Future Plans for Family Nexus Centres and Other Key Initiatives in Child and Maternal Health and Well-Being Taskforce Report

28 Ms Ng Ling Ling asked the Minister for Health with regard to the Strategy and Action Plan set out in the Child and Maternal Health and 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.

29 Dr Wan Rizal asked 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.

30 Dr Wan Rizal asked the Minister for Health with regard to the report from the interagency Child and Maternal Health and 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.

31 Ms Hany Soh asked the Minister for Health with regard to the setting up of Family Nexus sites under the Child and Maternal Health and 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.

32 Dr Wan Rizal asked 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 and Well-being (CAMH) Taskforce published on 14 June 2024, being evaluated.

The Second Minister for Health (Mr Masagos Zulkifli B M M) (for the Minister for Health): Mr Speaker, may I have your permission to answer related Parliamentary Questions together?

Mr Speaker: Minister, I assume these are Question Nos 28 to 31 on the Order Paper?

Mr Masagos Zulkifli B M M: My response will also cover the matters raised in both the questions for oral and written answers by Dr Wan Rizal,^1,2,3,4,5 which are scheduled for subsequent Sittings. 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.

Mr Speaker: Please proceed.

Mr Masagos Zulkifli B M M: Thank you. The Child and Maternal Health and 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.

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 rate.

In particular, Dr Wan Rizal asked about the reach of Project HOME, which stands for HOlistic Management and Enablement, and another project, HEADS-UPP or 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 who have received appropriate follow-up care as well as improvement in their postpartum mental health.

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.

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.

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, 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.

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. The Health Promotion Board (HPB) is working with preschools and mainstream schools to provide healthier meals for students.

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.

To help families better manage screen use and encourage balanced screen-time in children aged zero 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 (GPs) and preschools, and are available as resources on Parent Hub and Parents Gateway for parents of Ministry of Education (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 engage parents on screen use habits of children.

Over the past months, the Ministry of Health (MOH) and the Ministry of Social and Family Development (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 six years old through healthcare and preschools 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.

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.

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.

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.

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 homes.

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.

Dr Wan Rizal asked about the challenges we face. 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.

Mr Speaker: Ms Ng Ling Ling.

Ms Ng Ling Ling (Ang Mo Kio): Speaker, I thank the Minister for a very comprehensive update of the work that the CAMH Taskforce has done. I would like to express my appreciation for this task force because with the record low total fertility rate (TFR) in Singapore still continuing, every child is a precious one in Singapore. So, these initiatives are really important.

My supplementary questions are: firstly, with the many agencies across health, social and education involved in delivering over 40 initiatives, with 28 already implemented, how does the task force think that a mother who is coping with all the pregnancy demands and delivering her first baby would be able to have a more seamless experience, whether Health Hub maybe will be the digital platform that they can see all their case notes and intervention for coordination for their health?

Secondly, it is wonderful to have regional clusters doing community health talks. But because several of the initiatives are now still in the pilot phase, can HPB, being a national agency, take on maybe baseline training where most of the community centres can offer this, so that we can cover as many of these mothers and children as we can?

Mr Masagos Zulkifli B M M: I would say this is the first time we are actually trying to bring that many agencies across three domains: education, health and social support. Already, it is complicated because while everyone can do their work well, coordinating with one another in ensuring the support is done holistically is something we need to learn to do better.

But I would say that at the initial stages, the referrals that are designed into the programmes are being done properly. So, when a social service agency, for example, sees some health issues in the family, they do not just report; they make sure that it is addressed. If it is very complex, they ensure that the community nurses, for example, will attend to them and vice versa.

A health point like Family Nexus may find, during the interview, that they have other issues than just medical attention needed. That, too, has helped coordination among these agencies. Co-location is one solution so that when they come, they may be going for a particular issue to be addressed. But during the interview and triage, we also find out that there are other issues, and the agencies are already on hand and onsite to address the issues, if they want it to be done that way.

In fact, I also see that sometimes the mother needs more help than the children they bring to the Nexus. The children then get support and playing time, for example, while the issues of the mother are being addressed. I agree that we can do more to help the community provide support as we scale up the support.

I will consult with HPB on how this can be done, whether the Community Health Points, for example, can be used as one of the areas where we can rally our community to come together. But at the same time, our community nurses currently are only trained mostly for senior care, and we do need to train them to address maternal and child issues, which will also need a little time for us to keep up with.

Mr Speaker: Dr Wan Rizal.

Dr Wan Rizal (Jalan Besar): Mr Speaker, I thank the Minister for sharing on CAMH. I believe that this is a wonderful initiative, something that we have been waiting for, for some time. I have a number of supplementary questions, Mr Speaker. Is it okay if I go beyond the two?

Mr Speaker: Please ask all of them at one go and try to keep it succinct.

Dr Wan Rizal: Will do. Sir, my first supplementary question will be on the Family Nexus. There are Family Nexus sites already established. What considerations would the Ministry take into account when wanting to expand to other regions? I believe there are other regions which would also like to have these services. So, that is the first question.

The second question is about the usage of screen time. This is something that came up very strongly in the paper and there are only guidelines. Are there plans for the Ministry to consider making it into legislation, where we can limit the usage of these devices for children?

Sir, the third question I have is regarding the concerning rates of childhood obesity. Although we want to address obesity on its own, I remember back then that when we talked about obesity, a group of students in schools usually are sidelined. As we address this issue, I was wondering how we could better manage this situation so that we do not segregate this community too much where the children themselves are being targeted for being obese.

Mr Masagos Zulkifli B M M: When we designed the four Family Nexus centres, we considered a few models to try out. One model is like the one in our Tampines Hub, a community point where the community comes together naturally, regularly and makes a place where everyone is familiar with, but there are no medical facilities available, not like a polyclinic. We have another where it is actually a polyclinic and then we infused social services, so that if they come for medical attention, they can be referred to the social service agency. Another one is where the polyclinic has a small unit onsite together with the social service agency, which is a hybrid.

So, we are still looking at the various hybrids and the various configurations and then evaluate within, say, two years to see what best, how best and what suits where, in terms of the impact that we can provide for our mother and child dyad. But for now, what we are looking at is what is the density of the mother-child dyad like and that will be our priority on when we will roll this out, when the pilot is proven and chosen in terms of whether it is a hybrid type, community type or polyclinic type.

On screen time, it is a guideline right now. At the end of the day, to legislate something for the service providers is going to be really difficult because it is a complex issue involving both the Ministry of Communications and Information (MCI) and MOH. And everywhere in the world, we are trying to address this issue and looking for solutions to them.

But we can put this control in the hands of our parents to understand the different kinds of screen time that they are exposing their children to, especially when they are very young. Growing Up in Singapore Towards Healthy Outcomes (GUSTO), for example, talked about television (TV) time. In the very early years, a child may be watching TV, totally captured and enamoured by what is happening on TV, and we think, "Oh, the child is enjoying the show."

But what GUSTO has found is that it is stimulating the brain with lights. All the child is looking at is light. He does not understand what he is watching, and the stimulation on the brain is not good for the child. It is actually detrimental to the brain.

Therefore, when we look at other kinds of screen use, we have to understand whether it is for interactive purposes, which is recommended, but still must be regulated for different age groups; whether it is passive, where the child is watching and nobody is interacting; or, even worse still, in the background; where nobody is watching but it is in the background.

So, all these are kinds of screen device use which our parents must know about, more so because of social media and the ability of digital channels, like YouTube and so forth, so that we are aware about what we are exposing our children to and how their brains are developed and, in fact, even how their social behaviours are shaped. So, please read these guidelines. They are very well thought out and easy to use. We do not need regulations to get these things understood. We do not need lawyers to understand what they are. Just read them and they are very easy to use. Remember three things: need for interaction; avoid passive watching; and, worse still, do not have background screen use.

Finally, on obesity, I agree there are still many things we need to do and continue to do in addressing obesity in children. But a lot more effort ought to be done upstream. GUSTO studies also showed that there are things that we can do with our children that can prevent obesity setting in. For example, chewing time. Just getting children to chew more while they are growing up and not swallowing everything does affect obesity rate. Simple things that parents can do. Instead of us always trying to address the issues when they are in primary and secondary school, growing obese, actually there are things that we can do to address these issues as they are growing up.

That is why Family Nexus, the polyclinics, the interventions we are making with our mothers as they give birth to their children, other than lactation and so forth, these are important ideas, concepts, findings that we hope can help our children grow and develop their potential as much as possible by addressing and helping them far up and downstream as much as possible.

Mr Speaker: Last supplementary question. Ms Hany Soh.

Ms Hany Soh (Marsiling-Yew Tee): Speaker, I thank the Minister for the insightful sharing. My question surrounds the antenatal and postnatal mental wellness support which the Minister shared earlier that has been rolled out at KKH and NUH.

This supplementary question is in relation to whether there are plans to roll out to other hospitals, for example, like at the Singapore General Hospital (SGH), and also, in terms of the consistencies of the services to be provided by these public hospitals, are we ensuring that there is some level of consistency in terms of the practices that are being shared with the patients as compared to the private hospitals' patients in these aspects?

The other supplementary question is in relation to the expansion of the Nexus centres, which the Minister had given an earlier response to my Parliamentary colleague Dr Wan Rizal's supplementary question, I have asked Parliamentary Questions on this as well, specifically in relation to whether these expansions will be rolled out in due course to our Marsiling-Yew Tee Group Representation Constituency's Woodgrove divisions, that will, of course, definitely benefit the residents of Woodgrove and also Marsiling. The gist of why there is an emphasis for this is because we are expecting a lot of Build-To-Order (BTO) families with young children who will be moving in. So, I hope that the Ministry can, when it comes to expansion, take this into consideration when deciding on the locations for Nexus centres to be constructed.

Mr Masagos Zulkifli B M M: I thank the Member for the supplementary questions. To answer the second question, yes, indeed, we look at the density of where young couples live and the potential for them to have children, have families, and those are actually where we would roll out the earliest next tranche of Family Nexus centres. I hope that this can give the support to improve our TFR because this is part of the programmes that we want to put in place to help make Singapore that is "Made for Families", and to know that we will do everything and anything to support our mothers, particularly, in raising their children and having families.

On the issue of antenatal and postnatal care, the prenatal mental health guidelines for women of childbearing age were developed by KKH, together with the College of Obstetrics and Gynaecologists (OB/GYN) and have been launched in February last year and are already disseminated to healthcare professionals and the general public. So, there is one for healthcare and there is one for the professionals; and there is a consensus statement published in the Annals of the Academy of Medicine, summary of the guidelines and they are all available on the KKH website. So, it is already available to all OB/GYN specialists and hospitals, and I believe that within the fraternity, they are referring to this for their practice.