| 4. In which ways is the initiative creative and innovative?
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Engaging the right partners was key to the success of this initiative. Constituency directors and Wellness managers were engaged early because of their strong knowledge of the beat on the street. They know best what the residents require as they interact with them most on various issues including health. With the needs analysis, HPB was then able to plan and solicit support from healthcare, corporate and community partners and associations such as GPs, dentists, physiotherapists, exercise therapists, optometrists, etc. sometimes, HPB also engages Health Sciences faculties of polytechnics.
Once the partners agreed that they would come on board, an appropriate location was sourced for. This was normally the Community Centre which had a multi-purpose hall big enough to accommodate various activities.
As Community Centres have regular activities, holding a special screening session may result in the postponement or rescheduling of some of the activities normally offered at the Community Centre. This is where the Grassroots leaders came in. They assisted in engaging the residents and generating a response to ensure a good turnout on the day of the screening activity. (Please refer to Annex A for Components of the One-Stop Screening Package)
HPB built on the health ecosystem infrastructure by engaging key stakeholders - community partners, healthcare partners, and health ambassadors - to offer more affordable screening and follow-up services to residents.
Key highlights of the programme include:
- “Door-step” person-centric screening services
- On-site follow-up
- Formation of local healthcare networks
- Engagement of health ambassadors
- Strategic partnerships
Through this multi-pronged strategy, HPB aims to address the needs of our ageing population with regard to early detection and optimal management of key disease conditions, helping our older adults to remain functional with a good quality of life, as they age-in-place. (Please refer to Annex B for the Integrated Functional Screening Solutions Framework)
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The project team built on the health ecosystem infrastructure by engaging key stakeholders – agencies like People’s Association, Ageing Planning Office (MOH), Agency for Integrated Care; community partners like Community Clubs, local grassroots organisations and VWO partners; healthcare partners like private GPs, dentists, pharmacists and allied health professionals as well as their respective organisations; corporate partners like eyewear companies; last but not least a dedicated team of trained health ambassadors.
The team recognised the need for continual engagement of the partners and through regular dialogue & networking sessions helped partners see the benefit and value of the project to the elderly residents. Great effort was put in to engage and work continually with all partners to fine-tune the work processes while obtaining regular feedback during the planning phase. This was done at regular inter-agency as well as cross-divisional meetings and with regular progress updates. After-Action Reviews were also conducted to obtain feedback that helped to further streamline work processes. The resultant SOPs were shared with partners through various channels.
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| 6. How was the strategy implemented and what resources were mobilized?
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In 2007, the Wellness Programme (WP) was piloted by the People’s Association (PA) and supported by the then Ministry of Community Development, Youth and Sports (MCYS) and the HPB. Aimed at promoting active ageing and improving the quality of life among older adults, the Wellness Programme targets community dwelling adults aged 50 years and above. The Wellness Programme has acquired funding to conduct health screening in all 87 wellness sites until 2015. On-site counseling by HPB nurse educators is available as well as the 12-week exercise programme Strength Training Exercise Programme (STEP), which is a follow-up for those who are identified as having low physical function after being screened for functional decline.
The cost of screening on-site per resident is S$135 assuming that each resident is eligible to undergo all the available screening tests i.e. screening for chronic diseases, selected cancers and functional decline. The cost of STEP is S$400 per resident.
For the on-site follow-up solutions, HPB works with community organisations and associations who volunteer their services for free. Corporate partners sponsored items as well which could aid in interventions. Some may levy charges but the cost to the resident is minimal.
General Practitioners and Allied Health Professionals are offered honorariums. This together with the cost of transporting of equipment and logistics, brings the the total cost of organising one-stop screening and follow-up targeting 100 residents per session, at a community centre in Singapore is approximately S$20,000 .
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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A good measure of a community event is the size of its outreach. To achieve the targeted number, the programme must be attractive enough to get people to come. Residents should also be able to see the benefits of the programme.
Partnerships and collaborations with private and public organisations contributed to good results for this programme :
- Easy access to screenings for residents. Residents did not have to travel to get their screening done at a clinic or medical centre.
- Affordable screening and follow-up
- Good turnout for activities and services because of accessibility and affordability as well as the more appealing atmosphere (less clinical, more social).
- Residents were among their peers – their friends and neighbours who were going for the screening, as well as health ambassadors from their neighbourhood who were available to guide them and address queries or concerns
- Immediate access to most of the prescribed interventions
- Pooling of resources; efforts are not duplicated or wasted, resources were maximised
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| 8. What were the most successful outputs and why was the initiative effective?
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Other than an outreach number of 1,000-2,000 per event depending on the scale and a screening target of 100 persons per session, the following measures were put in place to monitor progress:
- Follow-up phone calls by screening providers for participants found to have abnormal readings
- Records by on-site healthcare professionals who provided the follow-up (e.g. on-site dental treatment records, referral records by optometrists)
- After action reviews with the community partner after the one-stop integrated screening and follow-up event.
- On-ground feedback from residents
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| 9. What were the main obstacles encountered and how were they overcome?
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The key challenge in putting this project together was the engagement and buy-in of the key stakeholders from the various agencies and organizations to organise this programme. The team tried to overcome the obstacles by building on existing community infrastructure.
The team also faced challenges in getting healthcare professionals to volunteer due to their time and work commitments, or general lack of interest. To overcome this, small honorariums were provided to healthcare professionals, to help offset their transport and meal costs for their voluntary efforts.
Lastly, as much as HPB tried to bring in all relevant forms of follow-up help, not all solutions could be provided on-site each time. For example, the dental bus on-site could provide basic dental treatment such as scaling, polishing, tooth extraction and filling but could not cater for more complex treatment such as root canal treatments and making of dentures. The on-site GP could provide free medical consultation and assessment, but did not have access to the patients’ full medical history records to do a comprehensive evaluation. The doctor also could not provide any forms of further medical assessment nor prescribe medication on-site. In an attempt to overcome this, the team built dentist and GP networks within a 2-kilometre radius of the screening site, and offered participants the contact list of the participating clinics that they could go to for further follow-up and assessment. However, being seniors with low health literacy, some participants were subsequently lost from the system. HPB has since trained Health Ambassadors to do follow-up calls for such participants, to encourage them to go for their further assessments and follow-up.
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