5 02.13 Healthcare System, Housing, Public Transportation and Education in Hong Kong and Singapore (II)

GCAP3007 February 13, 2023 1
Healthcare System, Housing, Public

Transportation and Education in Hong Kong and
Singapore ( II )
GCAP3007
A Tale of Two Cities
February 13, 2023
Housing, Healthcare System, Public

Transportation and Education in Singapore
Housing in Singapore
• From Singapore Improvement Trust (SIT) to Housing Development Board (HDB)
• Key housing policies
Images of the Tiong Bahru Estate (old and new), earliest low-cost public housing built by SIT in the 1930s
Background
• The first efforts of public housing in Singapore began in 1927 under the Singapore
Improvement Trust (SIT)
• By the time the SIT was dissolved in 1959
• It had only constructed 23,000 dwelling units during its existence, at an average rate
of 1,700 units per year after the Second World War
Background
• When the People's Action Party (PAP) assumed power in 1959, the Housing and
Development Board (HDB) was formed
• With much enlarged financial and legal powers to roll out large scale housing
programme
• By the end of 1972, HDB built a total of 155,301 dwelling and other units housing
800,000 people
• This amounted to 41% of the total population of Singapore in the span of less than
two decades
Background
• During the colonial period, the population was largely
concentrated in ethnic-based districts within the city
centre, around the Singapore River
• Housing in these enclaves primarily took the form of

shophouses where multiple families lived in confined,
often dangerous and unsanitary spaces
• Housing in the outskirts comprised traditional

kampungs with land for farming and the large estates
of wealthy Europeans
Background
• In light of the post-war baby boom in the early 1950s, the SIT was unable to catch
up with the housing needs of the city
• In 1947, the population was nearly 940,000 with more than 70% living in the city
centre
• Overcrowding, potential hazards such as fire and the spread of disease, are some
problems faced by the population living in slums located in the city centre
• The Bukit Ho Swee fire which happened on 25 May 1961 is one such example
where the fire destroyed 2,200 dwellings, killed 4 people and injured another 54
Background
• In 1960, the People’s Action Party (PAP) government replaced SIT with the Housing
and Development Board (HDB) and Lim Kim San was appointed as its first
Chairman
• Its mission was to embark on a far more aggressive public housing building
programme with its primary objective to provide affordable housing for the masses,
not just for the poor
Background
• When Singapore became independent in August 1965, home ownership became an

urgent priority
• Prime Minister Lee Kuan Yew “After independence in 1965, I was troubled by
Singapore’s completely urban electorate. I had seen how voters in capital cities
always tended to vote against the government of the day and was determined that our
householders should become home owners, otherwise we would not have political
stability… I believed this sense of ownership was vital for our new society which
had no deep roots in a common historical experience. ”
Background
• In the beginning, the focus was on the construction of basic one and two room rental
units. In later years, the HDB began to construct three room units for purchase and
its focus shifted towards promoting home ownership through the Home Ownership
Scheme (HOS) launched in 1964
• Home ownership is a way to maintain social stability and promote social mobility; it
gradually took off after changes were made to the Central Provident Fund (CPF) in
1968 to allow Singaporeans to use their CPF accounts to pay their monthly housing
mortgage
• Today, more than 80% of the population own a HDB flat in Singapore
Key Policies on Housing
• With limited funds and resources, the PAP government enacted legislation to obtain
land for urban development such as the Land Acquisition Act of 1966
• Prime Minister Lee Kuan Yew had explained the Land Acquisition Act as necessary:
“When we were confronted with an enormous problem of bad housing, no development,

overcrowding, we decided that unless drastic measures were taken to break the law, break
the rules, we would never solve it. We therefore took overriding powers to acquire land at
low cost, which was in breach of one of the fundamentals of British constitutional law –
the sanctity of property. But that had to be overcome, because the sanctity of the society
seeking to preserve itself was greater. So we acquired at sub-economic rates.”
• It was seen as a major policy innovation in 1968 for the government to utilize the
CPF as a vehicle for housing finance
• A new law was introduced to allow withdrawals from the fund to finance the
purchase of housing sold by the HDB
• Both employers and employees contributed a certain percentage of the individual

employee’s monthly salary toward the employee’s personal and portable account in
the fund
• When the CPF was established in 1955, the contribution rate was 10% (5% each by
employees and employers) of the monthly salary
• With the new law passed in 1968, the contribution rates were raised steadily, and by
1984, they were 25% of wages
ADBI Working Paper Series, Housing Policies in Singapore, 2016


• Integrated approach to urban planning through the first Concept Plan in 1971
• The first Concept Plan was put together with the help of the United Nations
Development Programme (UNDP) for an estimated population of 3.4 million by the
year 1992
• A key strategic feature of this plan is the system of four urban corridors, with the
inner two encircling the central catchment area and outer two extending to the city’s
east and west along the southern coast line

• Along these corridors, high-density satellite towns were earmarked, mainly for the
development of public housing
• The Concept Plan promoted a form of urban development and expansion structured
around a ring pattern of circulation
• This ring helped to ensure the safeguarding of land for essential transportation
infrastructure such as the island-wide expressway system, MRT network, and
Changi Airport

• In view of the massive resettlement of people from squatters to flats, the government
was looking for ways to nurture community spirit in the new high-rise environment
• New towns were therefore sub-divided into neighbourhoods, which were in turn
further sub-divided into precincts
• Each precinct, at about 3-5 hectares in size, could give the residents a sense of
attachment to the land as well as neighbourliness with surrounding households
• To reinforce this objective, town centres and neighbourhood centres were designed
for the dual purposes of commercial and civic activities

• Residents can not only shop in these areas, they can also meet friends and relatives
in eating outlets and small squares
• Other facilities such as institutional sites, religious sites for different religions, and
petrol stations were also carefully studied and incorporated into each New Town

• Industrial developments were also hierarchically dispersed across the island, with
light industries strategically located near homes for easy commute to and from work
• Under the “Green and Blue Plan”, a framework was introduced to safeguard nature
reserves while enhancing leisure opportunities through the creation of a
comprehensive system of open spaces and waterways in urban development
• Given the land scarcity, the continued efforts to green Singapore will have to depend
to a large extent on strategies to “borrow space” for greenery

• Two areas of innovation can be seen
• The first is to closely integrate greenery

with our waterways and reservoirs, and
transform them into beautifully-
landscaped streams and lake parks to
expand space for leisure and protect
biodiversity
• The second is to weave greenery into

existing buildings and spaces

• Ethnic Integration Policy (EIP) was introduced in 1989 to ensure a mix of ethnic
groups in each town and within each apartment block
• Sales of new HDB flats and resale HDB flats were regulated based on pre-
determined ethnic quotas
• This principle of encouraging social mixing and preventing enclaves from forming in
our public housing estates
• The Chinese, Malay, Indian/Others

neighbourhood limits were set at 84%,
22%, and 10%, respectively
• For new flats, a particular ethnic group

will not be able to buy a flat from the
HDB if the quota for that ethnic group
has been reached for the particular block
or neighbourhood

• With housing problems being largely resolved by the 1980s, the aim of the 1991
Concept Plan was to alleviate congestion in the city core through decentralization
• This requires the creation of a hierarchy of urban centres outside the central area
• In the plan, the island-city was carved into five regions–Central, West, North, North-
East and East

• Each region was to accommodate around a million or more inhabitants, and was
further subdivided into several highly self- sufficient New Towns featuring a mix of
high, medium, and low density housing forms
• Besides the Central Business District (CBD), the areas identified to become regional
centres were Jurong East, Woodlands, Nee Soon and Tampines
• Sub-regional centres and fringe centres


• Town Councils were formed in 1989 to empower elected Members of Parliament
(MPs) and residents to work together in the management of their estates
• Under this set-up, elected MPs are given the authority and responsibility to manage
the public housing estates in their constituencies, with residents participating in the
decision-making process
• In this way, each town can develop its own distinctive character and identity

• The concept of Town Councils was first
piloted in Ang Mo Kio Town and subsequently
introduced island wide over three phases, from
mid-1989 to mid-1991
• Currently, there are 17 Town Councils

managing the common property in HDB
housing estates in Singapore, following the
General Election in 2020
The First Five-year Housing Plan (1961-1965)
• Mainly apartments with one bedroom, one living

room and two bedrooms, one living room
• Units are priced affordably for rental; back then,

it was decided that the rentals to be charged on
all categories of flats should not exceed 15% of
the family income
• A total of S$194 million was invested to build a

total of 52,700 houses
The Second Five-year Housing Plan (1966-1970)
• By the second five-year housing plan (1966-1970), the focus was on improving the
structure and quality of HDB flats
• Floor area of per unit has also expanded with an investment of S$305 million to
build 66,200 houses
The Third Five-year Housing Plan (1971-1975)

• Build three-room or four-room HDB flat; upgrade
or demolish one or two-room HDB flats
• Children’s playgrounds, parks and other public

amenities are included to improve living conditions
and landscape
• A total of S$1.9 billion was invested to build a total of 113,800 three- or four-bedroom flats
• SIT flats have an average space location of 77 square feet per person, while HDB flats
average from 57, 76, 82 to 104 square feet per person in 1-, 2-, 3-, and 4-room units,
respectively
The Fourth Five-year Housing Project (1976-1980)

• By the Fourth Five-Year Housing Project (1976-1980), it was common to construct
HDB flats as high-rise buildings with 10-20 floors
• Each unit can consist of 5-6 bedrooms with an average living area of 125 square
meters (or 1345 square feet)
• The interior is not painted, allowing residents to design and decorate themselves
The Fourth Five-year Housing Project (1976-1980)
• The ground floor of each high-rise

HDB is an open public space that
serves as a place for residents to gather
and interact
• By 1990s, the government built

725,000 flats and 86% of Singaporeans
lived in the HDB flats
An Integrated HDB–CPF Framework

• Between 1968 and 1981, CPF savings could only be for payments related to the
purchase of public-sector-built housing (such as down payment or stamp duties)
• At the beginning of the 1980s, the scheme was gradually liberalized, allowing for
withdrawals for other, non-housing-related purposes, such as medical expenditure
• The interest rate on CPF Ordinary Account savings yields a minimum of 2.5%
An Integrated HDB–CPF Framework

• The HDB uses the loans from government to provide mortgage loans and mortgage
insurance to buyers of its leasehold flats (both new and resale)
• The typical loan represents 80% of the price of the flat
• The maximum repayment period is limited to 25 years
• Every household can apply for a maximum of two HDB loans
• The mortgage interest rate charged by the HDB is pegged at 0.1 percentage point
above the CPF ordinary account savings interest rate
• The integrated HDB–CPF framework contributed to the growth of housing loans and
the development of the mortgage sector as homeownership rates increased over the
years
Toa Payoh- HDB’s First Comprehensively Planned Satellite

Town (in 1965)
• Toa Payoh was the first comprehensively planned satellite town entirely planned and
built by HDB
• Planning was based on the “neighbourhood principle” where several

neighbourhoods were grouped around a town centre
• Each neighbourhood had its own Neighbourhood Centre, community facilities, and
primary and secondary schools. In planning for the town, planners and architects
also introduced more variety in the buildings, both individually and in their layouts

Town (in 1965)
• For example, building heights varied from 6 storeys to 25 storeys, lending diversity
to the town’s skyline
• The taller blocks of 25 storeys were used to mark strategic points in the town
• The Toa Payoh Town Centre was planned with facilities that would cater to some
200,000 people: with a projected 120 shops, department stores, two theatres, a
library, a clinic and community institutions

Town (in 1965)
• It was built on 16 hectares of relatively level land with a layout
that housed shops on the ground floor of low-rise slab blocks
• The shops were planned to face another row of shops so that a

main thoroughfare could be created through the continuous
wide central pedestrian mall
• The shopping pedestrian mall was meant to create a seamless

“shopping parade” leading to the major areas where the market,
library, emporium, and post office were located

Town (in 1965)
• In addition, the largest bus terminal in Singapore
was planned for the town
• Greater attention was also given to the provision

of better social, recreational including a fountain
(outside the Toa Payoh library), and sporting
amenities like the sports complex with a running
track, football pitch and swimming pools
Public Transportation in Singapore

• Important events and key milestones
• Hock Lee bus riots (1955)
• The integrated Concept Plan (1971)
• Area Licensing Scheme (ALS) introduced

in 1975 (up till 1998)
• Building the MRT (in 1987)
• Vehicle Quota System (1990s)

Background
• In the 1950s, public transport was in a state of disarray with poor regulation and lack
of enforcement
• It was a turbulent time for Singapore with communist agitation in the trade unions
(including bus unions) and strong anti-colonial feelings after the WWII
• Bus workers that were controlled by communist unions frequently initiated work
stoppages to get their employers to address their low wages and poor working
conditions, thus paralysing the whole bus system
Background
• There were as many as 57 strikes in the Chinese Bus Companies in 1955 alone, of
which the Hock Lee Bus Riot is one of the most well-known examples, resulting in
four deaths and 31 people injured
• In 1956, the colonial government published the Hawkins Report that recommended,
among other things, the 11 existing bus companies merged, with common ownership
and common management either as a fully nationalized government-run entity or
partly financed by private investment
• However, this recommendation could not be realized until 1973 with the formation
of the Singapore Bus Service
Background
• The public had to put up with a myriad of timetables, routes and fares offered by the
different bus companies
• The lack of integration often resulted in long and inconvenient journeys with
multiple transfers, especially for commuters who wanted to travel between territories
served by different bus companies
• In order to maximise profits, buses were not regularly maintained by the operators,
resulting in frequent breakdowns
Background
• As an alternative to the inadequate public transport system, pirate taxis were rampant
• These were private and usually old vehicles that transported people without a taxi
licence
• Such taxis were not metered, requiring passengers to negotiate their fares at the start
of the journey and often, sharing the taxi with strangers picked up along the way
• As they were not regulated, drivers often tried to take as many passengers as they
could to increase their takings, paying little attention to service quality and safety
Background
• Given the disorganized state of the public bus system that was often paralysed by
labour strikes, the government did not strictly enforce the taxi industry until the
1970s, where it was an era of stronger government intervention in the public
transport sector
• The government began to implement new regulations to ensure better bus and taxi
services.
Background
• The Public Transport Council was established in 1987 to regulate the industry
• The mid-1990s welcomed a new era of integrated transport management with the
merger of all land transport functions, both private and public transport into a single
integrated land transport agency
• In 1995, the Land Transport

Authority of Singapore (LTA) was
formed with the merger of five
inter-related departments
Background
• The future of transport in Singapore will be a greener one with greater emphasis on
more sustainable transport modes such as public transport and active mobility
• For example, with the addition of new and upcoming MRT lines, eight in ten
households will be within a 10-minute walk from a train station by 2030
Background
• Apart from expanding the cycling path network, new innovative features and designs
will be piloted in towns, starting with Ang Mo Kio, to provide a better walking and
cycling environment
• The Walk2Ride programme will expand the sheltered walk-way network linking
transport nodes to homes and key amenities, making it more convenient for people
to walk to their destinations
White Paper on the Reorganisation of the Motor Transport

Service (1970)
• Merger of 10 Chinese Bus Companies into three major bus companies with clear
territorial demarcations
• The Singapore Traction Company (STC) which was the main bus company covering
the main routes within the Central Business District, was making huge losses and
eventually ceased operation on 5 December 1971
• The government intervene again in 1973 with the merger of the three remaining bus
companies into a single private entity called the Singapore Bus Service

Service (1970)
• The merger saw the integration of

all bus routes and the
standardisation of fares
• By the 1980s, there was increasing public dissent against the Singapore Bus Service
(SBS) as a monopoly given its strong profits and fare increases
• The government mooted the idea of a second bus company to provide some degree
of competition to the SBS

Service (1970)
• In 1982, the Trans-Island Bus Services Pte
Ltd (TIBS) was formed and started operations
in April 1983
• It was also hoped that the introduction of

TIBS would serve as a catalyst for improving
bus services

Service (1970)
• New regulations were implemented to weed out the illegal pirate taxi industry in
accordance with the 1970 White Paper, these included:
1. Raising diesel taxes on private diesel vehicles (majority of which operated as pirate
taxis) by 100%
2. Suspension of pirate taxi drivers’ driving licences for one year if caught
3. Making pirate taxi operations a seizable offence where offenders could be arrested
on the spot and charged the following day

Service (1970)
• Other new regulations included establishing an
age limit of seven years for taxis and a
maximum age of 63 for taxi drivers
• Furthermore in 1970, the NTUC Comfort (cooperative commonwealth for transport)
was formed to manage the taxi drivers, freeing them from unscrupulous taxi barons
that controlled clusters of up to 100 pirate taxis and drivers
• It helped former pirate taxi drivers to become licensed taxi owner-drivers where
members of the cooperative could take up vehicle loans allowing them a four-year
period to repay the loans
Area Licensing Scheme

• The effect of traffic congestion was most severe within the Central Business District
(CBD)
• The Road Transport Action Committee (RTAC) was set up in the 1970s to look into
pre-empting traffic jams in CBD which led to the implementation of the world’s first
congestion pricing scheme known as the Area Licensing Scheme (ALS) in 1978
• The ALS was a usage restraint measure to control traffic congestion in the CBD
during peak hours

• An imaginary cordon was set up around the most congested
parts of the CBD. The cordoned area, called the Restricted
Zone, was demarcated by overhead gantry signs
• During the Restricted Hours, a paper licence had to be

purchased and displayed on the vehicle windscreen to enter
the Restricted Zone
• Enforcement was manual, requiring enforcement personnel at all gantry points and
sales staff at roadside sales booths located at the approach roads to the Restricted
Zone

• Licences could also be purchased at petrol stations, post offices and convenience
stores
• As vehicle population and car ownership grew in the 1980s, several refinements
were made over the years to better manage congestion
• For example, the ALS was extended to cover all vehicles except emergency vehicles
(e.g. ambulances, fire engines) and public buses in 1989
• Car and taxi pools were no longer exempted


• This was deemed to be more equitable as all vehicles contributed to the congestion
in the area and all should therefore be subject to the same restraints
• Restraint on all also meant a milder levy was sufficient
• The ALS fees were thus reduced by 40% to S$3 per day and S$60 per month
• The Restricted Hours were extended to include the evening peak hours between 4.30
pm and 7.00 pm due to worsening traffic conditions

• In 1994, the Restricted Hours were
further extended to full days, with peak
and off-peak differential pricing
• The Restricted Zone also expanded

over the next 14 years from an area of
610 hectares to 725 hectares with the
expansion of the CBD

• Along with the ALS, parking controls were applied to discourage trips by car,
especially work trips into the city in 1975
• This was done in two ways: raising parking charges differentiated between CBD and
non-CBD areas and imposing a charge on each lot owned by the private car park
operators
• This scheme was suspended in 1998 with the introduction of the Electronic Road
Pricing (ERP) Scheme, which was a more efficient and flexible traffic management
tool
The Great MRT Debate

• The decision to build a S$5 billion Mass Rapid Transit did not come easy
• While some argued for a bus-rail system, others preferred an all-bus system
• The decision took a long time primarily due to fiscal concerns
• The government had to weigh the benefits of the investment against the great cost of
building it at a time when Singapore needed funds for urgent housing development,
education and defence

• In the end, the argument for the MRT won as it was felt that an all-bus system would
impose considerable traffic externalities to all users; and developments in the CBD
would have to be scaled back to give enough space and priority for buses
• Furthermore, it was felt that the MRT would be an investment to the economy by
improving Singapore’s competitiveness in attracting the kind of higher value-added
investments desired, especially in the financial and business sector

• Construction of the MRT began in stages from
October 1983 to January 1988
• The timing of the MRT worked to Singapore’s

advantage as the early 1980s recession led to
considerable cost savings as contractors competed
for work, and the near completion of the Hong Kong
MTR system made expertise readily available
• Sixty-six trainsets comprising six cars each were procured; they were manufactured
from 1986 to 1989 by a Japanese consortium

• The first 6 kilometres of the North South Line between Yio Chu Kang and Toa Payoh
was opened on 7 November 1987, marking a milestone in Singapore MRT history
• The rest of the system opened in stages, including sectors of the East West Line, and all
42 MRT station were operational by July 1990, two years ahead of schedule
• In 1987, the Singapore Mass Rapid Transit (SMRT) Pte Ltd was incorporated to run the
MRT system as a private operator
• To facilitate the multi-modal integration between the newly-built MRT system and buses,
Transit Link was jointly established by then-public transport operators (SMRT, SBS
Transit and TIBS) in 1987 to integrate fare collection system for bus and rail network

• An integrated ticketing system was introduced by Transit Link in 1990 to provide a
common cashless fare payment system on both bus and rail services
• This allowed commuters to switch from bus to rail and vice versa, without the fuss
of having to change payment methods
• In 2010, a new rail financing framework was put in place to facilitate the future
expansion of the rail network in a financially sustainable manner; and inject greater
competition into the rail industry
Vehicle Quota System

• The government has used fiscal disincentives to control vehicle ownership and usage
• An excise duty (ED) is levied by Customs on each vehicle imported into the country
• Owners must pay a registration fee (RF) and additional registration fee (ARF) to
register the vehicle in addition to an annual road tax
• Over the years, heavier restraints were imposed primarily on cars due to the strong
demand for cars
• From 1975, excise duty, ARF and road taxes were raised periodically

• From 1975 to 1989, the car population grew on average by 4.4% per annum, or by a
cumulative total of 80% from 141,875 to 258,537 vehicles
• As the economy recovered from the economic recession of the mid-1980s, the
growth rate of cars picked up and reached 8.2% in 1989
• It was projected that the car population would double to 570,000 in nine years
• The objective of the VQS was to allow vehicle population to grow in tandem with
road capacity
• This system controls the growth of the vehicle population at a sustainable rate

The key features of the system are:
• Universality: the scheme applies to all vehicles except scheduled buses, school
buses and emergency vehicles such as ambulances and fire engines
• Rationing by market-based pricing: anyone who intends to register a vehicle must

first bid for a Certificate of Entitlement (COE) in an open tender
• Successful bidders need only to pay the lowest successful bid price
• Time-limited rights: The COE is valid for 10 years
• The owner must either de-register his vehicle, or renew the COE for another 10
years by paying the prevailing quota premium
• Five categories for the COE quota
• A COE for a category A car (up to

1600 cc) cost S$41,400 in 2018,
but in 2019 it stands at S$26,659,
a drop of roughly 36%
• If the LTA reduces the quota of

COEs available, the overall price
of COEs will increase
Healthcare in Singapore
• “A competitive, winner-takes-all society, like colonial
Hong Kong in the 1960s, would not be acceptable in
Singapore … To even out the extreme results of free-
market competition, we had to redistribute the national
income through subsidies on things that improved the
earning power of citizens, such as education. Housing and
public health were also obviously desirable. But finding
the correct solutions for personal medical care, pensions,
or retirement benefits was not easy.”
Healthcare in Singapore
• Background
• Introduction of user fees at public clinics (implemented for the first time in 1960)
• National Health Care Plan (in 1983)
• Central Provident Fund (CPF) and viability of the healthcare system in Singapore
Background
• In 1821, the first hospital, Singapore’s General Hospital was built on the island
• Staffed by army medical doctors, its primary goal was to provide medical services to
European soldiers, sepoys (local soldiers), and natives
Background
• As the population began to increase, so did the challenges arising due to poor
sanitation, unclean water, and pollution
• Lack of formal regulations in the areas of housing, water, and sanitation quickly
resulted in overcrowding of both people and waste
• This situation continued up until the 1900s, when concerted efforts were made to
improve the Singapore water and sanitation system
• In 1942, medical services came to a standstill as WWII broke out and Singapore fell
to the Japanese
Background
• Post-war reports of 1946–1947 revealed a grim health pattern among schoolchildren,
with malnutrition and epidemics of communicable diseases being the most
significant problems
• Almost 50% of school children examined in 1946 were malnourished and suffered
from nutritional deficiencies and infectious diseases, such as measles, poliomyelitis,
diphtheria, tuberculosis (TB), and smallpox
Background
• Yong Nyuk Lin, the Minister for Health at the time, once stated the situation bluntly:
“health would rank, at the most, fifth in order of priority” for public funds. National
security, job creation, housing, and education were in the queue ahead of health, in
that order.”
• Having said so, investment in public housing, provision of clean water, proper
sanitation services, clean environment, good nutrition, and health education are what
helped to improve the health status of Singaporeans
Background
• An example is the School Milk Scheme
introduced by the government in 1974 to
improve the nutritional intake of children,
and to inculcate in them good nutritional
habits
• Under this scheme, normal students could

buy milk at discounted prices, while
underweight children and those from needy
families would receive milk free of charge
Background
• After independence, it was believed that the

market-oriented, consumer-driven model of
healthcare would serve Singapore far better as the
individual would be incentivised to take
responsibility for their own health, with the
government providing a safety net
• A user fee of 50 cents for each attendance at the

clinics was imposed in 1960; the fees doubled
during public holidays
Background
• In 1962 and 1963, the attendances at clinics exceeded 3 million, but in 1964 and
1965, the total attendances dipped significantly
• The rate of attendance per 1000 population was 1777 in 1962, 1778 in 1963, 1280 in
1964, and 1090 in 1965
• Island and Travelling Clinics which functioned because of need in the rural areas
continued to be free
Background
• The government also began mass-
inoculation programmes in an effort to
battle infectious disease such as
tuberculosis, smallpox, diphtheria, and
poliomy-elitis
• Under the National Childhood Immunisation Programme (NCIP), it covers
vaccination against TB (BCG); hepatitis B (HepB); diphtheria, pertussis and tetanus
(DTaP); poliomyelitis (IPV/OPV); Haemophilus influenzae type b (Hib); measles,
mumps and rubella (MMR); pneumococcal disease (PCV); and human
papillomavirus (HPV)
Background
• High levels of overall immunisation coverage over the years has resulted in polio,
neonatal tetanus, diphtheria, childhood TB meningitis, and congenital rubella being
virtually eliminated from Singapore
• Complementing this, the Government began to push for education, increasing the
number of medical professionals and specialists on the island
• Before 1960, there were fewer than 50 medical specialists in Singapore to serve
Singapore’s two million residents
Background
• The Committee for Postgraduate Medical Education was set up in 1970
• Initially, there were few specializations offered in Singapore
• The government began sending its brightest doctors in the public sector to the best
medical institutions around the world for training
• In the 1980s, the Healthcare Manpower Development Programme was launched

giving specialists opportunities to work and train at world renowned overseas
institutes
• As of 2013, Singapore has 1.9 doctors per 1,000 population, which is the same as
South Korea but lower than countries like Japan (2.2) or the United States (2.4)
Background
• The service obligation introduced in 1978, requires all graduates of local medical
and dental schools to serve in the public healthcare institutions for a period of time
• The period depends on the course of study and citizenship and varies from 4–6 years
• Junior specialists who have benefitted from a Health Manpower Development Plan
training programme, need to serve 2–3 years
• Nurses and other healthcare professionals who receive scholarships or funding for
their course, also have a service obligation to fulfil
National Health Plan

• In the early 1980s, the Government announced its National Health Plan, which
detailed expansion of current health care infrastructure planned for the next 20 years
• This entailed the expansion and consolidation all primary health care services,
outpatient services, infant welfare clinics, and travelling dispensaries into a network
of government health clinics, “restructured” public health sector hospitals, tertiary-
care specialist centres and private general practitioners

• During this period, the number of hospitals grew from 8 in 1957 to 16 in 1965 and
21 in 1990, resulting in a bed-to-population ratio of 3.6 per 1000 persons
• By 1994, 20% of primary care and 80% of hospital care was being provided by the
government or restructured institutions
• The National Health Plan also introduced Medisave to finance individual healthcare

• Singapore today has a mixed healthcare delivery model
• The public sector dominates the acute hospital care sector, delivering 80% of the care
• The primary care sector is dominated by private sector providers, which account for
about 80% of the market. In the step-down care sector (e.g. nursing homes,
community hospitals, and hospices), service provision is mainly provided by
voluntary welfare organisations, most of which are funded by the government for
their services rendered to patients

• Healthcare in Singapore is widely regarded as efficient and widespread
• In the year 2000, Singapore was ranked 6th in the World Health Organization’s
ranking of world health systems
• Currently, there are eight public hospitals which comprise of six acute general
hospitals, one women and children’s hospital, and a psychiatric hospital


• All public hospitals are “restructured,” meaning that they operate as government-
owned corporations instead of typical public hospitals, which are owned by
government and receive government funding
• While this promote competition among hospitals, thus leading to greater autonomy,
efficiency and better services, it cannot serve the needs of chronic disease patients as
competently
CPF and Healthcare in Singapore

• In 1968, the uses of the Central Provident Fund (CPF) was expanded beyond
retirement funds, and allowed individuals to use a portion of it for buying HDB flats
• The rules governing the Fund have been changed to allow workers to use their
savings to also pay for healthcare, approved insurance schemes, and education
• As a compulsory savings account, the government sets contribution rates for workers
and their employers as a percentage of wages for the CPF
• Once in their accounts, the money may be used to pay for personal and family
healthcare along carefully established guidelines

• The monthly contribution by individual is then dispersed into three accounts:
• Ordinary Account: to be used to buy a home, pay for CPF insurance against death
and disability, investment and education
• Special Account: for old age and investment in retirement-related financial products
• Medisave Account: to be used for healthcare expenses and approved medical

insurance

• The mandatory allocation among the three accounts changes according to the age of
the participant
• For the 30-year-olds, their total contribution divided as follows: 23 percent of wages
to the Ordinary Account; six percent to the Special Account; and seven percent to
Medisave
• For 50-year-olds: 19 percent to Ordinary; eight percent to Special; nine percent to

Medisave

• As of 2012, workers up through age 50 contribute 20 percent of their wages, and
their employers add another 16 percent for a total contribution equaling 36 percent
of their wages
• Patients are allowed to spend their own money on care beyond the basic level,
including amenities in public hospitals, private hospitals, private doctors, and other
services
• They would pay the costs using their own money, Medisave funds, and approved
health insurance

• The government sets a maximum amount that individuals can accumulate in their
Medisave account
• The amount specified for Medisave is presumed to be adequate for an individual’s

projected future healthcare needs, freeing up the person’s other funds to go toward
other retirement purposes
• In 2012, it was fixed at S$43,500, but the ceiling is adjusted yearly to take into
account the impact of healthcare inflation and to ensure that account holders have
sufficient savings by the time of retirement

• A Singaporean may use his Medisave to pay for certain medical expenses
• Medisave could only be used to pay for charges for a hospital stay in the highly-
subsidized wards
• Gradually it was extended to include other hospital ward classes but subject to
maximum daily limits
• Now it can be used to pay for hospitalization charges as well as specified outpatient
expenses

• Medisave can presently be used for medical and surgical inpatient cases, approved
day surgeries, and psychiatry treatment
• Stays in approved community hospitals, hospices, maternity, and day rehabilitation

are also eligible
• Also allowed are treatment in approved day hospitals, outpatient treatments of

approved chronic diseases, vaccinations, outpatient MRI scans, CT scans and other
diagnostics for cancer patients, assisted conception procedures, and renal dialysis
treatment
• However, Medisave and insurance do not cover the costs of consultation alone

• In a demonstration of the system’s
willingness to respond to the financial
and healthcare needs of its current
citizens, as well as the state’s own need
to increase the numbers of its future
citizens due to falling fertility rate, the
government has introduced a number of
programs

• Among them, the government has extended the use of Medisave dollars to fertility
treatments as well as to maternity care
• Medisave can now be used to pay for delivery expenses as well as pre-delivery medical
expenses
• The government also created MediShield in 1990, it is a low-cost medical insurance

scheme available to CPF members and their dependents
• The idea behind MediShield is to provide assistance to individuals with prolonged

illnesses that may require long-term medical treatment—treatment that can become very
expensive over time and a burden on families, possibly draining their Medisave accounts

• On the other hand, Medifund, an endowment fund established by the government in
1993, aims to help individuals who cannot afford to pay for care in the most highly-
subsidized wards of public hospitals
• It is the system’s safety net, allowing even the poorest Singaporeans to receive a
level of care that would otherwise be out of their reach
• The program was initially funded with a S$200 million contribution by the
government and now stands at about S$2 billion
Education in Singapore
Three phases of post-war education in
Singapore
• 1965-1978: Survival-driven
• 1978-1997: Efficiency-driven
• 1997-present: Ability-driven
• Milestones and key policies

Background
• Before Singapore attained self-government in
1959, schools were mainly founded and
managed by different community groups
• The British colonial government set up schools

with the intention of producing English-
speaking public servants who could occupy
entry level jobs in the local civil service
Background
• The Anglican, Roman Catholic, Methodist, and Presbyterian missionaries that
followed the British out to the East established, along with their mission, more
English medium schools and a few Chinese medium ones
• The Malay community, often with the support of the colonial government,
established Malay vernacular schools
Background
• The immigrant Chinese counted on their clan ties, philanthropic organisations and
generous pioneers to fund schools using either Mandarin or Chinese dialects as the
medium of instruction
• Not being funded and adequately guided by the British, however, these schools
became susceptible to external influences from China
• From the 1920s they registered with the Chinese government, followed the official
curriculum in China and promoted a Chinese nationalistic outlook
• To bring these institutions under closer state surveillance, in 1923 the British started
subsidising small number of Chinese schools financially
Background
• The comparatively smaller immigrant Indian community could turn to schools
founded by Indian missions and which taught in Tamil, or the English medium
schools run by Christian missions
• Soon after the British returned to post-war Singapore, as early as August 1947, the
colonial administration drew up and published a ten-year programme for education
• It aimed to provide free primary education which was made available through the
free Government schools consisting of Malay vernacular schools, English schools,
as well as a small number of non-Government Chinese and Indian vernacular
schools
Background
• At the end of this ten-year programme, the ambitious aim of converting the majority of
Chinese and Indian vernacular schools into Government schools was far from achieved
• Another strategy adopted was to offer to pay for all teachers in all schools, thus laying
the foundation for a single system of remuneration, and therefore control over the
quality of teaching staff
• Not all the schools welcomed the move
• The Chinese school committees, in particular, responded cautiously out of fear that
they would have to surrender the autonomy they had enjoyed thus far in all aspects of
running their schools
Background
• The All-Party Report on Chinese Education in 1956 was a very significant document
impacting on education
• Its “equality of treatment” principle pointed to what was later to become core tenants
of the new state which were multi-culturalism, meritocracy and inclusiveness, among
others
Background
• The Report, while it recognised the significance of the Chinese language, Chinese
schools and other vernacular schools, noted that one should not ignore the
importance of learning a common link language on top of a mother tongue
• English was identified by the committee as the link language because of its high
commercial value both internationally and within Singapore
• In response to the increasing number of children reaching school-going age after the
war, the government also prioritised the construction of schools and training of
teachers
Background
• In 1957, double-session schooling was introduced – one session in the morning and
another in the afternoon – which allowed schools to accommodate a larger
enrolment of students
• Singapore’s total enrolment in 1959 was 272,254 for primary and 48,723 for
secondary schools
• A total of 83 new school buildings were completed between 1959 and 1965, a rate of
about one school a month for seven years
Background
Background
• Ong Pang Boon, then the Minister for Education once said in 1965, “The people of
Singapore are becoming so education conscious that we have achieved universal
primary education without making it compulsory … and once admitted, they [the
children] are assured of a 10-year primary and secondary education finishing at the
minimum age of 16.”
• In 1959, only 47 percent of children entering primary one were in the English stream,
while 46 percent were in Chinese schools
Background
• Twenty years later (in 1979), the English stream enrolled 91 percent of all primary
one children, with only 9 percent in the Chinese stream and a negligible number in
the Tamil and Malay language streams
• This dramatic drift was brought about by the free choice of pragmatic parents in
response to the nation's drive toward high-value-added industrialization and to an
economy where the language of business is English
• In terms of types of education, an English-stream education had greater monetary

payoffs to society than did other vernacular stream education
1965-1978 : Survival-driven Phase

• This period saw an intimate link between education and economic development of
the small city-state
• National integration through a national education system was seen as the key
condition for economic survival
• To attain these national objectives, the government rightly recognized the necessity
to provide every child with at least six years of education from the age of six-
without discrimination of race, language, sex, wealth, or status
• Bilingualism became a key component in Singapore's education system


• This period also saw the review and upgrade of technical and vocational education
• In 1964, the government established secondary vocational schools for the first time,
with an enrollment of 4,910 pupils
• These were pupils who did not pass the primary-leaving examinations to enter into
academic secondary schools
• In 1968, out of the 144,000 students in secondary schools, only some 18,000 were in
technical and vocational streams

• The government accelerated plans for the expansion of technical education
• A Technical Education Department was set up in the Ministry of Education in June

1968, and from 1969 all male lower secondary pupils were required to have two
years of training in technical subjects, while girls were given a choice between
technical subjects and home economics
• The Technical Education Department made use of all available training facilities to
turn out skilled workers for employment, such as welders and machinists, to service
the shipbuilding, oil refinery, electrochemical, electromechanical, precision
engineering, metalworking, and woodworking industries

• The survival-driven phase of education continued into the 1970s with the continual
propagation of an industrial-oriented education to produce the manpower for
industrial development

• The Vocational and Industrial Training Board (VITB, the predecessor of the current
Institute of Technical Education, ITE) was created in 1979 to take in secondary
school leavers who were less academically inclined
• By 1976, close to 20 percent of the secondary school population was receiving

technical education
1978-1997: Efficiency-driven Phase

• A New Education System (NES) was introduced in January 1979
• The NES provided for three streams in both primary and secondary school, to allow
pupils to progress at a pace more suited to their abilities
• Slower primary pupils were allowed up to eight years to complete primary

education, while secondary pupils could take up to five years to acquire the General
Certificate in Education (GCE) O level and a further three years for the advanced
(A) level
• A new lower-level secondary school leaving certificate, the GCE Normal (N) was
introduced

• In manpower terms, the effect of the NES was to enable each pupil to go as far as
possible in school, and thereby achieve the best possible educational takeoff for
training and employment
• By the early 1980s, the key features of the efficiency-driven education system were
in place: a national curriculum with a stress on bilingualism and moral, civics,
science, mathematics, and technical education

• One critical issue that did not receive much governmental attention was the failure of
the education system to inculcate positive values and attitudes toward technical
training and blue-collar jobs
• Until the early 1990s, little effort was made to upgrade vocational and technical
education
• Vocational training was specifically aimed at providing a form of continual

education for the less academically inclined pupils

• Unlike in South Korea, where vocational and technical training is held in high
esteem, the Singapore system failed to project the same image
• Vocational institutes became “dumping grounds” or “catch-nets” for those who failed
to measure up to the requisite academic rigor
• At the tertiary level, in line with the government's effort to enlarge the pool of
scientific and technical manpower and its overall economic vision to transform
Singapore into a developed nation, total enrollment in local degree and diploma
courses increased by more than 200 percent
• This is seen in the jump from 20,305 students in 1980 to 62,683 students in 1992

• Increasing university enrollment, however, did not hide the fact that Singapore was
critically short of university graduates to drive economic growth
• In 1980, only about 5 percent of the annual cohort of students entered universities
and 8 percent entered polytechnics (compared with 20 percent in Taiwan and 40
percent in Japan for universities and polytechnics combined)
• Admission was highly competitive, and too few places were available
• At the National Day Rally in 2012, Prime Minister Lee Hsien Loong announced to
“increase the current full time university intake … by 2020. […] That would mean
40 percent of each cohort will go to university, up from 27 percent today.”
1997-Present : Ability-driven Phase

• The transition to a knowledge-based economy shifts the emphasis of value away
from production toward innovation and creativity in the 1990s
• Ability-driven education would give all youth 10 years of general education,

including six years of compulsory education at the primary level, during which they
could participate in a variety of programs according to their ability
• The school system features a national curriculum, with major national examinations
at the end of the primary, secondary, and junior college years

• However, the ability-driven education provides greater flexibility and choice
• Upon leaving primary school, the young Singaporean now can choose from a range
of educational institutions that cater to different strengths and interests
• Schools also develop customized programs to meet individual students’ aptitudes

and skills
• These specialized programs include the Music and Art Elective Programs, Gifted
Education Program, and specially designed physical education and Chinese classes
• Vocational training under the ITE was also given a strong boost

• It was also during this period that information and
communication technology (ICT) took off in
Singapore's schools and tertiary institutions
• In the first Master Plan of 1997, the underlying

rationale was that ICT could be integrated into the
curriculum to motivate students to be creative and
independent learners
• Funding was set aside to introduce ICT in schools and to have pupils spend 30
percent of curriculum time learning with, or through, computers
Reflections on Streaming
• Under the New Education System Primary
Scheme introduced in schools, pupils were
streamed into three courses (Normal, Extended,
Monolingual) according to the results of their
Primary Three examinations
• Some children were deprived of access to higher

education and faced social stigma of being
streamed to the monolingual course which was
termed to be “less academically-inclined”
• For those against the idea of streaming, it was thought to
have categorised students at an early stage and did not
sufficiently allow for the fact that different students may
have strengths in different subjects
• Before streaming was introduced, 20 percent of primary

school pupils dropped out of school without getting any
educational qualifications, while another 20 percent
dropped out of secondary school without getting any
secondary qualification
• After streaming, the corresponding dropout rates were reduced to 10 percent for
primary schools and five percent for secondary schools in 1985
• At the end of 1987, less than one percent of students below 16 years old left school
with fewer than 10 years of schooling, thus reducing education wastage and
provided the state with an educated workforce that could cope with the demands of a
rapidly expanding economy
• The Ministry of Education has recently announced its plan to replace streaming in
schools with full subject-based banding by 2024

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GCAP3007 February 13, 2023 1

Healthcare System, Housing, Public

Housing, Healthcare System, Public

• Key housing policies

• By the time the SIT was dissolved in 1959

• Housing in these enclaves primarily took the form of

• Housing in the outskirts comprised traditional

• When Singapore became independent in August 1965, home ownership became an

Key Policies on Housing

“When we were confronted with an enormous problem of bad housing, no development,

Key Policies on Housing

• Both employers and employees contributed a certain percentage of the individual

Key Policies on Housing

ADBI Working Paper Series, Housing Policies in Singapore, 2016

Key Policies on Housing

Key Policies on Housing

Key Policies on Housing

Key Policies on Housing

Key Policies on Housing

Key Policies on Housing

• The ﬁrst is to closely integrate greenery

• The second is to weave greenery into

Key Policies on Housing

Key Policies on Housing

• The Chinese, Malay, Indian/Others

• For new flats, a particular ethnic group

Key Policies on Housing

Key Policies on Housing

• Sub-regional centres and fringe centres

Key Policies on Housing

Key Policies on Housing

• Currently, there are 17 Town Councils

The First Five-year Housing Plan (1961-1965)

• Mainly apartments with one bedroom, one living

• Units are priced affordably for rental; back then,

• A total of S$194 million was invested to build a

The Second Five-year Housing Plan (1966-1970)

The Third Five-year Housing Plan (1971-1975)

• Children’s playgrounds, parks and other public

The Fourth Five-year Housing Project (1976-1980)

The Fourth Five-year Housing Project (1976-1980)

• The ground floor of each high-rise

• By 1990s, the government built

An Integrated HDB–CPF Framework

An Integrated HDB–CPF Framework

• The typical loan represents 80% of the price of the flat

• The maximum repayment period is limited to 25 years

• Every household can apply for a maximum of two HDB loans

Toa Payoh- HDB’s First Comprehensively Planned Satellite

• Planning was based on the “neighbourhood principle” where several

Toa Payoh- HDB’s First Comprehensively Planned Satellite

Toa Payoh- HDB’s First Comprehensively Planned Satellite

• The shops were planned to face another row of shops so that a

• The shopping pedestrian mall was meant to create a seamless

Toa Payoh- HDB’s First Comprehensively Planned Satellite

• Greater attention was also given to the provision

Public Transportation in Singapore

• Hock Lee bus riots (1955)

• The integrated Concept Plan (1971)

• Area Licensing Scheme (ALS) introduced

• Building the MRT (in 1987)

• Vehicle Quota System (1990s)