MINISTRY OF HEALTH

Now that full establishment has been reached for all grades of staff, the time has come to chart the future progress by striking out on a new course.

The task in the coming years will be to sustain the high standards already achieved. The key-note will be greater sophistication in the Health Services together with greater demands on the civic responsibility particularly in public health measures. It is essential that in the reappraisal of development, priorities are assigned; costs are kept down as far as possible without stunting growth.

Environmental Health

The new sophistication will be apparent in the new and aggressive approach to the challenge of keeping Singapore clean. A "people orientated problem" being more complex will require that the main effort will be directed in wrestling out a successful solution which will involve mass participation of the public.

Progress has been made in recent years in the control of hawkers by licensing and re-siting. The labour force of the Cleansing Services will have to be further reorganised for better efficiency and discipline. There is much room for improvement. Dirt, flies and mosquitoes are all too evident. The recent occurrence of two cases of cholera underscores the need for maintaining vigilance and the highest standards of sanitation.

The Public Health Division will be strengthened by integrating some of its sections which have hitherto been working as separate units; by strengthening the supervisory staff to achieve better control and discipline. Reappraisal or the methods of collection, haulage and disposal of rubbish to improve the efficiency of procedures.

At the same time the people will have to play their part as citizens in making Singapore a garden city. For those who are incorrigible, new laws will be enacted to penalise litter bugs, and those who unnecessarily add to the c1eansing problem.

Public Health legislation is being consolidated into a comprehensive environmental health code capable of maintaining the highest standards of public health required in a modern complex urban society.

Hospitals

The aim is to develop the medical care services as a premier curative service. Further hospital accommodation will have to be manned when the British Services vacate their hospitals at Alexandra, the British Military Hospital - 400 beds; at Changi - 125 beds; at Sembawang - 74 beds.

The development of certain sophisticated specialties will be selected for stimulated development to standards equal to the best in the world. We must keep abreast with the latest in the world and keep up facilities, knowledge and skills as the best and highest in the region. The construction of the Institute of Medical Specialties as a joint project with the University has already started. The first section to house the Cobalt Units will be completed about August of this year. The other sections for the specialties such as the artificial kidney unit; cardiac unit, open-heart surgery, neurology, neuro-surgery, gastrology and others will be built soon. Some of these units have already been established within existing facilities in the hospitals e.g, an artificial kidney unit in the Outram General Hospital; a neuro-surgical unit in the Thomson General Hospital and a Cardiac-vascular Surgical Unit in the Tan Tock Seng Hospital. Dental Health

Dental health services require to be improved and expanded. The standards of dental care amongst the population are low. Only the younger generation of the population show the beneficial effects of fluoridation of the water supplies which started in 1958. Although the main effort for dental care is directed at school children (there are 50 school dental clinics) it reaches less than half the primary school-going population.

Improvement in dental health will be achieved if there is greater attention to dental hygiene and if dental services become more universally available. Great stress will therefore be placed on an intensive and sustained dental health education programme. This will be started in the schools and then directed to the general public. Dissemination of dental health knowledge is regarded as urgent at this stage as our population is not conscious enough of the importance of maintaining dental health.

The dental care services will be expanded as rapidly as resources are available. The limitation is the shortage of dentists (there being only 156 Division I registered dentists in Singapore; 60 of whom are in Government service). Priority will be given to the establishment of dental clinics for school children.

Medical Charges

The maintenance of the Health Service and its plans for development make an ever growing demand on the public purse. Already 12 per cent of the Republic's budget (or $78,000,000) is apportioned to the Health Service. The rise in costs cannot be sustained without limit without either contracting the services or a fall in the standards of health practices.

Neither alternative is acceptable. Hence some other means of holding down costs is essential.

Since the services are almost entirely free a token proportion of the costs will have to be borne by patients if the services are not to be limited.

A revision on medical fees is therefore being undertaken on the principle that services must be partially paid for. Examples of the proposed revision will be: -

(a) extending charges for hospital care to classes of patients who have hitherto been treated and fed free;

(b) increasing the number of paying class beds in hospitals (there are insufficient B class beds to meet the increasing demands chiefly due to the increasing number of collective agreements where employees, are entitled to admission to paying class wards);

(c) charges for workmen injured at work and persons injured in road traffic accidents who are covered by Workmen's Compensation or third-party insurance schemes, respectively;

(d) increasing outpatient charges per attendance and for attendances during Sundays and public holidays;

(e) enhanced accouchement charges for the third and further child to discourage families who can least afford to increase their numbers.

Family Planning

If the economic growth, social development and the quality of living is to be maintained and not absorbed by over-population the family planning programme will have to be pursued to maintain the accelerated drop in birthrates. Family planning, which has achieved notable results in recent years, will be prosecuted with greater vigour augmented by the proposed legislation to legalise abortions and the voluntary sterilization of persons.