Gan Kim Yong
Singapore
“Consumer complaints relating to the secondary resale market for tickets to major events and concerts have generally remained low. Nonetheless, to protect the public from scams on secondary ticket resale platforms, the Police have imposed Code of Practice requirements under the Online Criminal Harms Act to require designated online service…”
“Singapore does not condone the use of forced labour. We criminalise forced labour in Singapore under various laws. Relevant Government Ministries and agencies, such as the Ministry of Manpower, Ministry of Home Affairs and Singapore Police Force, play their part in investigating complaints of suspected breaches in domestic laws that relat…”
“The Association of Banks in Singapore (ABS) discontinued the PayNow nickname feature as scammers had been exploiting the use of nicknames to impersonate legitimate entities and trusted individuals.”
“As of end-2025, around 6,900 private residential buildings have registered their solar installations with SP Group for the export of excess solar-generated electricity to the grid. The installed solar capacity of these residential buildings is 115.3 megawatt-peak (MWp), or around 5.5% of all current installed solar capacity in Singapore.”
“The one-year pilot extension of liquor trading hours has seen strong interest from businesses. As of 31 May 2026, the Police have approved 88 applications for the extension of liquor trading hours from public entertainment outlets in these areas.”
“The Government does not make projections of domestic or regional demand for renewable diesel or sustainable aviation fuel. Demand depends on commercial considerations, evolving market conditions and regulatory developments across different jurisdictions.”
The complete record
Every one of 3,841 lines we hold for Gan Kim Yong, in date order, each linked to its source. Free to read, in full, without an account. Page 45 of 77.
“The public healthcare clusters have also extended the re-employment age of public healthcare workers to age 67 since 1 July 2016, one year ahead of the statutory change. We are pursuing efforts to redesign jobs through the use of assistive equipment, such as patient mobility aides and hoists, as well as encouraging healthcare institutions to offer more flexible work arrangements, to enable older staff to continue working. In parallel with efforts to increase the supply of local healthcare workers, we are stepping up productivity efforts to reduce manpower demand through improving workflows, redesigning roles and leveraging technology. Our public healthcare institutions are rolling out more self-service formats and training patients, caregivers and volunteers to support the healthcare workforce in care delivery. With productivity efforts, we will strive to keep manpower expenditure growth sustainable so as to maintain affordability of healthcare services for Singaporeans.”
“Since the commencement of the PCPs, more than 1,000 PCP candidates have undergone healthcare training. To bring in more mid-career entrants into the community care sector, the Agency for Integrated Care has also facilitated a series of manpower recruitment initiatives for the sector, which include organising recruitment fairs, introducing the Community Care Traineeship Programme to train new local support care staff for their new roles as well as the Senior Management Associate Scheme to train mid-career talents to take on managerial and operational positions in the sector. We will continue to provide more training pathways to enable more mid-career professionals to join the healthcare sector. Second, we are leveraging SkillsFuture (SF) initiatives to support professional development and capability building in the healthcare workforce. MOH launched the Healthcare SF Study Awards in June 2016 to encourage skills acquisition in the areas of aged care, healthcare information technology and data analytics, and healthcare design, organisation and delivery. NYP is also rolling out a new Earn and Learn Programme in gerontology nursing for nursing graduates to deepen their skills and knowledge to provide aged care in the community. Third, we seek to better retain healthcare workers. We have strengthened career pathways for clinical and support care staff across the public healthcare sector through more upgrading opportunities and better career progression and are making efforts to increase workforce longevity in the healthcare sector. Nearly all eligible public healthcare staff were offered re-employment upon reaching age 62.”
“In tandem with the expected increase in demand for healthcare services that comes with an ageing population, we projected that an additional 30,000 healthcare workers could be needed between 2015 and 2020. Over 10,000 of the additional healthcare manpower demand is projected to come from the aged care sector, while the remaining will come from the acute and primary care sectors. About 50% of the new jobs are projected to be professionals, managers, executives and technicians positions, which include doctors, nurses, allied health professionals, and managerial and administrative staff, such as centre managers and operations and administrative executives. The Ministry of Health (MOH) has been and will continue to grow a strong local core to anchor our healthcare sector. Locals made up about 75% of the healthcare workforce in 2015. MOH has been making efforts on a few fronts to attract, develop and retain the local healthcare workforce. First, we have expanded intakes at local medical and nursing schools to attract more young Singaporeans to join the healthcare sector. Between 2012 and 2015, local medical and nursing intakes have increased by 29% and 17% respectively. In addition, the four allied health profession courses in Physiotherapy, Occupational Therapy, Diagnostic Radiography and Radiation Therapy have transited from diploma courses in Nanyang Polytechnic (NYP) to four-year degree programmes at the Singapore Institute of Technology in 2016, and the intake will grow over time. Apart from attracting fresh school leavers, we have put in place Healthcare Professional Conversion Programmes (PCPs) for mid-career professionals to acquire relevant training to join the healthcare sector as nurses and allied health professionals.”
“The dental subsidies under the Community Health Assist Scheme (CHAS) vary, depending on the status of the cardholder and the dental procedure required. For example, to make a complete upper denture, CHAS Blue and Orange cardholders can receive a subsidy of up to $256.50 and $170.50 respectively. The subsidy for Pioneer Generation (PG) cardholders is $10 higher per procedure than that for CHAS Blue cardholders. Those who have made a claim received about $320, on average, in dental subsidies in 2015. Those aged 60 and above received about $370. The existing dental subsidies already cover close to 85% of the bill for the majority of visits, including for seniors. The Ministry of Health will continue to review CHAS from time to time so as to meet our objective of providing accessible and affordable dental care to Singaporeans, including our senior citizens.”
“As at 31 December 2016, 458 Zika cases have been reported to the Ministry of Health (MOH). The incidence of new reported cases has been on the decline. Twelve cases were reported in November and four cases were reported in December. In comparison, 283 cases and 43 cases were reported in September and October respectively. As of 31 December 2016, a total of 17 pregnant women have been diagnosed with Zika and reported to MOH. Four of the women have since given birth, and their babies show no signs of abnormalities thus far. One had a miscarriage for reasons not linked to Zika while two pregnancies were terminated for personal reasons. As the two foetuses were at early gestation, it is not possible to determine whether there will be Zika-related abnormalities. The remaining 10 cases are in their second and third trimesters and their babies will be monitored over three years as part of the monitoring programme. There is currently no obvious evidence to show that there are any Zika-related abnormalities. MOH has put in place a programme to monitor infants whose mothers were exposed to the Zika virus during their pregnancies. We will track their development until they are three years old. Given the presence of the Aedes mosquito here in Singapore, we are likely to continue to have Zika cases in Singapore. Some of these cases may be undiagnosed as the infection may result in mild or even no symptoms. I urge fellow Singaporeans to remain vigilant and to do our part to prevent mosquito breeding so as to protect ourselves and our loved ones.”
“The collaboration between the Ministry of Health (MOH) and Raffles Hospital in emergency care started in June 2015. The objective is to improve access to emergency medical care in Singapore by tapping on available capacity in the private sector. Under the collaboration, Singapore Civil Defence Force (SCDF) ambulances send patients with non-life threatening conditions to Raffles Hospital for emergency medical treatment. To support care continuity for patients, doctors at Raffles Hospital are given authorised access to the patients’ medical records and discharge summaries in the National Electronic Health Records. MOH provides Government subsidies to patients under the collaboration for their medical treatment at Raffles Hospital, similar to how they would receive means-tested subsidised services at public hospitals. The collaboration with Raffles Hospital has served more than 3,500 patients so far, with comparable health outcomes to patients who went to public hospitals. More than 90% of patients surveyed have indicated that the arrangement has met or exceeded their expectations. The collaboration benefits other patients, too, as it increases our overall capacity for emergency medical care in Singapore. It has also reduced the travel time and turnaround time for SCDF ambulances. MOH is open to partnerships with private sector healthcare providers, whether in hospital services, primary care or intermediate and long-term care. In deciding future extensions or expansions of such collaborations, we will continue to focus on achieving good outcomes for patients in terms of care quality and affordability.”
“Based on the two most recent national health surveys conducted in 2010 and 2013, smoking prevalence among those aged 18 to 69 declined slightly from 14.3% to 13.3%. Amongst those aged 30 and below, smoking prevalence decreased more significantly from 16.8% to 13.4%. The age-standardised hospitalisation rates of Singapore residents for smoking-related diseases fell slightly over the last three years, from 15.8 per 1,000 residents in 2013 to 15.4 per 1,000 residents in 2014 and 15.0 per 1,000 residents in 2015. Reducing hospital subsidies for smokers as a deterrent measure could result in unintended consequences, for example, patients may delay seeking treatment, which can increase the risk of complications and further affect their health. We want to focus on helping smokers to quit smoking. The Ministry of Health has developed a comprehensive tobacco control plan with both legislative and non-legislative measures to encourage smokers to quit and discourage non-smokers, especially youths, from picking up smoking. The Health Promotion Board has more than 200 smoking cessation touchpoints, including healthcare institutions and retail pharmacies in the community. Smokers who want to quit smoking can also seek help through the toll-free QuitLine and available online resources. Page: 139”
“Healthcare institutions can also play their part by providing greater support for these healthcare workers, as the Member pointed out, and provide more opportunities and take care of their personal aspirations as well as their needs. Page: 28 But, more importantly, I believe all of us can play our part, too, whether we are patients, family members helping to take care of the patients or as a general member of the public. Very often, when we give due recognition to the contribution of the healthcare workers, it will help them in their work. As I mentioned many times before in this House, a simple "Thank You" card will go a long way in making a healthcare worker's job a lot easier. I believe that if we work together, we will be able to help our healthcare workers do a better job to take care of our loved ones.”
“Madam, as the Member has pointed out, we have an ageing population going forward and this will continue to add demand on the healthcare system as well as our healthcare workers. We will continue to work on our journey to transform our care delivery system so that it is more effective and sustainable in the long term. I mentioned this during the Committee of Supply debate. We are moving from hospital to community: we are moving from quality to value. At the same time, we are also moving from healthcare upstream to health. These are three key shifts that will make sure that our healthcare, healthcare system and healthcare workers will be sustainable in the long term. Healthcare, indeed, is a very demanding career but it is a very meaningful and rewarding one. That is what drives Singaporeans to want to join this sector. I want to take this opportunity to thank all our healthcare workers for their dedication. But all of us can make their job easier in many ways. I have shared our efforts over the last few years. The Government has improved the career prospects for our healthcare workers. For example, for nursing, we introduced the Care Package to improve their recognition, to provide more opportunities for career advancements as well as training, education and development. These are very important efforts. We have also rolled out a campaign "Care To Go Beyond" to profile many of our healthcare workers, including allied health professionals as well as support staff, to ensure that they have a fulfilling and rewarding career and are well-recognised.”
“MediShield Life now provides lifetime protection for large hospitalisation bills for all Singaporeans, including coverage for the elderly, many of whom were previously uninsured or unable to obtain coverage. In its first 11 months, MediShield Life paid out about $282 million for claims by older Singaporeans aged above 65, almost double the total $151 million payout under the previous MediShield over the same period last year. MOH will continue to review affordability and coverage of healthcare for the elderly, while ensuring that our healthcare financing system is sustainable over the long term.”
“Madam, Singapore's healthcare system has served us well. With our life expectancies at birth of 81.9 years in 2015, Singapore residents are not just living longer, but are also enjoying more healthy years of life. We were ranked first and third in the world for male and female Healthy Life Expectancy (HALE) respectively, according to a 2015 Global Burden of Disease study (GBD) by The Lancet. There are certainly areas where we can still improve. In addition to quality of care, the Ministry of Health (MOH) continues to invest in developing healthcare infrastructure, manpower and technology in line with our Healthcare 2020 Masterplan so as to meet our current and future healthcare needs. Between 2014 and 2020, we will add about 3,500 more acute and community hospital beds, 6,300 more nursing home beds as well as 8,300 more home and centre-based care places. Under the 2020 Healthcare Manpower Plan announced recently, we are taking steps to expand our healthcare workforce by 30,000 between 2015 and 2020 to meet the changing needs of Singapore's population. Through care redesign and adoption of technology, we will further Page: 27 enhance the delivery of healthcare services. Besides improving quality and access, we have also substantially improved healthcare affordability to provide better assurance, especially to our elderly. For example, the Pioneer Generation Package, which many of us are familiar with, provides significant support for Pioneers. Since the Package was launched in 2014, more than 400,000 Pioneers have benefited from it and the Government has provided over $700 million in benefits in total.”
“Between financial year (FY) 2008 and FY2015, the number of patients seen by the National Addictions Management Service (NAMS) for suspected gambling disorder each year varies between 168 and 526, averaging 407 over the last five years. Among patients with pathological gambling treated at NAMS, the top associated psychiatric conditions were adjustment disorders, depression and substance abuse.”
“Foreign nurses need to meet the requirements set by the Singapore Nursing Board (SNB) before they can practise in Singapore. Those who wish to be registered with SNB have to fulfil four requirements. First, they must be found suitable and offered employment by our local healthcare institutions. Second, they are required to sit for and pass the SNB’s Licensure Examination conducted in English for either Enrolled Nurse (EN) or Registered Nurse (RN). Third, they must meet the minimum standards in English language proficiency, demonstrated through passing recruitment interviews and the SNB's Licensure Examinations. Finally, foreign RNs will be assessed on the job during the probation period of six to twelve months before they are "confirmed". SNB conducts direct source verification of the professional qualifications of overseas-trained foreign nurses. This is done by requiring the foreign nursing educational transcript to be sent directly from the foreign educational institution to SNB. Foreign nurses who do not meet SNB's standards to be registered as RNs may be considered for enrolment as ENs, but they need to work under the supervision of RNs. Those who are not able to meet SNB's requirements to be RNs or ENs can be hired as support care staff. RNs, ENs or support care staff can work in different care settings, including step-down care facilities and nursing homes. However, regardless of the settings, they need to meet the respective job requirements to ensure appropriate patient care and safety. The decisions on employment and transfer of care staff are made by the respective healthcare institutions as they are in the best position to assess their suitability.”
“A Singaporean colleague of a foreign nurse is allowed to be a guarantor for a foreign nurse pursuing further studies under a sponsorship in the public healthcare sector. Such sponsorships are awarded based on the candidates’ merit, including their performance, potential and commitment to serve in our public healthcare sector. Over the past five years, our public healthcare institutions awarded over 3,600 nursing sponsorships. Four hundred and forty-eight of these sponsorships were awarded to non-Singaporean nurses. Of these, four nurses were unable to complete their studies. Two of them paid liquidated damages and another compensated by serving a bond. Our public healthcare institution is following up on the remaining nurse. Over the past five years, no guarantor was required to pay liquidated damages. Our public healthcare institutions closely monitor the academic performance of all sponsorship recipients. Those who have difficulties meeting the minimum course grades will be given closer supervision. Those who have non-academic issues affecting their training will be provided support and counselling. With an ageing population, we will need more nurses to support our growing healthcare needs. Our priority is to continue growing the number of local nurses, and we have stepped up efforts to attract more locals to join nursing. Over the last five years, the total number of local nurses has grown by about 2,700 to about 26,000 in 2015. However, we will still need foreign nurses to supplement our local manpower. Foreign students who are sponsored to undergo nurse training are required to serve a bond in our public healthcare sector upon graduation. We will continue to offer such sponsorships in order to meet our national needs.”
“The objective of the Health Insurance Task Force (HITF) is to achieve more efficient and sustainable outcomes for patients, healthcare providers and insurers. This is an important priority as we face an ageing population in Singapore. We are currently studying the HITF's recommendations. As the Task Force highlighted in its report, the issue is multifaceted and there are many factors that contribute to the increase in health insurance claims costs. Examples include the longer life expectancies for our ageing population, better access to healthcare services, advancements in healthcare technology and drugs, over-servicing or over-consumption of healthcare, as well as the design of some health insurance products. All stakeholders have a role to play in managing healthcare costs and insurance claims. Healthcare providers should ensure that treatments provided are appropriate for the patient's needs; patients need to make informed decisions on their choice of healthcare services; and insurers should ensure that their products are designed to encourage appropriate care. Over the years, the Government has taken steps to enhance fee transparency to help patients and healthcare providers make informed choices. We have also designed our healthcare financing system to include co-payment, to encourage prudence and appropriate care. Our shared objective is to achieve a more sustainable and affordable healthcare system and deliver greater value and better outcomes for our patients.”
“The reasons for suicides are often complex and multidimensional. Each suicide is one too many. We will continue to improve our interagency and multi-pronged suicide prevention efforts.”
“For instance, students identified to be depressed or are at risk of suicide are typically referred to school counsellors, or the Child Guidance Clinic in IMH for more challenging cases. For young persons between 16 and 30 years old, the Community Health Assessment Team (CHAT), located at *SCAPE Youth Park, provides a one-stop centre (CHAT Hub) for mental health help and resources. Within the community, Family Service Centres (FSCs) provide counselling and support services to families and individuals with social and emotional difficulties. Senior Activity Centres organise befriending programmes to reach out to elderly persons who live alone in rental flats so as to prevent social isolation and depression. Schools, FSCs and VWOs are, in turn, supported by the Response, Early Intervention, Assessment in Community mental Health, or REACH, teams set up by IMH. These are multidisciplinary teams that provide training and support to partners so as to strengthen their ability to identify and manage at-risk youths and children and to make appropriate referrals. Fourth, we have services in place for individuals in crisis who need urgent help. SOS operates a 24-hour hotline to counsel persons in distress. IMH also operates a 24-hour Mental Health Helpline manned by counsellors who are trained to de-escalate situations, assess and triage cases, and activate home visit teams quickly if necessary. For cases of attempted suicide, the Police may refer the person to SOS for counselling or engage the next-of-kin to assist in supporting and caring for the person. If there are clear signs indicating possible mental instability, the Police may refer the person to IMH for an assessment. The person may be warded at IMH for care and treatment if necessary.”
“Singapore adopts a multi-pronged approach to prevent suicide, in line with the recommendations under the World Health Organization (WHO) Public Health Action for the Prevention of Suicide Framework. Government agencies and stakeholders in the social sectors work together to prevent suicides by promoting upstream prevention, encouraging help seeking, providing support to at-risk groups and offering crisis support. First, in the area of prevention, we seek to build mental resilience in our population and increase public awareness of the importance of good mental well-being. Students in our schools are taught socio-emotional skills and coping strategies, as well as how to look out for one another and to seek help from trusted adults if necessary. In the community and at workplaces, Health Promotion Board (HPB) offers programmes to promote mental health literacy. It also conducts workshops to provide our elderly tips on mental well-being and resilience. Second, we have various programmes to reduce the stigma about seeking help for mental issues. Voluntary welfare organisations (VWOs), such as the Samaritans of Singapore (SOS), have been active in promoting public awareness on suicide prevention. Silver Ribbon (Singapore) is another organisation that has been combating stigma about mental illness. It reaches out to persons who need help in building mental wellness and encourages them to seek early treatment. In addition, the Institute of Mental Health (IMH) also conducts public education programmes in schools and in the community. Third, we have put in place services and programmes to provide support to those identified to be at higher risk.”
“HPB and its partners also reach out proactively to lower-income Singaporeans, such as those in HDB rental blocks, to encourage and facilitate regular health screening. Singaporeans with diabetes, as with other conditions, can receive subsidies for their treatment at CHAS GPs, polyclinics and specialist outpatient clinics in the public hospitals. Those with lower-income receive higher subsidies. The national Diabetes Prevention and Care Taskforce will step up public education to ensure that Singaporeans of all socio-economic backgrounds lead a healthy lifestyle and practise effective diabetes care and management.”
“The correlation between socio-economic background and diabetes prevalence is a commonly-observed and widely-reported phenomenon worldwide. MOH's National Health Survey showed a similar correlation where those in smaller housing type and lower education level had higher prevalence of diabetes. However, the same survey also showed that they have good access to care. MOH’s strategy on diabetes emphasises healthy eating and physical activity; appropriate screening and follow-up; and effective diabetes care and management. These efforts must be accessible and affordable to the lower income. In promoting healthier eating, HPB's Healthier Choice Symbol (HCS) Programme offers a wide range of healthier product options, including house brands, which are typically more affordable. HPB has also distributed almost 200,000 Health Calendars which feature low-cost healthy recipes, exercises and self-care tips to women aged 40 years and above in lower-income households. For dining out options, HPB has partnered major foodcourt chains, including Kopitiam and NTUC Foodfare, to offer affordable lower-calorie dishes. HPB also works with Primary school canteen vendors to provide nutritious breakfast meals to needy students under MOE's Financial Assistance Scheme. On health screening, MOH ensures that it is available to lower-income Singaporeans at highly subsidised prices. Under our Screen for Life (SFL) programme offered at Community Health Assist Page: 107 Scheme (CHAS) GPs, screening tests for chronic diseases, including diabetes, are free. Patients in the lowest income tier and Pioneers enjoy a subsidy of up to $18.50 and $28.50 respectively for consultation fees.”
“Early detection and prompt treatment of active cases is key to controlling the spread of tuberculosis (TB) in Singapore. Persons with symptoms of active TB, such as a prolonged cough of more than three weeks, are advised to seek early medical assessment. For Page: 106 those on treatment, adherence is crucial to prevent recurrence or development of drug resistance. TB is endemic in Singapore and in the region and there are measures in place to prevent importation of TB. Work permit applicants are required to undergo a medical examination upon arrival in Singapore. This includes a chest X-ray to rule out active TB disease. We also work to prevent the spread of TB. Doctors are reminded to look out for cases of possible TB. Once cases are diagnosed, the doctors are required to notify MOH. The Tuberculosis Control Unit (TBCU) then identifies those who had prolonged and close contact with the TB patient, such as household members and workplace colleagues, to undergo screening for TB, as they have the highest risk of contracting the disease. Those found to have latent TB, which is TB without any symptoms and is not infectious, may be placed on treatment to prevent development of active TB. This practice is aligned with the World Health Organization’s recommendations, and practices in other developed countries. In addition, to better understand the spread of disease and to identify clusters, TBCU conducts DNA fingerprinting studies. We have made some progress in reducing the rates of TB in Singapore. Among Singapore citizens and permanent residents, the number of new cases has fallen from 52 per 100,000 persons in 1995 to 38 per 100,000 persons last year. We will continue to work on reducing TB as a public health threat.”
“Singapore Citizens and Permanent Residents receive Government subsidies at public healthcare institutions, with citizens receiving a higher level of subsidies. This is in line with the larger Government policy of differentiating social benefits and subsidies by citizenship status. Patients are extended healthcare subsidies based on their citizenship status and not that of their children. This principle applies to all healthcare services, including maternity and delivery services. For newborns who are Singaporeans, they are eligible for healthcare subsidies and other benefits such as the Medisave Grant for Newborns and the Government's contribution to the Child Development Account. We understand that some Singapore Citizens with non-citizen spouses and some Singaporean children with non-citizen parents may require additional support. This feedback has also been raised by other Members previously. Since 2012, MOH has extended inpatient subsidies to non-citizen spouses who are on Long-Term Visit Pass-Plus. We have to take into account the policy objective of differentiating social benefits and subsidies by citizenship, to give greater support to Singapore Citizens. We also need to be mindful that the cost of giving more Government subsidies will ultimately be borne by all Singaporeans. Hence, any proposal to further extend more Government subsidies to foreigners who are neither Permanent Residents nor Long-Term Visit Pass-Plus holders would need to be carefully considered.”
“With MediShield Life implemented in November 2015, all Singaporeans now have portable medical insurance. MediShield Life is a basic health insurance scheme that covers all Singaporeans and for all pre-existing illnesses, regardless of any change of employment status or employer. It provides sufficient coverage for subsidised treatment in public hospitals. Today, many employers also extend medical benefits to their employees voluntarily as part of their employment contracts. MOM and the tripartite partners encourage employers to structure these benefits on a portable basis and the Government provides incentives for employers to do so, by offering higher tax deductions for medical expenses of up to 2% of total employees’ remuneration. Portable medical benefits can take different forms, such as additional contributions to the employee’s Medisave account, which the employee can use for his healthcare expenses or insurance premiums for MediShield Life or Integrated Shield Plans even if he changes his job. Alternatively, employers may choose to pay for their employees' health insurance premiums directly. MediShield Life is the mandatory, portable health insurance for all Singaporeans, covering them at all stages of life. Employers are already required to make mandatory contributions to their employees’ Medisave to help pay for the premiums of MediShield Life. MOH's focus will be to ensure that MediShield Life continues to meet the needs of Singaporeans.”
“For example, Assisi Hospice’s new development, which is supported by MOH, will have a dedicated inpatient hospice ward for persons with advanced dementia. Dover Park Hospice and Tan Tock Seng Hospital have piloted a new dedicated home palliative care service called "Programme Dignity" for persons with dementia. We will continue to expand these services to meet the increasing need in the future.”
“Dementia is a term used to describe the symptoms and clinical features reflecting the gradual deterioration in cognitive ability. Early and accurate diagnosis is key to good management of dementia. MOH has been expanding the capacity of memory clinics in our public hospitals to provide early diagnosis and management for dementia patients. Between 2011 and 2016, the number of attendances in our memory clinics increased from about 7,500 attendances to more than 13,000 attendances. In addition, through staff training and reconfiguration of wards, public hospitals are better equipped to care for general patients who also have dementia. Public hospitals also collaborate with primary care providers through joint consultations and case discussions to support persons with dementia. MOH also supports persons with dementia and their families in the community through various ways. First, we are enhancing community support and raising dementia awareness through initiatives, such as public education campaigns, dementia resource toolkits and community resource, engagement and support teams (CREST teams). Second, we are strengthening the capability of care staff and caregivers in supporting those with dementia. Between 2013 and 2015, for example, AIC offered over 2,400 training places in dementia-related courses and talks. AIC also provides a Caregivers' Training Grant to caregivers, including foreign domestic workers, to attend many of such courses. Finally, we are expanding community-based and home-based dementia care services. We aim to increase the number of dementia day care services by three-folds, to 3,000 places by 2020. We recognise the importance of expanding palliative care for those who have advanced dementia.”
“MOH is guided by the Expert Committee on Immunisation (ECI)'s recommendations in deciding on the use of Medisave and provision of subsidies. Medisave use is allowed for all recommended vaccinations. We also provide full subsidies at the polyclinics for children who are Singapore Citizens for vaccines that are recommended for preventing disease outbreaks in the community, such as the compulsory childhood vaccinations for measles and diphtheria. Medisave can be used for influenza and Pneumo23 vaccines recommended for high-risk groups, such as the elderly and suffering from chronic diseases. Based on the ECI's advice in August 2016, MOH is reviewing the use of Medisave for the Pneumo13 vaccine. In addition, subsidies for influenza have been extended to Singaporeans who are subsidised residents in nursing homes. The ECI does not recommend diphtheria, pertussis, tetanus and herpes zoster vaccinations for the elderly. Currently, every Singapore citizen baby receives a $4,000 Government grant in their Medisave accounts. This grant can be used for medical expenses and all vaccinations under the National Childhood Immunisation Schedule (NCIS). There are also other government measures, such as the Baby Bonus scheme, which can also be used for NCIS vaccinations, including at accredited private GP and paediatrician clinics. Through Medisave and the Baby Bonus, the cost of these vaccinations are thus fully supported by the Government even at private clinics. MOH will continue to review our vaccination policies based on professional inputs from the ECI, to ensure accessibility and affordability for Singaporeans.”
“The majority of the patients, or about 95%, in public hospitals settle their hospital bills within two months of discharge. This has remained similar over the last six years. Among patients with arrears outstanding for more than two months, Singapore Citizens and Permanent Residents account for about 86%. The average amount owed was around $350. The equivalent figure for foreign patients was $1,400. The arrears of foreigner patients are typically larger because these patients do not receive Government subsidies at our public hospitals. These arrears may eventually be paid up over time. They also include patients who are currently paying their outstanding bills by instalment or are under assessment for financial assistance by the hospitals.”
“It also introduces questions about the treatment of unused eggs, including whether these eggs can be used for other purposes. Ultimately, egg freezing, like all other assisted reproduction techniques, is not a guaranteed solution or a panacea to delayed marriages and parenthood. Age-related fertility problems affect both men and women, and there is no better substitute to having healthy children than when couples are relatively young and healthy. Hence, social egg freezing is currently not allowed. However, we will continue to monitor international developments in the field of social egg freezing and will review our position taking into account the medical and social implications of egg-freezing, as well as prevailing societal norms and values.”
“Licensed Assisted Reproduction (AR) Centres in Singapore are allowed to carry out egg freezing in cases where there are medical needs. For example, some women need to undergo medical treatment such as chemotherapy or radiotherapy that will adversely affect their fertility. Egg freezing carries some risks to the woman: (a) the process of stimulating production and collecting a woman’s eggs for freezing can result in complications such as over-stimulation of the ovaries, bleeding and infection; (b) the risks of developing certain age-related complications during pregnancy are not mitigated by egg freezing. For example, pregnancy-related diabetes and hypertension occurs more frequently in women above 40 years of age. For pregnancy-related diabetes, the risk can be up to 74% higher for mothers above 40 years of age, compared with mothers below 30 years of age.2 In addition, such diseases also impact the growth and development of the unborn child; (c) there is limited information on the long-term outcomes of children born from eggs that have been frozen for extended periods. To date, no long-term follow-up of these children has been published.3 Medically, these issues can be addressed by regulation, as well as enhanced public education and counselling to potential users. However, this issue cannot be decided purely on medical considerations. There are also social and ethical implications that need to be considered carefully. The expectation that egg-freezing guarantees fertility preservation might not be met, thus resulting in greater disappointment for couples who delay marriage and parenthood4 and yet are later not able to conceive using this method. They will be left with few alternatives then.”
“Evidence-based health screening plays an important role in helping individuals to detect chronic diseases early for prompt treatment. Since 2014, the Health Promotion Board has partnered general practitioner (GP) clinics under the Screen for Life programme to provide free screening tests and subsidies for follow-up consultations for Pioneers and Community Health Assist Scheme cardholders. In addition, community health screenings are conducted by our Regional Health Systems. For example, the Eastern Health Alliance provides residents in the East with community health screenings and lifestyle management programmes. Healthcare workers will follow up with patients with abnormal test results to help them with their chronic disease management. As subsidised health screenings are widely available for different groups of Singaporeans, there are no plans to include these under MediShield Life which is a basic health insurance scheme to help pay for large hospital bills and selected outpatient treatments. We need to balance the scope of coverage and the amount of benefits with premium affordability. As part of the War on Diabetes, the Ministry of Health (MOH) is reviewing the Screen for Life programme to encourage and support more Singaporeans in the target groups to undergo evidence-based screening and, importantly, to follow-up with a doctor if they have any abnormal screening results.”
“We will continue to work with the Life Insurance Association to remind the Integrated Shield Plan insurers to ensure that their appointed TPAs, if any, should not have any conflict of interest and should disclose to policyholders any financial arrangements they have with the doctor.”
“Managed care has been a feature of our healthcare landscape for many years. Managed care companies serve to provide intermediary services to various stakeholders, such as insurers, corporations, healthcare providers and patients. In recent months, the Ministry of Health (MOH) and the Singapore Medical Council (SMC) have received feedback from individual doctors and the Singapore Medical Association (SMA) regarding managed care companies, or third-party administrators (TPAs), entering into contracts with doctors, where the doctor would commit to pay a fee for each patient referred by the TPAs. This raises concerns that TPAs' decisions on patient referral may be influenced by the fee arrangement rather than the interest of the patients. The doctor may, in turn, pass on the cost of the referral fee to the patient through higher charges. In some cases, the patient may not be aware of this, especially if his bills are fully covered by his insurance plan or employee benefits. It is of particular concern if the fee is determined as a percentage of the doctor’s charges, without relation to the actual services rendered by the TPA. The SMC is revising its current Ethical Code and Ethical Guidelines, which already address fee-sharing between doctors, to also address fee-sharing between doctors and TPAs. The revised guidelines will explicitly state that doctors must not allow financial arrangements in managed care to lead to any compromise in the care of the patient. MOH is also working with the medical professional bodies and associations to raise doctors' awareness of appropriate arrangements with TPAs.”
“The registration of clinical psychologists and other allied health professionals is provided for under the Allied Health Professions Act. Since 2013, we have registered occupational therapists, physiotherapists, speech-language therapists and, from April this year, diagnostic radiographers and radiation therapists. Psychologists' practices cover a wide range of job roles and settings beyond healthcare. For example, there are also educational psychologists, social psychologists, counselling psychologists and organisational and occupational psychologists. Given this wide range, we are studying in greater detail the issue of accrediting and licensing clinical psychologists. We are currently engaging the stakeholders to address such issues. In comparison, psychotherapy is broadly used for mental health therapy, marriage and family therapy and other personal social problems. Healthcare professionals such as psychiatrists, psychologists, medical social workers and nurses, can apply psychotherapy or a form of it in their course of work. It is also used in non-healthcare related counselling. Psychotherapy is thus less well-defined and, given its use across different groups and in different life situations and settings, it would be impractical to regulate the practice of psychotherapy currently. The Singapore Psychological Society and the Association of Psychotherapists and Counsellors have voluntary membership for psychologists and psychotherapists in Singapore. These organisations have published their own standards, for example, a code of ethics to guide their members and membership criteria.”
“Madam, let me just make a correction. Earlier on, I said that based on a study, more than 90% of people find it easy to find the information on Zika. Actually, the survey was done by the feedback unit Reaching Everyone for Active Citizenry @ Home (REACH), and not by MCI. That is the correction. Just now, Mr Dennis Tan asked about the strain of the current Zika virus in Singapore. Our scientists – the A*STAR scientists as well as the National Public Health Laboratory scientists – have worked together to sequence the virus and based on their analysis, the Singapore strain that we have discovered so far, came from the Southeast Asian strain, which is not the same as the strain in Brazil. In fact, the strain in Brazil is a later strain that was derived from the Asian strain. So, the strain that we have is an earlier generation, which means that it has been circulating in Asia even before Brazil had a Zika outbreak. So, this is the current strain that we have identified. But research is still ongoing.”
“That is also part of the system to track imported cases. That was how the first case in Watten Estate was discovered, because he had a travel history to Brazil. When he returned, we discovered that he had symptoms. Therefore, we sent his blood for testing, and we discovered Zika that way. The Member's second question on a large number of patients in the construction sites, again, as I had explained, the key gatekeeper is our primary care system. We work through our GPs when they notice unusual trends, whether it is Zika or any other infection. We are on the lookout not just for Zika but also other potential infectious diseases, including diseases that we may not be aware of as well. So, our frontline GPs are the most important. When they see cases that they have doubts about, or when they see patterns that are unusual which they cannot explain, they will usually alert MOH, and we will work together with them to find out the truth. This was how we discovered a locally transmitted case in the first instance.”
“Madam, first, on the question of the 36 patients we detected in the look-back exercise, some of them went to the clinics. But the symptoms were very mild. So, very often, the clinics may not be able to identify them as having potential Zika infection. Members would remember that I had explained how we identified the first case. It was because of a GP clinic that had identified a large number of patients with similar symptoms, and they were not able to determine the cause of the symptoms. They had tested the patients for dengue and chikungunya, and they were not able to determine what infection the patients had. And so, they alerted us. That is part of our surveillance system. As I had also explained in my reply, our primary care system is, in fact, on the frontline of our surveillance. They are more sensitive because they are trained and on the lookout for unusual trends. If they identity trends like what I mentioned earlier, they will alert us and then, we would go in and investigate. In addition to the GP network that we work with to identify unusual trends, we also have a sentinel surveillance system, where we work with partner GPs and our polyclinics to monitor and test selected samples regularly to ensure that even if they have no significant symptoms, if we are not able to determine the cause of the symptoms, we also test them for Zika to make sure that we are able to identify Zika infections if it is transmitted in the community. Most of the clinics, when they do testing, under normal circumstances, the focus is on imported cases as well. So, if they see symptoms that resemble Zika, even if they are light symptoms, they would check the travel history. If the patient has been to Zika-infected countries, then alarm will be raised. And they would then inform us.”
“Ms Tin asked about the capacity for testing. We have sufficient capacity, in the meantime, to handle the daily testing that we are encountering, and we also have measures put in place to increase the capacity, if need be. On research funding, it is an area that we are also interested in. Our National Medical Research Council (NMRC) has funds to support meaningful research with regard to Zika. It is something that we are discussing with the researchers and if they have worthwhile projects, they can put these up to NMRC, and we will support them accordingly.”
“Madam, whether Zika is endemic in Singapore, I think it is too early to say. It is actually not productive for us to discuss on terminology, whether it is endemic or otherwise. Our immediate task is to focus on vector control, do our level best, try to eradicate as much as we can and, if not, to minimise as much as we can. That is our immediate task, and we should focus on this. I certainly hope that Zika will not be endemic. But it is something that we will have to monitor over a longer period of time before we can make a definitive assessment. On pregnant ladies, WHO did not recommend regular routine testing for non-symptomatic pregnant women because, to test them, there is a very narrow window. You have to test them while they are infected. After a period of time, when their infection has recovered, it will be very difficult to detect whether the lady has been infected before. Therefore, the window is very narrow, and it is not practical to keep testing the lady every day, every week, or every other week. WHO did not recommend regular testing for those who are non-symptomatic. Our Clinical Advisory Group also advised against it. For symptomatic pregnant women, the advice is for them to consult their doctors because each case is different, their risk factors are also different. So, it is better for them to consult their doctors. How often they need to be tested and monitored, their doctors will be able to advise them accordingly. Ms Tin also asked about the additional cost. For treatment in our public healthcare institutions, they will always have access to our subsidy framework. If they are subsidised patients, and if they are unable to afford the cost, especially for the lower-income families, MediFund is available for them, whether for the test or the treatment.”
“There will be new discoveries and developments, and we need to continue to engage the public and keep them informed of these new developments.”
“By the time of the look-back, in fact, most of the patients in the look-back exercise had already recovered. They were no longer symptomatic because, in the look-back exercise, we looked quite far backwards and many of them had already recovered. We were just approaching them and asking them whether they were ill before, what their symptoms were and when their symptoms started. That is how we did the look-back exercise. On microcephaly, Zika is not the only cause of microcephaly. Microcephaly can be due to a number of factors. It could be due to genetic and environmental factors, such as Down Syndrome, exposure to drugs and alcohol, rubella, as well as other infectious diseases. Even before we encountered the first case of Zika, microcephaly cases were present in Singapore. Over the last five years, we had, on average, between five and 12 microcephaly cases per 10,000 live births. For these patients with microcephaly, we continue to provide support and manage them in the same way as we manage children with congenital conditions. Mr Alex Yam also asked about the level of public awareness. Those of us who have done home visits would know that the level of awareness is very high among the public. Every door that we knock on, I always tell them, "I want to remind you about Zika." They will say, "Yah, Zika I heard of it. I read about it in the newspapers. I watched the TV." Most of them are aware of Zika. Based on a recent survey by MCI, more than 90% of Singaporeans found it easy to access information with regard to Zika. And we will continue to raise public awareness. Because research on this is still on-going, our knowledge of Zika is still very limited, in terms of scientific knowledge.”
“Madam, I can answer some of the questions first and then I will allow my colleague to answer. First, Mr Alex Yam asked about the origin of the local transmission. I presume he is asking about the first case locally. It is very difficult to determine the first case of Zika because Zika is not transmitted from person to person. From epidemiological studies, it is very difficult to trace who passes on to who because there is an intermediary factor and, that is, the mosquito. We are unable to trace the mosquito for obvious reasons. Therefore, we do not know who is the first so-called index case. We also have to be quite careful not to identify the person with the earliest onset of symptoms on 31 July as the first case. It may well not be because, again, 80% of the patients actually do not have symptoms. So, it is not necessary that the first person with symptoms is the first case. I hope I have addressed the Member's question. So, the answer is we do not really know who the index case in this outbreak is. Secondly, Mr Alex Yam asked about the look-back exercise. The look-back exercise was important to us in order to have a sense of how wide the cluster was and how many patients were involved, to allow us to determine very quickly rather than to have to wait for further cases to be investigated, and to size up the situation. We decided to look back to allow us to have a quick assessment of the size of the cluster and to also allow NEA to focus its efforts where it matters. It is helpful in that sense. For patients who are tested positive, we do inform them. And for those who are still symptomatic, we isolated them in the beginning, as I had explained earlier. They were hospitalised for us to observe them, as we wanted to be sure that they did not have complications either.”
“MOH and the Ministry of the Environment and Water Resources (MEWR) are grateful that we have had strong support from our healthcare partners and professionals, Government agencies such as NEA, MCI, MOM and PA, in responding to this outbreak. Lastly, but even more importantly, a whole-of-Government approach is still not enough. We need a whole-of-society approach. I am grateful to many grassroots leaders and volunteers who helped to reach out to fellow residents on Zika and I want to thank all Singaporeans for helping us on the ground to eliminate mosquito breeding sites. Madam, there is still much to do, and all of us need to play our part in the fight against Zika. It is still early days to ascertain what the long-term trend of Zika infections will be. We cannot afford to be complacent, even if we see day-to-day numbers coming down. Even as NEA continues its vector control efforts, each one of us should do what we can to reduce the spread of Zika by taking personal precautions against mosquitoes and checking for mosquito breeding in our homes and our workplaces. I urge all Singaporeans to continue to remain vigilant and do our part, to protect Singapore against Zika. Madam, the journey in our fight against Zika is likely to be a long one because of the presence of Aedes mosquitos here. Even if we can control the present outbreak, we will need to continue to guard against imported cases, as the Zika virus is still circulating among many countries, including several in this region. Therefore, as we tackle Zika, life must go on. By working together, I am confident that we can succeed in managing Zika in the long term.”
“We will work with our doctors to monitor the outcomes of babies born to women with Zika over time. Madam, allow me to say a few words in Mandarin, please. (In Mandarin): [Please refer to Vernacular Speech.] Mdm Speaker, most people infected with the Zika virus will only have mild symptoms and can recover without treatment. However, Zika infection is a concern among pregnant women as some babies born to pregnant women with Zika infection may be at risk of developing microcephaly. We provide free Zika tests for the symptomatic pregnant women and those whose male partners have tested positive for Zika. Doctors will provide counselling to pregnant women who tested positive for Zika and closely monitor the development of the foetus. MOH has been working closely with NEA to intensity vector control and eradicate mosquito breeding grounds. We also stepped up public education. To further reduce the risk of transmission of Zika, we must take a whole-of-society approach in our fight against Zika. It is not NEA's job alone. Each one of us also has a part to play. I believe that as long as we work together, we can win the battle against Zika. (In English): Let me continue to conclude in English. Madam, Ms Tin Pei Ling asked if there are useful insights learnt from managing and communicating the latest Zika incident. I would like to share three learning points. First, it is important to be transparent and timely in sharing accurate information. This is why we released regular updates on Zika, in order to keep the public apprised of the situation. This also prevents rumours and untruths from spreading and creating confusion and suspicion. Second, a whole-of-Government response is key.”
“In Chua Chu Kang, for example, with the support of NEA, students from Pioneer Junior College and the Institute of Technical Education (ITE) College West, grassroots leaders and volunteers, we visited 134 blocks in my constituency on 4 September, to share with residents information on Zika and what they can do. And I am sure many other Members have done the same. I have no doubt that we will be able to learn more about the Zika virus through global and local research efforts. The National Public Health Laboratory has worked with the Agency for Science, Technology and Research’s (A*STAR's) Bioinformatics Institute to complete the sequencing of the Zika virus found in two patients here and shared their results publicly. We cannot tell at this moment whether the viruses found here cause more or less severe disease than those in South America. Further research will be needed to shed light on this. We can also expect more test kits to be on the market in future. They will need to undergo field trials, be validated by laboratory professionals, and approved by regulators to ensure they are safe, and the results are reliable before they are available for use. Currently, there is no specific anti-viral treatment or approved vaccine for Zika. Early-stage human trials have commenced for experimental vaccines. There are also ongoing research efforts in Singapore on Zika. But testing and translating these to practical clinical use will take time. Mr Alex Yam asked whether the Ministry will consider setting up a National Zika Registry. We will study this carefully. Meanwhile, we are already tracking Zika, which is a notifiable disease. Microcephaly has been tracked by the National Birth Defects Registry since January 1993.”
“The People's Association (PA) has also worked with NEA and specially arranged for insect repellents to be available to pregnant women at community clubs island-wide since last Saturday. We hope this is helpful. Mr Christopher de Souza and Mr Png Eng Huat asked how we could raise public awareness of Zika. Public awareness is one of the most critical elements in our fight against Zika and we have undertaken multiple efforts on this front. Since January this year, we have kept the public updated on Zika developments through the media and the MOH website, providing information on precautions to take when travelling to Zika-affected areas. Since 27 August, we have shared information with the media and the public on a daily basis. I would like to thank the media for following the news closely, taking the effort to understand the issues and presenting the news on Zika in a clear and accurate way. The Ministry of Communications and Information (MCI) has set up a microsite on Zika with useful and easy-to-read infographics and videos on "What is Zika?", providing advice to pregnant women, as well as the latest updates on the Zika situation in Singapore. MCI has also produced some interstitials on Zika, which have been broadcast on free-to-air channels, starting from last week. NEA has also set up a website with statistics on Zika infections and clusters. NEA, in collaboration with the grassroots organisations, has continued its outreach to the community through information leaflets and posters on Zika and dengue. This has gone hand-in-hand with their vector control operations.”
“As more cases were found in other parts of Singapore, we extended Zika testing beyond the clusters and now provide a subsidy to all Singaporeans with Zika-like symptoms at the public healthcare institutions. Many pregnant women are understandably anxious about Zika. We are paying particular attention to them because of the possible risks to their foetuses if they are infected by Zika. The Clinical Advisory Group for Zika and Pregnancy had, on 30 August, updated its guidelines on the health advisory, testing and clinical management for pregnant women. These were aligned with WHO guidelines which advise that Zika testing for asymptomatic pregnant women is not routinely recommended. However, WHO's guidelines do recommend testing for symptomatic pregnant women and those whose male partners had tested positive for Zika. Symptomatic pregnant women and those whose male partners have tested positive should seek the advice of their doctors. They will be provided with free Zika tests at both public and private healthcare institutions if their doctors assess that testing is needed. Pregnant women who are tested positive for Zika will be referred by their doctors to an obstetric or maternal-foetal medicine specialist for counselling and subsequent follow-up. Regular ultrasound scans will be carried out to monitor the development of the foetus. Zika infection does not always result in abnormal foetal development. It is, therefore, important that pregnant women be appropriately advised and monitored by the relevant specialists. Babies born with microcephaly will be supported and cared for, just as we do for babies with other congenital conditions.”
“MOM and NEA have stepped up the engagement of construction sites and dormitory operators to intensify their vector control efforts to prevent mosquito breeding. MOM has also reminded employers and dormitory operators to encourage workers to seek medical attention and notify their supervisors, should they feel unwell. Measures such as temperature taking have limited effect for Zika since a majority of infected individuals are asymptomatic, that is, they do not run a temperature. As Zika is a mosquito-borne disease, the key strategy is vector control. I would also like to assure Assoc Prof Daniel Goh that our primary healthcare system is accessible to foreign workers, should they need to see a doctor. The cost of their treatment will be borne by their employers. Let me now explain our approach towards Zika going forward and how we are going to manage Zika in the long term. As more cases and clusters emerge, our efforts are focused on vector control. Minister Masagos will speak on this later. Isolation of patients has limited effect as 80% of those with Zika are asymptomatic, that means they have no symptoms. Secondly, there are already mosquitoes in the community carrying the virus. Hence, we now no longer isolate patients. Hospitalisation of Zika patients is also not necessary as we have found that most cases have mild symptoms. Patients will be hospitalised only if it is clinically necessary. We had also reviewed our policy on the testing of suspect cases. Initially, we were focused on the clusters in order to quickly assess the nature and extent of the outbreak to guide our strategy. We therefore provided free testing for those with symptoms who lived, worked or studied in the areas that were affected.”
“By now, MOH and NEA have moved beyond the surveillance phase, to actively detect cases and identify clusters to manage the spread of Zika. To determine the extent and the locations of the spread, we not only looked out for new cases, but also looked backwards in time to investigate past cases in the vicinity. As a number of such cases were construction workers, we went back to the construction site on 27 August to trace and test workers who had recently recovered from fever, and also assessed and tested new patients. We obtained most of the results by the next day and included them in our subsequent announcement. This active back-tracing was why the number of confirmed Zika cases increased from one reported on 27 August to 41 on 28 August. This sudden jump was surprising to some people, who wondered if these cases had, in fact, been detected earlier but held back by MOH. In reality, the number of confirmed new Zika-positive patients – and I repeat – new Zika-positive patients, increased only by five. The other 36 were from our proactive back-tracing of workers at the construction site. Many of them have already recovered from the sickness. Through the back-tracing, we also checked the onset of symptoms to determine the epidemiology of the outbreak. The analysis showed that the earliest case had onset of symptoms on 31 July. Some people misinterpreted this as MOH having known of the first Zika-positive case since 31 July. This is not so. As I explained, we only confirmed the first locally transmitted Zika case on 27 August, and we released the information the same evening. We subsequently identified new clusters beyond Aljunied and Sims Drive and we provided updates daily. Assoc Prof Daniel Goh asked how we manage construction sites and dormitories.”
“We screened the patient's household members, and NEA deployed a larger team of officers to conduct intensive vector control operations in the area around his home in Watten Estate. Residents in the area were given Zika information leaflets and were advised to seek medical attention should they develop symptoms of fever and rash. We also asked the clinics in the vicinity to look out for Zika-like symptoms. The man was discharged after he tested negative for the Zika virus and recovered. No other cases were subsequently linked to this case and the virus was successfully contained. Three months later, in the evening of 22 August, MOH was alerted by a GP from the Sims Drive Medical Clinic on an unusual increase in cases of fever, rash and joint pain that had tested negative for dengue and chikungunya. The next day, MOH arranged with the GP to refer new cases with similar symptoms to the CDC. On 25 August, that is, two days after, we approached the supervisor of a nearby construction site for records of workers who had recently been unwell, so that they could be investigated further. The following day, a lady visited the same GP clinic with similar symptoms and was referred to the CDC, as was arranged with MOH. She was confirmed as Zika-positive on 27 August. Three other patients were preliminarily tested positive that day, pending confirmation tests. That very evening, MOH announced all four cases of locally transmitted Zika cases – one confirmed and three pending confirmation. Following this, we alerted the GPs in the Aljunied Crescent and Sims Drive area to specifically look out for patients with Zika-like symptoms, and advised residents in the area to see their doctors if they had such symptoms. NEA also intensified vector control operations in the vicinity.”
“Our GPs are the first line of care for most Singaporeans. They have been helpful in alerting us to unusual disease patterns. We have also made Zika a notifiable disease under the Infectious Diseases Act from January this year, so that MOH would immediately be alerted if any doctor or laboratory in Singapore detects a case of Zika. Third, we sought to reduce the risk of importation of Zika. We issued travel advice to outbound travellers to Zika-affected areas and inbound travellers returning from these areas. Fourth, we stepped up public education and issued health advisories. In early February, we set up the Clinical Advisory Group (CAG) on Zika and Pregnancy, to develop a health advisory for pregnant women, and also to advise doctors on the clinical management of pregnant women with Zika. An interim clinical guidance was issued in mid-April. Fifth, we strengthened our operational readiness for an outbreak. In January this year, MOH worked with partner agencies to prepare our operational plans in case of an outbreak. In July, we conducted a multi-agency exercise where we simulated the import of an infectious disease into Singapore. This exercise involved a wide range of partner agencies, including the Ministry of Trade and Industry (MTI) and the Ministry of Manpower (MOM). Meanwhile, we continued to monitor global developments related to Zika closely to obtain regular updates on the situation worldwide. Madam, on 12 May, a man was hospitalised after he fell ill upon returning from Brazil. On 13 May, he tested positive for Zika, and the patient was quickly isolated at the Communicable Diseases Centre (CDC) at Tan Tock Seng Hospital (TTSH).”