Charting the path for (a) Healthier SG | MEDICUS 2023 Issue 4

Charting the path for (a) Healthier SG

By Sruthi Jagannathan, Senior scientific editor

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In a commentary recently published in The Lancet, a team of public health experts, led by researchers from the National University of Singapore’s Saw Swee Hock School of Public Health and Duke-NUS’ Health Services and Systems Research Programme, has identified three factors that are critical to the success of Healthier SG—a major health reform rolled out by Singapore’s Ministry of Health in July this year, to enhance the health and wellbeing of residents.

Coming in the aftermath of the COVID-19 pandemic that exposed chronically-ill patients as the weakest links of a nation’s public health network, the Healthier SG initiative demonstrates the country’s commitment to re-align its primary healthcare strategy into one that prioritises proactive measures of “preventing sickness and enhancing wellness” as much as the reactive measures of “caring for the sick”, the researchers wrote.

However, from launch to large-scale implementation, the success or effectiveness of the programme will eventually be defined by the enrolment rate of residents and general practitioners (GPs), and the sustenance of their partnership over the years.

“For any policy to sit well with all stakeholders, in this case, GPs, community care providers, patients and policymakers from other sectors, an all-stakes, all-perspectives approach must be taken. This will ensure that the cracks which had emerged from the misalignment of expectations and aspirations from previous national-level transformation strategies do not surface in Healthier SG”, noted first author Dr Foo Chuan De, who is a regional leader for the International Working Group on Health Systems Strengthening for the Western Pacific and a research fellow at the Saw Swee Hock School of Public Health.

By studying previous such transformation strategies and through discussions with various stakeholders, the team identified three “cracks” that will need to be addressed to seal the programme’s success.

Firstly, the programme requires patients to trust their GPs. Enrolment into the programme is voluntary at the moment, and linking more than a million residents with a GP of their choice in the coming years is going to be daunting.

“There should be incentives for the people to treat their GPs as their predominant point of contact within the health system”, said Foo.

While this could include benefits like free health plan consultations and free nationally recommended health screenings and vaccinations upon enrolment, residents should eventually feel confident in entrusting their health journey, which may be riddled with several personal and sensitive issues, with their chosen GP. Positive experiences of enrolled family members, friends and neighbours may engender trust and motivate more residents to sign up for the programme.

But it is not just residents who need to be motivated to sign up. Ensuring GPs’ needs are considered was the second “crack” the researchers point to.

Portrait of Foo Chuan De

Dr Foo Chuan De advocates adopting an all-stakes, all-perspectives approach in ensuring the success of the Healthier SG programme // Credit: Foo Chuan De

Beyond their traditional role as a clinician who provides precise and timely diagnosis and treatment to patients, GPs now have to transform into health coaches who guide their patients through their personalised health plans, track their long-term health status and suggest timely and relevant interventions, such as community support services, health screenings and vaccinations.

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GPs also have to tread unchartered territory, such as collaborating with community care providers, government agencies while having to optimise new administrative workflows. Since these additional duties place a significant strain on their already heavy workloads, lack of adequate support would dissuade them from participating in the programme, the researchers found. It is, therefore, imperative that the government provides them fair salary compensations, clear guidelines on administrative workflows, and superior infrastructural capabilities to honour their time and efforts, urged the researchers in their paper.

Portrait of David Matchar

Professor David Matchar emphasises the importance of a three-pronged approach in maximising the effectiveness of Healthier SG// Credit: David Matchar

The third “crack” to consider after trust and motivational barriers have been removed, is the IT infrastructure backbone. This should provide a seamless, interactive, and rewarding user experience in order to sustain interest in the programme. While residents can already make use of the Healthy 365 mobile app and fitness trackers to adopt healthier lifestyle choices and stay on top of their health status, the focus is now on upgrading clinic management systems to streamline administrative workflows and integrate patient data with the National Electronic Health Records.

“A more automated and interoperable IT system that is easy to navigate amid a busy (clinical) day is a good starting point”, quipped Foo on how the adoption of digital solutions will address this important need.

This could be beneficial when sharing large volumes of data across the healthcare sector during the mass implementation of the programme.

As the nation gears up for the phased implementation of Healthier SG, new cracks are likely to emerge. “By proactively addressing such cracks, we can maximise the programme’s effectiveness,” said Professor David Matchar from Duke-NUS’ Health Services and Systems Research Programme, “And achieve the desired outcomes—a heathier population and a more robust healthcare system that will significantly strengthen the country’s resilience and response to any future public health crises.”