| 4. In which ways is the initiative creative and innovative?
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We looked through the lens of the older worker
We used a person-centric approach through staying close to the ground, walking a mile in the shoes of our older workers through job-shadowing, conducting focus group discussions and in-depth interviews. This allowed us to sense the deeper concerns before customising relevant holistic health packages.
Moving beyond programme-centric to operationally-ready models
Instead of attempting to forcefully fit plug-and-play programmes, we designed new health packages around operational schedules. We involved worker’s unions and companies from the onset to design sector-specific health models that would fit seamlessly into operational schedules. We then tapped on the Public Transport Tripartite Committee as a lever to push transport companies to adopt these models.
Making business sense, not just health sense
Companies are ultimately driven by profit margins. An intentional effort was made to translate health efforts into measures on staff engagement, retention and worker productivity. Such value propositions were necessary to persuade companies to invest in workplace health for their older workers. Since the pilot, all local bus companies have co-funded health initiatives as a way to retain their workers and to be seen as a more caring employer.
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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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As part of the SGD$3 billion Action Plan for Successful Ageing chaired by Singapore’s Ministerial Committee for Ageing, the Health Promotion Board (HPB), Singapore, was tasked to administer the initiative, bringing customised health to the doorstep of older workers across seven key sectors (Annex 1). HPB is a statutory board under the Ministry of Health (MOH), Singapore, aiming to empower the people of Singapore to attain optimal health, increase the quality and years of healthy life and prevent illness, disability and premature death.
Through this initiative, HPB has since impacted more than 31,000 older workers in a short span of two years since 2014. By 2025, MOH and HPB aim to impact 120,000 older workers (~10% of Singapore’s current mature workforce) aged 40 and above through customised and sustained health efforts.
For more information on Singapore’s Action Plan for Successful Aging, refer to https://www.moh.gov.sg/content/dam/moh_web/SuccessfulAgeing/action-plan.pdf (Annex 6)
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| 6. How was the strategy implemented and what resources were mobilized?
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Element 1: Established clear responsibilities, funding and performance indicators at Ministerial level
A strategy paper approved by the Ministerial Committee on Ageing spelt out the key tenets of the “Workplace Older Workers’’ Health Programme” including HPB’s role as Programme Manager and approved a government budget of SGD$29 million over 10 years to ensure older workers in the identified sectors would receive customised health programmes. As Programme Manager, HPB is responsible for delivering on key performance indicators to MOH on a 6-monthly basis, as part of a clearly established performance management and accountability framework. The indicators monitored include:
Number of unique older workers impacted
Number of companies which adopted interventions
Tracking of improvement in workers’ health biometric indicators
Element 2: Developed human capital to meet industry demands
We conducted industry briefings with workplace health consultants and service providers to understand their current capabilities and identify gaps. It was noted that service providers were (i) only used to conducting general population mass market activities and did not have content knowledge especially in health needs associated with aging (ii) not equipped to implement high impact activities such as health coaching with sustained follow-up (iii) unable to find suitable manpower to conduct on-ground activities
To address gaps related to points (i) and (ii) in service provision, HPB conducted compulsory training sessions to up-skill service providers and developed toolkits incorporating information on both age and work-related health needs. Further, to address gaps relating to point (iii), HPB is working upstream with educational institutions and re-employment agencies to groom a pipeline of trained manpower to meet the growing demands for workplace health services.
Element 3: Determined programme funding cost
We conducted a landscape sweep to determine existing market prices to develop and deliver targeted programmes for older workers. This was benchmarked against high-impact programmes in the community and in clinical settings. As a result we derived a subsidy cost of $200 per worker.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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For a flowchart of stakeholders involved, see Annex 1
Aging Planning Office: Oversees initiative
Singapore’s Ageing Planning Office is the Secretariat of the Ministerial Committee on Ageing. It oversees and provides guidance on the delivery of this health initiative, as well as monitors achievement of performance indicators by HPB.
Health Promotion Board: Implements initiative
HPB is the appointed Programme Manager, with a team of seven officers leading the implementation of this initiative. It is the main agency to design relevant holistic health packages, building in-roads with downstream stakeholders (unions and companies) and service providers for implementation, and ensure that the initiative is rolled out to workers.
Unions: Bridge between companies and HPB
HPB collaborates with workers’ unions in Singapore to publicise initiatives to companies. The unions also act as a platform for sharing of best practices to influence companies in establishing equitable health initiatives.
Private Sector Companies: Co-implements initiative
Companies act as co-implementers of the initiative together with HPB, advising on operational needs and managing day-to-day ground efforts. For example taxi company, ComfortDelGro has since scaled-up the initiative to all their taxi service centres island-wide and has been running the programme on its own.
Workers: Co-design initiative
HPB ensured the workers could act as co-designers of programmes. Candid feedback from workers during focus group discussions were critical in the design of relevant programmes, by informing HPB on their health worries and needs.
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| 8. What were the most successful outputs and why was the initiative effective?
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At population level: Benefiting large numbers of older workers
The initiative impacted more than 31,000 older workers in a short span of 2 years. We expect another 12,000 to have participated by March 2017. Aggressive outreach to the companies resulted in HPB reaching workers from all seven key sectors.
At industry level: Workplace health is now a norm for companies in the transport industry
In two years, we have piloted and scaled-up the health programmes for taxi and bus drivers, from 2 to 5 taxi service centres across 3 taxi anchor players collectively covering 80% of the market, and from 3 to 24 bus interchanges across all 4 public transport operators covering 100% of the market. We have also garnered commitment from all rail transport companies and major supermarket chains in Singapore to implement the initiative for rail and retail workers respectively.
At company level: Equipping companies with skills to sustain workplace health initiative
Companies were equipped to expand pilot success to a larger scale, with the desired outcome of reaching out to all employees. Sustainability frameworks were also in place to ensure that impact would be maintained beyond the first year of implementation (Annex 5). Companies now have at least one personnel equipped with the capability to manage the day-to-day on-ground implementation of the initiative, in order to build long-term ownership.
At worker level: Workers’ see real improvements to health
Participants benefited from improved access to workplace health programmes because of greater inclusiveness. They have also improved based on measurable health outcomes. For example, attributing his health improvements to health coaching sessions brought down by HPB to his company, 67-year-old bus driver Mr Lee achieved his weight goal of 60kg, lowered his blood pressure and brought his cholesterol level down to normal over a span of 9 months. He now makes better food choices and practices stretches in between shifts. See Annex 5 for overview of impacts made with workers. For more testimonials, view https://youtu.be/xgDmfOw0wU4
Testimony to the initiative’s effectiveness, HPB was awarded ‘Most Innovative Project/Policy (Gold Award)’ in 2016 by the Singapore Public Service, standing out from more than 100 entries. The initiative was well covered with at least 77 media mentions, resulting in increased interest in workplace health by companies who did little or none before. Citizens’ confidence in the public service is enhanced when they view us doing sincere real work impacting the under-served.
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| 9. What were the main obstacles encountered and how were they overcome?
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Scarce nursing manpower
To prevent taxing Singapore’s scarce nursing manpower, we grew a new pool of health coaches from non-medical staff. This was a planned and measured attempt at training non-medical staff for health promotion roles with the view of addressing the shortage of medical staff. This new pool of non-medical staff were trained in both health and motivational interviewing, to ensure that they were equipped in both hard facts and “heart wear”.
Allocation of limited manpower and resources
With a head count of only seven staff, we found multipliers to push the same agenda by working with new stakeholders such as workers’ unions and service buyers. To prioritize workers who need most attention, a health risk stratification system was developed to provide different pathways for those with different health risks, ensuring that those who needed more support, were able to receive it.
Obtaining buy-in from workers
Not being used to having such “health benefits”, the older workers were often sceptical when they first encountered the health initiative at their workplaces. For example, 20% of bus drivers waited for more than two months to take part before wanting to participate in their first workplace health activity. We had to create a notable presence of health coaches at their work site, for a sustained period for often at least six months for older workers who took a 'wait-and-see' approach. This allowed on-ground health coaches the opportunity to convince the workers to participate, and build rapport with them.
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