Community healthcare goes beyond making sure standard medical facilities and treatments are provided in neighbourhoods. It also calls for people to drive public education, plug gaps in services and think of fresh ways to deliver care outside of medical institutions.
To bring some of these ideas to life, the Tote Board in 2015 committed close to $100 million to its community healthcare fund till 2019. This is on top of the $130 million pumped in since 2009, when the Tote Board Community Healthcare Fund started.
It is a collaboration between the Tote Board, the Health Ministry and the Agency For Integrated Care.
So far, the fund has seeded more than 240 projects in the community and reached nearly 900,000 people, said a Tote Board spokesman.
Projects include those that target unmet needs, test innovative models of care and help to improve community healthcare services. Some examples are initiatives to meet the specialised transport needs of seniors and peritoneal dialysis for kidney failure patients.
Successful pilots may be granted funds so that they can be accelerated or scaled up, said the spokesman. "The fund serves as a catalyst in test-bedding innovative services, models and programmes with the aim of transiting them to mainstream government-funded programmes, if successful," he said.
Earlier this month, Health Minister Gan Kim Yong said in Parliament that there is a need to "mobilise the community" on healthy living. He said the growth in healthcare capacity must be coupled with efforts such as better disease prevention and healthy lifestyle choices.
The Straits Times takes a look at three projects that were rolled out recently.
Motivating one another in therapy class
It is not always easy for Madam Chan Puay Chin, 62, to cope with Parkinson's disease.
Once, when she was getting off a bus, another passenger scolded her for moving too slowly.
"She told me rudely to hurry up," recalled Madam Chan, a housewife who was diagnosed in 2010 with the degenerative disorder of the central nervous system.
The neurological condition tends to affect one's motor skills. At her regular taiji class, her body would tremble uncontrollably.
Since joining a physical therapy programme at St Luke's Eldercare Centre in 2015, she has managed to keep her symptoms at bay. "The exercises are good," she said.
The therapy programme was set up in 2014 by the Parkinson Society Singapore (PSS). It has so far helped some 160 people, who do exercises to boost flexibility, posture, muscle strength, balance and walking.
The plan is to roll it out at all 14 St Luke's day rehabilitation centres over the next six months.
A study of 61 participants done by St Luke's between 2014 and last year found that more than half of them showed improvement. Many did better at a 10m-walk test, for instance, while others were able to stand up from a seated position more easily.
The programme is supported by the Tote Board Community Healthcare Fund and the money is used to train therapists, for example.
PPS president Julie Lau said the elderly people benefit from being motivated by their peers.
Retired secretary Margaret Wan, 67, said the group classes made her feel less alone. "There is care and concern in class and we spur one another on."
Her problem came to light about 11/2 years ago, when a doctor noted that her movements were slow. She sought help at the National Neuroscience Institute.
Madam Wan could not brush her teeth or put on tight-fitting clothes herself, but is now able to perform these tasks. She does the therapy exercises at home daily.
Such tasks may be mundane but being able to do them enhances a person's well-being, said Ms Lau.
Former teacher Josephine Phun, 75, was diagnosed with Parkinson's four years ago and was prone to falling. She once dislocated her shoulder and was hospitalised.
Her handwriting had deteriorated but her mind remained sharp.
Madam Phun, who sometimes uses a wheelchair to move around, said her strength had improved with the help of St Luke's trainers.
"I feel stronger and more confident and I am now able to walk by myself," she added.
Poon Chian Hui
Help to sail through life with ease
A day rehabilitation centre at the void deck of a Housing Board block in Bukit Merah was a hive of activity on a weekday morning.
A group of 16 elderly people, seated in plastic chairs, were gearing up for an exercise session.
It was no ordinary workout, but a series of moves aimed at improving their strength and balance, so that they would be less prone to falls.
The programme, Stay Active and Independent for Life (Sail), was introduced earlier this year at Apex Day Rehabilitation Centre for the Elderly.
During a visit last month to the centre in Bukit Merah View, the elderly people, some less steady on their feet than others, had their eyes focused on a TV screen as they tried to mirror the moves demonstrated in a Sail exercise video.
Several Apex staff were on hand to guide and support the seniors, some of whom have dementia or had suffered a stroke.
Mr Lionel Oh, chief executive of Strengthening Communities, a non-profit organisation that runs Sail, said many elderly people and their families may be unaware of the factors that put people at risk of falls, such as poor balance and deteriorating eyesight.
Exercise can help to reduce this risk significantly, Mr Oh said.
In 2013, 61 per cent of the 354 trauma deaths in Singapore were due to falls. Six in 10 cases of unintentional falls were suffered by people aged 65 and older, according to the National Trauma Registry Annual Registry Report.
The Sail programme originated from the United States, where a 2010 study found that 93 per cent of more than 100 participants reported improved performance of daily activities, such as going to the toilet and putting on their clothes.
Sail classes in Singapore are designed to last an hour per session and can be conducted two or three times per week. Each class can take up to 20 participants, said Mr Oh.
It involves warm-ups, balance, strength training and stretching exercises. Participants are also taught how to prevent falls and injuries that can arise from them.
Sail has been supported by the Tote Board Community Healthcare Fund for a one-year period since last April.
The programme will roll out in Bedok, Bukit Merah, Jurong West, Tampines and Yishun over the next three years, with a targeted reach of 1,800 people.
Before embarking on Sail, participants undergo an assessment of their physical abilities, such as their leg and arm strength.
Mr Oh said: "Subsequent fitness checks are done at recommended intervals, which can motivate them as they can see how much they have improved."
After Madam Poon Oi Kheng, 78, fell and hit her head a year ago, she felt unstable on her feet.
But taking part in Sail at the Apex centre has helped her regain her balance. "At first, I couldn't stand up," said Madam Poon, who lives alone in a five-room HDB flat.
"But I can now stand and walk without any problems."
Poon Chian Hui
Fun way to pick up healthy lifestyle habits
Healthy habits that start from young are likely to be carried into adulthood.
This is a key idea behind Sengkang Health's Millennia Kids Programme. It was started in 2014 to get primary schoolchildren to build the foundations of healthy living through hands-on activities, talks and a dose of competitive fun.
The hope is that they will create a "multiplier effect" by influencing their families and friends to take up healthy habits, said Ms Cecilia Pang, director of communications & service quality at Sengkang Health, a public healthcare group that will run Sengkang General Hospital when it opens next year.
She said: "It is designed to help children live, learn and lead a healthy lifestyle from an early age, while influencing their families and the community to do the same."
The programme has reached 6,500 upper-primary schoolchildren in three schools - Compassvale Primary, Sengkang Primary and Fernvale Primary.
The pupils take part in talks and workshops on nutrition, sports safety, stress management, anti- smoking messages, listening skills and fall prevention. These are usually held during school assembly.
Pupils also take part in a "task card" activity, where they complete a series of tasks in various categories, such as healthy eating and positive thinking.
"Their progress is logged in an activity book and incentives are given," said Ms Pang. "For every task completed, they are awarded varying numbers of stars."
The stars collected go towards earning annual badges to help spur them on till the end of the three- year programme.
A carnival is also held during the school holidays to encourage family bonding.
At the Millennia Kids Challenge, the pupils are joined by their families and friends for lifestyle activities such as an "obstacle course" featuring games to improve their speed and coordination, said Ms Pang.
The Millennia Kids Programme has received funding from the Tote Board for a three-year period.
So far, results have been heartening. In a survey done with parents, a majority indicated a greater awareness of healthier lifestyles.
Six more schools have come on board this year, said Ms Pang.
Poon Chian Hui