SPEECH BY MR MASAGOS ZULKIFLI, SECOND MINISTER FOR HEALTH, AT THE MINISTRY OF HEALTH COMMITTEE OF SUPPLY DEBATE 2023, ON FRIDAY 3 MARCH 2023

I thank members for their suggestions on ways we can enable Singaporeans to keep healthy and build strong families.  

2. Health, like education and housing, is foundational to the well-being of a family. When families are healthy, they can thrive, support their seniors, and enable their children to flourish and reach their fullest potential in life. This is why over the years, we have strengthened our policies to build strong and healthy families. 

SUPPORTING FAMILIES THROUGH CHAPTERS OF THEIR LIVES  

Strengthening integration across health and social domains

3. The Ministry of Health (MOH) has been building an integrated ecosystem to support children and their families across the health and social domains. We are further enhancing it through the Child and Maternal Health and Well-being Strategy. 

4. We have begun the effort to enable families to access cross-domain services at a one-stop community node near their homes. Last year, I announced that we were piloting this programme, which we call ‘Family Nexus’. 

5. I am pleased to update that the first Family Nexus pilot has since been rolled out at Our Tampines Hub. Since November last year, families with young children living in the East have been able to access health services and parenting programmes close to home at FamNex@OTH. Over the next few months, a wider spectrum of services and programmes for families will be added on with more partnerships forged, providing holistic support for families. 

6. For example, the father can bring his elder child to the library for reading programmes while waiting for the mother and their newborn child who are receiving support on recommended childhood developmental screening and lactation support from Family Nexus. The family could attend parenting programmes organised by Family Nexus before enjoying a meal at OTH or participate in family-oriented sports activities by ActiveSG. 

7. One such family who has benefitted from the Family Nexus’ support is Mdm D and her family who reside in Tampines. The FamNex@OTH team noticed that her children frequently hang out at the community space. With the help of the volunteer from the Family Service Centre, Mdm D was connected to the FamNex team from SingHealth and shared her concerns on the health conditions of her children, including her observation that one of her children might be slower in development. The FamNex community nurses followed up with a comprehensive health assessment for her children with the support of a paediatric nurse from KK Women’s and Children’s Hospital (KKH) and provided Mdm D with guidance and knowhow to better care for her children’s health conditions. This includes educating her on the right medication to manage asthma for one of her children, working out a plan to support her children’s development and equipping Mdm D with educational resources and visual aid to guide her in monitoring her child’s behaviour and symptoms. Mdm D has also attended parenting workshops to pick up relevant parenting skills. With the support from FamNex@OTH and other partners, Mdm D is now more confident and equipped to care for her children aged 2 to 18 years old. 

8. Integrated hubs like FamNex@OTH will be rolled out to more sites across Singapore, at Choa Chu Kang and Punggol, supporting more families. Family Nexus@ Sembawang will also be ready when the new Sembawang Polyclinic opens at Bukit Canberra later this year. 

9. Chairman, we will also continue to roll out mother-child dyad services at our polyclinics nationwide, enabling more children and mothers to benefit from services such as vaccination, childhood developmental screenings, breastfeeding and lactation support, and maternal mental health screening. Parents and children can receive support concurrently at a single session without making multiple trips. 

10. Today, there are nine polyclinics which offer mother-child dyad services, an increase from the two polyclinics a year ago. We will roll out these services to several more polyclinics by the end of this year and are ahead of our target to scale these services to 14 polyclinics by 2025. 

Going upstream in preventive health

11. We are investing more in upstream measures to help families keep healthy. This is in line with the Healthier SG effort on preventive health. 

12. To improve the health outcomes of our women and children, we are going upstream starting from as early as at the pre-conception stage. Ensuring that couples are supported throughout the different stages of their parenthood journey. 

13. In addition, to ensure that we address emerging issues and trends in a relevant manner, we need to adopt an evidence-based approach and be informed by research. Findings from local studies such as the GUSTO (Growing Up in Singapore Towards Healthy Outcomes) have shown that maternal depression and anxiety affects the brain development of the fetus which could give rise to vulnerability to mood and anxiety disorders in the child’s later life, as well as their readiness for school. This is not a foregone conclusion, fortunately. Early identification and intervention will help. 

14. I’m glad that hospitals and professionals are tapping into this evidence-based finding in designing services and resources. Last month, KKH together with the College of Obstetricians and Gynaecologists Singapore launched the Perinatal Mental Health Guidelines. These guidelines provide comprehensive advice to better address maternal depression and anxiety during the preconception, antenatal and postnatal phases. These guidelines are readable, and I encourage all, from family physicians, general practitioners to social workers and couples themselves to reference them. 

15. Early detection of diseases is key to enable timely intervention to achieve good health outcomes. Which is why we have encouraged our residents to take up the appropriate health screening programmes.

16. Similarly, early identification and intervention are key to support maternal mental health.  Hence, I’m pleased to learn that KKH has implemented the Psychological Resilience in Antenatal Management (PRAM) since last December. Under this programme, all pregnant women receiving outpatient obstetric care at the hospital can access universal antenatal mental health screening and will be referred to the necessary care if they have depressive symptoms.

17. Through these efforts, families will be supported in keeping healthy through the various chapters of their lives.   

EMPOWERING FAMILIES TO KEEP HEALTHY 

18. We will empower parents, providing them with more evidence-based resources and practical help to raise healthy and happy children. 

19. Our children today grow up in a world of digital services. However, the best practices on the use of such devices are not always clear. I can understand that many parents would be concerned to learn that studies such as GUSTO show that early passive screen use for young children especially those under 18 months old has been associated with poorer language skills and shorter attention spans when the children are in primary school. 

20. To provide more practical help to parents, I am pleased to launch the advisory on screen use for children aged 0-12 years old. The advisory has been developed by an expert panel comprising professionals from healthcare, social and educational sectors. It provides useful tips such as for parents to be role-models for positive screen-use behaviours and set boundaries on screen use with children. We hope that it will be a helpful guide for parents, educators, and more. 

21. We share the same view as Dr Wan Rizal that we need to do more to support fathers. The role that fathers play in early childhood development may not be well-known, but it is no less important. Studies such as SG LEADS show that fathers play a sizeable role in the development of a child’s self-regulation and ability to delay enjoyment. This refers to the ability to defer short-term enjoyment for longer term gain, an important predictor of ability and academic achievement.  

22. Hence, it is important that we support the mental well-being of fathers too, to keep them well. I am glad to share that NUH will be extending its mental health screening and support to the fathers of children and husbands of women under its care. 

23. Besides parents, we will also leverage existing natural touchpoints such as schools and pre-schools to do more, to give every child a good headstart in keeping healthy.

24. We will be enhancing school health and pre-school health programmes to provide a more comprehensive and holistic school health package for students to foster good healthy habits from young. More details will be announced together with Ministry of Education and Ministry of Social and Family Development (MSF) later this year.

25. Ultimately, we want to empower families to take charge of their health and enable families to flourish.

SUPPORT FOR LOWER INCOME FAMILIES

26. We recognise that some families may need more support. For such families, a single health event can be destabilising. Early detection and intervention will prevent small issues from snowballing into larger problems later. Keeping families on an even keel and helping them achieve stability, self-reliance, and ultimately social mobility.

27. I agree with Mr Xie Yao Quan that we can do more to integrate health and social services to provide more holistic support for lower-income families.

28. We have made progress. Today, public healthcare institutions are in partnerships with Social Service Offices (SSOs) to jointly support lower-income residents in their region.

29. For example, Changi General Hospital (CGH) community care staff and SSO officers work together as one team at SSO@Bedok. When families come to SSO@Bedok for financial assistance, CGH community nurses take the opportunity to assess their health needs and provide support such as advice on recommended health screenings. Clients with health concerns are referred to the community nurses who are stationed onsite at SSO@Bedok, and who will liaise with their primary care doctor if there is a need. For those who are unable to make a trip down to the SSO, the community nurses visit them at home together with the SSO officers to offer support and help.

30. We are also improving lower-income families’ access to health promotion programmes. Last year, HPB worked with community partners such as People’s Association, M3@Towns and ComLink, to proactively reach out to lower income families with young children, supporting them with resources and encouragement to facilitate healthier lifestyle choices such as buying groceries with healthier choice symbol and engaging in regular physical exercises.

31. This year, we will be enhancing efforts to support lower-income families through two regional pilots, in collaboration with social agencies and pre-schools. Supporting these families in accessing health services and providing wraparound support for both parents and children. This involves redesigning the care model and services around these families, facilitating health and developmental screenings, equipping pre-schools and social agencies to identify and refer at-risk pre-school children for further assessments, equipping parents through home visits, and fast-tracking referrals for medical appointments where needed.

32. In the Northeast Region, SingHealth will lead cross-domain and multi-agency efforts to support children from low-income families through Project HOME (Holistic Management & Enablement). These efforts will build on the efforts of existing programmes like KidSTART and ComLink.

33. Healthcare agencies like Sengkang General Hospital (SKH), KKH, Punggol Polyclinic will partner My First Campus preschools as well as social services agencies, the SSOs and Family Service Centres to jointly support case management of children under six years old.

34. A similar pilot will be rolled out in the West by NUH through the HEADS-UPP (HEAlth and Development SUpport in Preschool Partnerships) programme. NUH will partner Care Corner and PCF Sparkletots preschools in the West.

35. These pilots will provide deeper insights on how we could further strengthen cross-domain collaborations to better support lower income families. If they are proven effective, we will explore scaling them nation-wide to benefit even more families.

36. With Healthier SG, we expect these collaboration to be further deepened, particularly with polyclinics and the Primary Care Networks.

SUPPORT FOR CAREGIVERS

37. Last but not least, we are also enhancing support for caregivers who are the cornerstones of our families’ well-being. Like Mr Gerald Giam and Ms Carrie Tan, we recognise that caregivers play a significant role and must be supported well.

38. The Government has enhanced our support for caregiving for families over the years. In 2019, we introduced the Caregiver Support Action Plan that outlined key initiatives in the areas of financial support, respite care, caregiver empowerment, workplace support and care navigation.

39. Last year, we shared more initiatives to recognise caregivers’ contributions and ease their burden when we debated the White Paper on Singapore Women’s Development.

40. MOH has recently enhanced the Home Caregiving Grant (HCG) to further defray the costs of caring for seniors and those with disabilities. From this month, those who are eligible will start receiving enhanced payouts of either $400 or $250 per month, up from the current $200, with more support provided to the lower income. This already covers households earning up to median income per household member.

41. As Minister Ong shared earlier, we are also taking steps to further improve affordability for those receiving care at home, as part of the holistic shift for healthcare services to be more premises-neutral and care-centric.

42. For those taking care of very frail seniors, there are around 60 nursing homes which offer residential respite care. Others could tap on various subsidised eldercare services, such as home and day care services for respite.  

43. For those families with lighter caregiving needs, Ministry of Manpower (MOM) has earlier shared that it will expand the scope of the Household Services Scheme (HSS) to provide basic child-minding and elder-minding services. This will offer an additional option for families.  More details will be shared by MOM at a later time.

44. There have also been suggestions to enhance family care leave.  Beyond legislating leave provisions, it is more critical and sustainable for caregivers to be provided with family-friendly work environment, to help them balance work and caregiving responsibilities. We will continue to enhance efforts to support a more family-friendly work culture including promoting flexible work arrangements (FWAs).

45. We are also enhancing support to persons with disabilities and their caregivers in building an inclusive Singapore and we will share more about our plans later during MSF’s COS.

CLOSING

46. In closing, healthy families lay a foundation for a strong society. We want to empower families to sustain their health through the chapters of their lives. Making it easier for families to access services and enhancing support for caregivers. Adopting a preventive health approach to better support fathers, mothers, and their children, maximising their well-being and helping their children achieve their fullest potential in life. Creating a Singapore that is truly Made for Families. Thank you.