Speech by Mr Amrin Amin, Senior Parliamentary Secretary, Ministry of Health and Ministry of Home Affairs, at the Ministry of Health Committee of Supply Debate 2020, on Thursday 5 March 2020

Beyond Healthcare to Health – going upstream and supporting healthy living. This is part of our ongoing transformation.

2.      To push this transformation, we will do three things which I will cover in my speech:

•       The first, better financial support.

•       Second, community partnerships.

•       Third, better use of technology.

Better Financial Support

3.      On better financial support, we want Singaporeans, regardless of income or social background, to enjoy good health. We will do so in a fiscally sustainable, targeted and effective manner.

4.      I am happy to announce three initiatives.

a)      First, full subsidies for nationally recommended childhood vaccinations and developmental screening.

b)      Second, subsidies for nationally recommended adult vaccinations.

c)      Third, subsidies for nicotine replacement therapies for eligible participants at smoking cessation pilots.

The effective dates for the vaccination subsidies and child developmental screenings will be before the end of 2020 – exact dates will be announced later.

5.      Today, only recommended childhood vaccinations against infectious diseases with high outbreak potential such as measles and diphtheria receive full subsidies, and this is only available at polyclinics in the primary care setting. There are currently no subsidies for adult vaccinations and smoking cessation in the primary care setting.

Subsidies for NCIS Childhood Vaccinations and Developmental Screening

6.      Full subsidies will be given to Singaporean children for all vaccinations recommended under the National Childhood Immunisation Schedule or NCIS. These also include pneumococcal and HPV vaccines.

7.      Subsidies will be available at polyclinics, and at Community Health Assist Scheme (CHAS) general practitioner (GP) clinics across Singapore.

8.      For Singaporean children up to the age of six, full subsidies for child developmental screenings will be extended from polyclinics to include CHAS GP clinics.

9.      We are doing this to ensure early detection and timely intervention for developmental delays for all Singaporean children.

10.     This measure is part of our ongoing efforts to ensure Singapore remains one of the best places to raise a child, so I urge parents to take advantage of the free vaccinations to give our children the best possible start.

Subsidies for Adult Vaccinations

11.     All eligible Singaporean adults will enjoy subsidies for vaccinations under the National Adult Immunisation Schedule or NAIS at polyclinics and CHAS GP clinics.

12.     The NAIS covers seven types of vaccines that protect against 11 diseases, including influenza and pneumococcal disease. NAIS recommends vaccination to two main groups of adults: (a) the first group, persons with certain medical conditions such as diabetes, chronic heart diseases and chronic respiratory diseases, and (b) the second group, seniors aged 65 years and above.

13.     Subsidies will be means-tested. At polyclinics, eligible lower to middle income Singaporeans will get 75% subsidy. This corresponds to CHAS Blue and Orange cardholders at CHAS GP clinics. Other eligible Singaporeans will get 50% subsidy for the vaccinations. Pioneer Generation get an extra 50% subsidies and Merdeka Generation get an extra 25%, off the remaining co-payment amount.

14.     Let me illustrate. Now Singaporeans pay about $70 to $80 for PPSV23 pneumococcal vaccination at a polyclinic. Assuming you fall within the NAIS recommendations and qualify for the subsidies, you can expect to pay about $20 to $40, depending on means-test. Pioneer and Merdeka Generation gets additional subsidies.

15.     Singaporeans can continue to pay out-of-pocket amounts using MediSave.

16.     Singaporean adults will receive similar means-tested subsidies for these vaccinations at CHAS GP clinics. We will share details when ready.

17.     To ensure vaccination subsidies are passed to eligible Singaporeans at CHAS GP clinics, MOH will introduce fee caps for NAIS and NCIS vaccinations done at CHAS GP clinics. MOH have also worked with vaccine manufacturers so CHAS GP clinics can get these vaccines at favourable prices.

18.     We are studying ways to help those who may have difficulties going to polyclinics and CHAS GPs, such as nursing home residents, to benefit from these subsidies.

19.     I mentioned earlier about providing subsidies in a fiscally, sustainable and targeted, effective manner. Let me explain.

20.     First, the NAIS scopes the group of people whom the Expert Committee on Immunisation has assessed to be more vulnerable to certain diseases and are therefore recommended for the vaccinations. So targeted group based on need.

21.     Second, our aim is to reduce the number of people who fall ill from vaccine-preventable diseases. Singaporeans with chronic medical conditions are particularly vulnerable and fall sick more easily. If diseases can be prevented, we can gain system-wide savings in the long  run. Essentially, this is what we are doing: keep out vaccine-preventable diseases through vaccinations, keep our people out of hospitals, and keep them healthy.

22.     Mr Perera asked about the coverage of childhood vaccinations and how we can raise adult vaccination coverage in Singapore.

23.     Coverage for childhood vaccinations in Singapore is high, with most vaccinations exceeding 95% coverage in the past five years. This is due to efforts in health promotion, comprehensive childhood immunisation services and a robust school health service. All childcare centres and kindergartens require immunisation certs for compulsory vaccinations under NCIS before enrolment. Parental inertia and lack of awareness are some of the reasons a small minority of children are not vaccinated.

24.     We have a two-pronged approach to increase children and adult vaccinations: the first is to make vaccinations affordable through subsidies and the second, public education. Public education has taken on renewed importance with misinformation from the anti-vaccination camps.

25.     We aim to increase vaccination coverage among adult Singaporeans to over 50% by 2025.

Subsidies for Nicotine Replacement Therapies

26.     Smokers will get more support to quit. Subsidies will be given for nicotine replacement therapy, if found suitable, in smoking cessation pilots.

27.     New smoking cessation models will be piloted in our public healthcare institutions such as hospitals, polyclinics and our national specialty centres.

28.     Singaporeans can benefit from:

•       intensive behavioural support,

•       follow-up for up to a year, and

•       a three-month nicotine replacement therapy, if found suitable.

MOH is evaluating the pilot proposals.

29.     The pilots will target 10,000 smokers. We plan to start the pilots after public healthcare institutions resume normal operations. This will depend on how COVID-19 situation develops.

30.     Mr Charles Chong asked about existing measures to help smokers to quit, and their efficacy.

31.     Success rates for smoking cessation programmes in Singapore have ranged from 10% for telephone-based interventions to 20% for programmes that combine intensive counselling and pharmaco-therapy.

32.     Smoking is one of the biggest risk factors for poor health. Standardised Packaging for tobacco products will start in July 2020. The minimum legal age for smoking will be raised to 21 next year. This will set a good momentum to drive down our smoking rates further.

33.     I shared in 2018 our stretch target of reducing our smoking rate to below 10% by 2020. Smoking rate in Singapore dropped to 10.6% in 2019. We will do our best to reach that stretch target.

Better Community Partnerships

Working with the Community

34.     SPS Faishal asked about community health promotion activities.

35.     Indeed cultural connections and understanding are strengths we are tapping on to mobilise the community towards a healthy cause.

36.     HPB’s Jaga Kesihatan, Jaga Ummah (JKJU) – which means take care of health, take care of community – is one good example. JKJU started in August 2017. JKJU brought together MUIS, 28 mosques and Malay Activity Executive Committees. I am proud they have reached out to over 35,000 Malay participants in 2019. This is important. Involving the community, empowering community institutions to take ownership and mobilise people to action. Truly a healthy development!

37.     Masjid Maarof organised piloxing, zumba, a skit on coping with dementia, and urged congregants to give up a cigarette puff for a less calorie curry-puff (“Puff for a Puff”). Masjid Al-Ansar offered circuit training and stretch-band exercises for seniors.

38.     We are stretching out to involve more partners and people. Our Regional Health Systems (RHSes) will partner JKJU to bring more quality programmes and deepen outreach. This will help greatly. It is a promising partnership. Because RHSes treat patients who are residents in the area, they know the local ailments and the common problems within the community.

39.     RHSes can help local partners like JKJU shape programmes, provide targeted interventions customised to local needs, and offer medical expertise to raise awareness on community trending topics.

40.     I am also proud of the excellent work of Chinese and Indian community groups.

•       27 churches and 10 temples have worked hard to organise health promotion programmes, from health screenings, National Steps Challenge roadshows to physical activity workouts.

•       The Hindu Endowment Board, SINDA and Narpani and various places of worship partnered HPB and reached out to 5,000 people in 2019.

•       The Hindu Endowment Board partnered National Healthcare Group to conduct health screenings for 1,500 people at Sri Perumal Temple in 2019.

Working with lower-income families

41.     SPS Baey asked about helping lower-income Singaporeans stay healthy.

42.     HPB will pilot the “Healthy Living Passport” in mid-2020, beginning with five sites located in Boon Lay, Woodlands, Jurong Spring, Chua Chu Kang and MacPherson. We aim to reach at least 15,000 residents, about 5,000 families, over a three-year period.

43.     Healthy Living Passport seeks to improve health literacy and promote healthy lifestyles, customised to the needs of lower-income residents.

44.     Lower-income residents have specific concerns. They shared with us about working shifts, not having enough sleep and missing out on various community exercise programmes. They shared that healthier food such as vitamins, vegetables and low-calorie options, tend to be more expensive. They raised stress as a concern and many, unfortunately, turned to smoking to unwind. We cannot brush these concerns aside And we should try to address them and hear them out.

45.     Healthy Living Passport is a modest effort, a sincere outreach to help our fellow Singaporeans lead healthy lives. Let’s work together!

46.     We are still working out the exact parameters of the Healthy Living Passport. Broadly, we are focusing on equipping participants with knowledge on shopping for budget, healthier ingredients, prepare healthier, tasty meals, and promote physical activity, oral health and mental wellness.

47.     We are targeting to impart health tips to both parents and children in a fun and interactive way.

48.     Volunteers from HealthySG Buddies will encourage and support families to use this Healthy Living Passport and embark on a meaningful and fulfilling journey.

Supporting Partners to Deliver Better Care

49.     Mr Charles Chong asked about how MOH empowers and supports community care providers.

50.     We are committed to supporting community care partners deliver better care to Singaporeans.

51.     One way is through funding support. An example is the Tote Board Community Healthcare Fund. This fund helps non-profit organisations pilot and scale innovative projects in preventive health and community care. The Tote Board Community Healthcare Fund has committed approximately $230 million since FY2009.

52.     The Tote Board Community Healthcare Fund funds the Wellness Support Package. This package supports nursing homes to upskill their manpower and implement senior-friendly activities such as table-top gardening and wheelchair taichi. Seniors enjoy these activities and homes reported improvement in seniors’ mood, well-being and self-esteem. 25 nursing homes have benefitted from this.

Working with Other Agencies

53.     We are working more closely together. For instance, the RHS-HPB Integrated Volunteer Network and the Shared RHS-HPB Learning Hub. We recruit, train and deploy HPB Health Ambassadors and RHS volunteers together to promote health in the community.

54.     Since April 2019, volunteers in the Integrated Volunteer Network reached out to over 4,000 patients and residents in areas such as rehabilitation, health screening and quit-smoking programmes.

55.     In 2020, we aim to bring volunteers from all public hospitals on board the Integrated Volunteer Network.

Leveraging Technology in Health Promotion

Greater Precision in Public Health

56.     Advances in technology present opportunities to better tailor programmes and messages, and engage residents and deliver effective health promotion programmes to the right person, at the right time, at the right place.

57.       In the next few years, HPB will develop a Population Health Data Hub. This will be a national data hub containing information such as demographics, lifestyle, and health information.

58.     The Hub will help us better understand Singaporeans’ lifestyle, behaviour and health. Interventions and nudges may be customised to individual’s needs and lifestyle, empowering behavioural change and driving health outcomes.  This will help us to better address the causes of ill health early, and reduce incidence of chronic diseases.

59.     We are developing a virtual Health Booklet (vHB) that can send personal reminders to empower individuals to better manage health. We expect to launch the virtual Health Booklet in end-2020.

Leverage Technology in Health Promotion

60.     We are making good progress with HPB’s National Steps Challenge™. Now in its fifth season, more than 850,000 participants have taken part. Participants have grown more active over time with more step counts and higher-intensity physical activity.

61.     Mr Chong asked about screening rates. Screening rates have gone up from 45.1% in 2010 to 66.3% in 2019. Under Screen For Life, over 62,000 individuals aged 40 and above have gone for cardiovascular screening at CHAS GP clinics. Of those with borderline and abnormal screening results, 84.4% have gone for medical follow up as at 9 Jan 2020.

62.     We want more Singaporeans to attend screening and follow up on their screening to reduce risk of developing chronic diseases. This year, we will pilot tele-coaching for people found to be at risk of cardiovascular diseases through the Screen for Life programme. HPB's health coaches will reach out to selected individuals and invite participants to work on health goals through HPB or other programmes.

63.     Mr Chairman, in Malay, please:

64.     Izinkan saya merakamkan setinggi-tinggi penghargaan kepada pegawai barisan hadapan yang memerangi virus COVID-19 dan berpesan tentang kepentingan menjaga kesihatan:

Gunung didaki terbongkar hutan,

Kagum putera melihat pelangi.

Wahai kakitangan kesihatan,

Kamulah wira yang kami sanjungi.

Putihnya awan jernihnya embun,

Menghias taman jadi sebutan.

Mencuci tangan berserta sabun,

Amalan harian dilupa jangan.

65.     Masyarakat sihat matlamat utama kami. Tidak kira pendapatan atau latar belakang, kami mahu warga Singapura menikmati kesihatan dan mutu kehidupan yang baik.

66.     Saya gembira untuk mengumumkan bahawa tahun ini, MOH akan memperkenalkan tiga subsidi baru:

•       Pertama, subsidi penuh untuk vaksin yang disyorkan untuk kanak-kanak dan pemeriksaan perkembangan kanak-kanak.

•       Kedua, subsidi untuk vaksin yang disyorkan untuk orang dewasa.

•       Ketiga, subsidi untuk terapi penggantian nikotin untuk mereka yang dipilih semasa sesi terapi berhenti merokok.

67.     Pertama, subsidi vaksin untuk kanak-kanak. Mereka akan mendapat subsidi penuh. Maknanya, semua jenis vaksin yang disyorkan di National Childhood Immunisation Schedule atau NCIS, termasuk pneumococcal dan HPV, diberi percuma untuk kanak-kanak warga Singapura.

68.     Subsidi ini ditawarkan di semua poliklinik dan klinik CHAS di merata Singapura.

69.     Subsidi penuh juga akan diberikan untuk pemeriksaan perkembangan kanak-kanak warga Singapura berumur enam tahun ke bawah, di semua poliklinik dan klinik CHAS. Pengesanan dan pemulihan awal dapat mendatangkan kesan lebih baik. 

70.     Melentur buluh biar dari rebungnya. Kita mahu anak-anak memulakan hidup mereka dengan sihat. Ini usaha berterusan untuk memastikan Singapura menjadi tempat yang unggul untuk membesarkan anak dan membina keluarga.

71.     Kedua, subsidi untuk vaksin yang disyorkan untuk orang dewasa.

72.     Subsidi akan diberi untuk vaksin yang disyorkan di bawah National Adult Immunisation Schedule atau NAIS untuk sebahagian tertentu warga dewasa Singapura:

•       Pertama, warga emas yang berumur 65 ke atas; dan

•       Kedua, mereka yang mempunyai penyakit kronik.

73.     NAIS merangkumi tujuh jenis vaksin yang melindungi 11 jenis penyakit, termasuk flu dan pneumococcal.

74.     Subsidi mengikut kemampuan individu.

75.     Di poliklinik, warga Singapura yang berpendapatan rendah dan pertengahan mendapati subsidi sebanyak 75 peratus. Secara umumnya, kumpulan ini memegang kad CHAS biru dan jingga.

76.     Warga Singapura yang lain mendapat subsidi sebanyak 50 peratus.

77.     Generasi Perintis mendapat tambahan subsidi sebanyak 50 peratus manakala Generasi Merdeka pula mendapat subsidi tambahan 25 peratus, daripada baki jumlah pembayaran bersama.

78.     Saya menggesa warga Singapura, terutama ibu bapa dan warga emas, untuk meraih manfaat dari subsidi ini. Pencegahan lebih baik dari rawatan.

79.     Warga Singapura boleh terus membayar baki jumlah ‘out-of-pocket’ melalui MediSave.

80.     Contohnya, vaksin pneumococcal (PPSV-23) harganya sekarang antara $70 hingga $80 di poliklinik untuk warga emas. Dengan subsidi, warga emas Singapura hanya bayar antara $20 hingga $40. Lebih kurang lagi jika Generasi Perintis dan Merdeka.

81.     Warga dewasa Singapura akan menerima jumlah subsidi yang sama jika mereka ke klinik CHAS. Kita akan umumkan butiran lanjut pada lain masa.

82.     Ketiga, subsidi untuk terapi penggantian nikotin untuk mereka yang menjalani terapi berhenti merokok.

83.     Satu daripada empat masyarakat Melayu Singapura merokok. Kita akan mulakan program perintis terapi berhenti merokok di institusi kesihatan awam selepas keadaan COVID-19 reda dan operasi kembali seperti sediakala.

84.     Program ini menyasarkan 10,000 perokok dan menawarkan

•       kaunseling,

•       terapi penggantian nikotin, jika sesuai, dan

•       konsultasi susulan sehingga setahun.

85.     Sudah terhantuk baru teng-adah. Jangan tunggu sakit baru hendak berhenti merokok.

86.     Banyak yang telah kita lakukan bersama. Antaranya, kempen

•       “Kita dah Cukup Manis” untuk kurangkan gula,

•       “Puff for a Puff” untuk buang tabiat merokok, dan

•       “Get fit for Haj/Umrah” serta “Gerak Gelak” untuk mempelawa semua untuk menjadi lebih aktif. 

87.     Terima kasih atas sambutan hangat dari masyarakat. Saya gembira dan yakin telah ada perubahan ketara.

88.     Saya mengalaminya sendiri. Semasa saya jalan hari raya, sering saya dihidangkan air putih dan diingatkan: “Kita dah Cukup Manis, ya”. Benar, cukup manis sekali!

89.     Ayuh kita perhebatkan lagi usaha kita bersama supaya kesihatan terjamin, kehidupan lebih manis!

Conclusion

90.     Mr Chairman, truly health is wealth. We are reminded of how quickly things can change and how fragile life is with COVID-19.

91.     Let’s support one another to stay healthy. Thank you.