INTRODUCTION

The Neighbourhood Health Service (NHS) is a local health screening service project involving:

  • Medicine and Nursing students of the Yong Loo Lin School of Medicine, NUS

  • Social Work students of the Faculty of Arts and Social Sciences, NUS

  • Medicine students of the Lee Kong Chian School of Medicine, NTU.

The inaugural NHS was held in January 2008, serving the residents of Taman Jurong Zone B. Only 3 basic triage services were offered: Capillary Blood Glucose (CBG), Blood Pressure (BP), and Height & Weight (BMI). In its eleventh year, In its eleventh year, NHS has grown substantially and has since extended its service to residents in Eunos Crescent, MacPherson, Bukit Merah, Marine Terrace, Kampong Glam and Queenstown.

The extensiveness of services provided has grown in tandem with the outreach of the project. Residents now enjoy more than 20 different screening modalities and follow up services such as basic and advanced eye screening, dental check-up and cancer screening.


OBJECTIVES

NHS aims to identify residents-in-need, especially the elderly and residents of lower socio-economic status living in rental blocks, and act as a bridge to reconnect them back to the healthcare system.

In essence, NHS seeks to reduce the size of two main groups of residents:

(i)  Residents who suffer from illness but have not been diagnosed yet;
(ii) Residents who have previously been diagnosed with illness, but are not receiving medical treatment due to various barriers to healthcare (e.g. cost, mobility, personal reluctance). 

In the long term, NHS also hopes to evolve into a replicable health service model that can be adopted by healthcare institutions nationwide.


TARGET GROUP

NHS targets the rental block population in Singapore, which has a larger proportion of elderly and residents of lower socio-economic status. Many of these residents (i) do not go for regular health screenings (may suffer from latent chronic conditions) and/or (ii) do not actively seek treatment for diagnosed conditions [1,2]. 

Such poor health-seeking behavior can be attributed to several barriers to healthcare, including (but not limited to):
1. Financial limitations : unable to afford healthcare
2. Physical limitations : immobile; cannot access health facilities
3. Psychological gap : low risk perception of illnesses, doubts about Western Medicine, fear of mockery
4. Knowledge gap : imperfect information on health services and financial schemes available

Furthermore, extensive research has shown that the general health of the rental block population (influenced by socio-economic status) is generally poorer than that of a non-rental block population [3,4]. There is thus a need for an intervention such as NHS, to identify residents-in-need (through screening and diagnosing latent conditions), and reconnect them back to the healthcare system (by breaking down barriers to healthcare).


APPROACH 

Today, NHS is more than just another health screening.

We bring a comprehensive, holistic health service right to the doorsteps of residents-in-need. This is especially convenient for immobile residents, who are thus encouraged to participate. Our screening module comprises five distinct categories – chronic diseases, functional, mental health, frailty, and cancer. Each contains multiple modalities and add to a total of 26.

The work does not stop there. NHS continues to engage more than 300 residents with abnormal results through our comprehensive follow-up programme. The aim is not to replace primary care physicians, but to motivate these residents to see GPs to follow up on on their screening results.  To ensure that they do so, our committee members – trained in motivational interviewing techniques frequently used by family medicine physicians – engage residents via phone calls (and house visits in more complex cases). This happens at regular 3-monthly intervals, for up to a year after these residents’ last screening, thus encouraging positive health-seeking behaviour.

Crucially, we take a holistic view on health. We are well aware that healthcare decisions are always influenced by socio-economic factors. Thus, NUS Social Work students form a core part of our committee and volunteer group. They work tirelessly to connect residents-in-need to social support organisations, in order to overcome socio-economic barriers to healthcare.

[1] Wee, L. E., Koh, G. C-H., Chin, R. T., Yeo, W. X., Seow, B., & Chua, D. (2012). Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention. Preventive Medicine, 55(1), 61-67.

[2] Wee, L. E., Koh, G. C-H., Yeo, W. X., Chin, R. T., Wong, J., & Seow, B. (2013). Screening for cardiovascular disease risk factors in an urban low-income setting at baseline and post intervention: a prospective intervention study. European Journal of Preventive Cardiology, 20(1), 176-88.

[3] Low, L. L., Tay, W. Y., Ng, M. J. M., Tan, S. Y., Liu, N., & Lee, K. H. (2016). Frequent hospital admissions in Singapore: clinical risk factors and impact of socioeconomic status. Singapore Medical Journal, 1-6.

[4] Low, L. L., Wah, W., Ng, M. J., Tan, S. Y., Liu, N., & Lee, K. H. (2016). Housing as a Social Determinant of Health in Singapore and Its Association with Readmission Risk and Increased Utilization of Hospital Services. Front. Public Health, 4(109), 1-7.