitates hospitalisation.

With the liberalisation of Medisave, patients can reduce their out-of-pocket expense when seeking treatment for their chronic disease.  Many of the clinics package the essential care components for these diseases and thus this ensures that more patients receive the required care. These care components were developed based on current medical evidence and this decreases the risk of over-servicing by health providers. In this way, we linked financing to access to affordable care and medical evidence. We estimate that $15 million from Medisave will be used by 90,000 patients under this Programme for the whole of 2007.

Focusing on primary healthcare

Secondly, this programme also focused on primary care providers as the key provider of chronic disease care for the population. I believe this is line with one of the themes of this meeting ‘Health service design and delivery, with emphasis on primary health care’. Of the projected $15 million to be paid through Medisave, about 70% or $10.5 million will be paid to primary care providers. This is because all public sector primary care clinics and more than 700 private sector primary care clinics are already part of this programme. The large number of participating clinics ensures convenient access for patients.  Elderly patients will especially welcome such convenience.

Patient empowerment and patient-centred care

Patient empowerment and patient-centred care is the third feature of our CDM programme.  Patient education as an essential component of the programme. Our Health Promotion Board produces many patient education materials to help support CDMP clinics in this aspect. Preliminary data from the CDMP showed that those with primary care physicians are more likely to complete essential care components compared to those without primary care physicians. These are early and encouraging signs that we are headed in the right direction when we promote ‘One family physician for every Singaporean’ approach.  We will persist in our efforts.

Next steps in chronic disease prevention and control

Expanding CDMP

The next step in chronic disease prevention and control is to expand the CDMP. We will move on from public education to disease-specific or target population-specific education. There are plans to introduce nurse educators in the community to support the work of the CDMP clinics. In addition, we are strengthening our screening programmes, including working through community organisations, to maximise the likelihood for individuals to be diagnosed early.

Mental Health

Another chronic disease that Singapore will be focusing on is mental illness. My Ministry has developed plans to improve community-based mental health services. Community-based services that are readily accessible and convenient enable the early detection and treatment of mental health problems, and the smooth reintegration of discharged patients into the community. We will be enhancing manpower, including training of general practitioners so that they are better able to diagnose and manage mental health conditions.

We have also set up four multi-disciplinary programmes, catering to different age groups, to strengthen the ability of our community partners (such as schools, social agencies and voluntary organisations) to detect early and treat those with mental health difficulites, and in helping these individuals work, live and play normally in the community.

Closing

In closing, Singapore welcomes and values such opportunities for sharing and learning with WPRO and WHO member states. I wish all participants an enriching and stimulating time of discussion and learning.

Thank you.