Update On Child and Maternal Health and Well-being Taskforce

NOTICE PAPER NO. 2872

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 2 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 6222

To ask the Minister for Health (a) what is the impact and utilisation of the Family Nexus sites established at Tampines, Punggol, Sembawang, and Choa Chu Kang; (b) what feedback has been received from the community; and (c) whether there are plans for expanding such sites to other regions.

NOTICE PAPER NO. 2877

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 2 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 6229

To ask the Minister for Health with regard to the report from the interagency Child and Maternal Health & Well-being (CAMH) Taskforce published on 14 June 2024, what measurable outcomes have been observed from the 28 initiatives that have been implemented so far.

NOTICE PAPER NO. 2904

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 2 JULY 2024

Name and Constituency of Member of Parliament

Ms Hany Soh

MP for Marsiling- Yew Tee GRC

Question No. 6234

To ask the Minister for Health with regard to the setting up of Family Nexus sites under the Child and Maternal Health & Well-being Taskforce's Strategy and Action Plan (a) what is the timeline for rolling out this plan; and (b) when can residents of Woodgrove division expect to have access to such facilities at the Woodlands Polyclinic and other community spaces within Woodlands town.

NOTICE PAPER NO. 2880

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 2 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 6241

To ask the Minister for Health how is the effectiveness of the key initiatives for the mental health screening and support for mothers, as provided in the report from the interagency Child and Maternal Health & Well-being (CAMH) Taskforce published on 14 June 2024, being evaluated.

NOTICE PAPER NO. 2883

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON 2 JULY 2024

Name and Constituency of Member of Parliament

Ms Ng Ling Ling

MP for Ang Mo Kio GRC

Question No. 6257

To ask the Minister for Health with regard to the Strategy and Action Plan set out in the Child and Maternal Health & Well-being Taskforce report (a) whether there will be resources provided for ground-up or grassroots efforts to support the action plans; and (b) how long will it take for Family Nexus centres which provide integrated health and social services for families with young children

and couples planning for marriage and parenthood to be established at all polyclinics in Singapore.

NOTICE PAPER NO. 2872

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 3 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 6223

To ask the Minister for Health (a) what guidelines and educational resources are being provided to parents to manage their children's screen use of mobile devices; and (b) how is the Ministry ensuring widespread awareness and adherence to these guidelines.

NOTICE PAPER NO. 2872

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 3 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 6224

To ask the Minister for Health (a) how is the Ministry ensuring that lower-income families receive adequate health and social services support through initiatives like Project HOME (Holistic Management and Enablement) and HEADS-UPP (HEAlth and Development SUpport in Preschool Partnerships); and (b) whether data can be provided on the reach and impact of these initiatives on the target population.

NOTICE PAPER NO. 2881

NOTICE OF QUESTION FOR ORAL ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 3 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 6253

To ask the Minister for Health in respect of the report from the interagency Child and Maternal Health & Well-being Taskforce published on 14 June 2024 on the stable yet concerning rates of childhood obesity (a) whether the Ministry is taking additional steps apart from the initiatives provided in the report to address this issue; and (b) whether there are any new additional partnerships planned to promote physical activity and healthier eating habits among children.

NOTICE PAPER NO. 2872

NOTICE OF QUESTION FOR WRITTEN ANSWER

FOR THE SITTING OF PARLIAMENT ON 2 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 5889

To ask the Minister for Health (a) what progress has been made in integrating health and social services to support child and maternal health more effectively; (b) whether there are any identified challenges; and (c) if so, how is the Ministry addressing them.

NOTICE PAPER NO. 2872

NOTICE OF QUESTION FOR WRITTEN ANSWER

FOR THE SITTING OF PARLIAMENT ON 2 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 5890

To ask the Minister for Health given Singapore's low maternal and infant mortality rates, what steps are being taken to address emerging concerns such as the rising age of mothers at childbirth and the incidence of low birth weight in newborns.

NOTICE PAPER NO. 2881

NOTICE OF QUESTION FOR WRITTEN ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 3 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 5910

To ask the Minister for Health (a) whether an update can be provided on the new perinatal mental health guidelines on depression and anxiety and the universal antenatal mental health screening programme introduced in 2023; (b) what has been the response from healthcare providers and patients; and (c) how is the Ministry monitoring the programme's effectiveness.

NOTICE PAPER NO. 2881

NOTICE OF QUESTION FOR WRITTEN ANSWER

FOR THE SITTING OF PARLIAMENT ON OR AFTER 3 JULY 2024

Name and Constituency of Member of Parliament

Dr Wan Rizal

MP for Jalan Besar GRC

Question No. 5911

To ask the Minister for Health (a) how is the Ministry expanding community-based health services to support children, adolescents and women; (b) what role do community nurses play in this expansion; and (c) how is the impact made by community nurses being assessed.

Answer

1 Mr Speaker, may I have your permission to answer PQs 5889, 5890, 5910, 5911, 6222, 6223, 6224, 6229, 6234, 6241, 6253, 6257 together? My response will also cover the matters raised in both the oral and written questions by Dr Wan Rizal, which are scheduled for a subsequent Sitting. If he agrees that the questions have been addressed, it may not be necessary for him to proceed with the Questions for future sittings, Sir.

2 The Child and Maternal Health & Well-being (CAMH) Taskforce published its Strategy and Action Plan report on 14 June 2024. In the report, we set out action plans to help keep mothers and children healthy, tackling challenges such as the rising age of first-time mothers and incidence of childhood obesity. The various initiatives are designed to serve families better by wrapping both health and social services around them. Of the 48 initiatives, 28 have been rolled out and the remainder will be progressively implemented over the next two years.

3 Dr Wan Rizal asked about the progress and evaluation of various initiatives. As the 28 initiatives have only been rolled out over the last two years, we will evaluate them from 2025 onwards, based on their effectiveness in achieving their intended outcomes, and other dimensions such as participation rates. In particular, Dr Wan Rizal asked about the reach of Project HOME

(HOlistic Management & Enablement) and another project - HEADS-UPP (HEAlth and Development SUpport in Preschool Partnerships). As of mid-2024, Project HOME has enrolled more than 100 families in the North-East region, while HEADS-UPP has onboarded 147 children in the West. Just to remind members, these are pilots and therefore, small cohorts are involved. On how we are evaluating the key initiatives related to mental health screening and support for mothers, we will obtain feedback from participants, and monitor the percentage of pregnant women identified and received appropriate follow-up care, and the improvement in their postpartum mental health.

4 Let me move on to the progress of other maternal and child health initiatives. Dr Wan also mentioned some areas for improvement, which the Taskforce had identified - rising age of mothers at childbirth, low birth-weight, and maternal mental health. We have addressed these in three ways.

5 First, we make more information available to all as early as possible. We do this by increasing access so that everyone can self-help, by publishing guidelines and providing bite-sized information on Parent Hub and other websites. The guidelines also help frontline providers in their work in supporting families. Second, we are introducing more accessible programmes, such as community antenatal education programmes at Choa Chu Kang by the National

University Hospital System (NUHS) and at Family Nexus sites by healthcare clusters. Third, our public healthcare system proactively identifies those who are at-risk or need more help, and offers additional support as needed.

6 Across KK Women's and Children's Hospital (KKH) and National University Hospital (NUH), all pregnant women will be screened for mental health conditions, and those who need help will be provided follow-up care. KKH provides a Psychological Resilience in Antenatal Management (PRAM) programme to provide antenatal mental health screening, materials on mental health during obstetric visits, and follow-ups with women at risk of developing postnatal depression. NUH runs the ProPEL programme, which stands for promoting Parental emotional health to Enhance child Learning (ProPEL) and similarly identifies patients to ensure timely follow-up and care. NUH has also extended their Women's Emotional Health Service programme to women receiving care at NUH up to six years after their children are born, up from the follow-up period of one year previously, to ensure mothers receive adequate support. The programmes at KKH and NUH have benefited over 2,200 women.

7 Let me now turn to how the CAMH strategy is addressing childhood obesity. Childhood obesity is a significant risk factor for developing obesity and other chronic illnesses later in life. Proper diet, sufficient physical activity and sleep, and balanced screen use can minimise sedentary lifestyles and reduce obesity. Multiple agencies across the health, education and social domains have worked together to introduce various measures to tackle childhood obesity. In the area of nutrition, we put out a set of guidelines for feeding and eating in infants and young children in February 2024. HPB is working with preschools and mainstream schools to provide healthier meals for students.

8 To ensure children have sufficient physical activity, preschools and schools are catering time for physical activities, and raising awareness of the need to remain physically active. The Government and schools cannot do this alone. Behaviours still and will need to be sustained both in and out of school-time to be effective. We will continue to engage parents, and encourage partners to improve access to healthier choice meals and physical activities in the community.

9 To help families better manage screen use and encourage balanced screen-time in children aged 0 to 12, we issued the Guidance on Screen Use in Children in March 2023. The advisory has been disseminated to medical associations, polyclinics, General Practitioners, preschools, and are available as resources on Parent Hub and Parents Gateway for parents of MOE students. Some polyclinics

have also incorporated screen use check-ins and education as part of child health visits. The four Family Nexus pilot sites are actively engaging parents on screen use habits of children.

10 Over the past months, MOH and MSF have been discussing the need for more decisive and effective measures to shape the habits of device usage. MOH and MSF oversee the key touchpoints for children up to 6 years old, through healthcare, and preschool touchpoints. We will make our advice clearer and more definitive, deliver them consistently across all healthcare settings, with more reminders, put them into practice in preschools and find ways to encourage their adoption at home. We will share more about these efforts in coming months.

11 Finally, let me turn to addressing the questions around integrating health and social services, and how this is being done via the Family Nexus concept. Family Nexus brings together the health and social support services that families need. We have so far introduced the Family Nexus initiative across four sites to improve coordination and make it easier for families to access the support they need.

12 There has been positive ground feedback received on Family Nexus, from both partners and families. For instance, FamNex@Bukit Canberra has attracted more than 1,500 participants since it began operations in November 2023, reflecting a keen interest among parents and caregivers to engage in educational and wellness building activities with their children. In terms of referrals, FamNex@OTH had received more than 380 cases from community nurses since its soft-launch in November 2022 while FamNex@Punggol had referred more than 500 cases to Social Service Agencies from December 2023 to May 2024. We are tapping on these pilot sites to test out different models of bringing together partners to offer co-located programmes and services. MOH will study which elements of these models are most effective and explore how they can be scaled to residents in other regions.

13 Mr Speaker, having access to integrated services is especially important for lower-income households and vulnerable groups. I mentioned Project HOME and HEADS-UPP earlier in my response. MOH works closely with MSF, MOE, and community partners to provide holistic health and social support through these two initiatives. Social workers and preschool educators are equipped with skills to identify and refer preschool children who are at-risk of health, developmental, behavioural and dental issues to KKH (for Project HOME) or NUH (for HEADS-UPP) for further assessment. Home visits are made to families who have more complex needs to provide additional support to the parents, and to enable fast-tracking of referrals for medical appointments as needed.

14 To improve access, we have expanded community-based services to support children, adolescents and women in the community. They can now access services such as antenatal classes, breastfeeding and lactation support and screening for maternal mental health at polyclinics and Family Nexus sites closer to home.

15 Our community nurses and other frontline colleagues play a key role in ensuring that services in the community are integrated and delivered well. They support families and children with their specialised skills, such as growth and developmental assessment, and counselling on common childhood illnesses and allergies. In addition, they help to link and direct families to other related services. We will need to continue to count on them to care for families.

16 Dr Wan Rizal asked about the challenges we faced. Let me touch on this briefly before I end. There is still much to be done and many of these initiatives require close coordination among multiple partners and stakeholders. We also need to raise awareness of the importance of anchoring healthy behaviours as early in life as possible. I encourage everyone to share the report and resources such as Parent Hub more widely to families, during programmes and healthcare appointments, and via schools and Government platforms, so that more families can benefit, and we can better help the next generation to grow well and realise their potential.