GROUP 4

HEALTH SYTEM IN
SINGAPORE AND ETHIOPIA
SERVICE DELIVERY
 Singapore Ethiophia
The philosophy of Singapore’s healthcare system The health sector in Ethiopia has shown
consists of three pillars. Firstly, the country is aimed to
build up a healthy population with preventive health remarkable progress involving a number of
cares and to encourage healthy lifestyles. Secondly, health, nutrition, and population indicators
Singapore also emphasizes personal responsibility over the last decade
towards healthy living through the “3M” (Medisave,
Medishield and Medifund) system. Lastly, the
government has to keep the healthcare costs down by
controlling the supply side of the healthcare services
and providing heavy subsidies at public healthcare
institutions.

Singapore’s healthcare delivery system

provides population the primary
healthcare, hospital care, long-term
care and other integrated care.
 Singapore Ethiophia
The health system is consists of primary, secondary and The health system is a three-tier system involve a
tertiary levels of care primary health care unit(PHCU)
Primary care: It is accessible to all Singaporeans, these clinics Primary health service coverage reached 93% with 127
generally serve the lower-income population, the bulk of primary hospitals, 3,245 health centers, 16,048 health posts and
care is delivered by private general practitioner (GP) clinics more than 4,000 private for profit and not for profit
Outpatient specialist care: There are numerous specialty care clinics.
centers, including ones focused on cancer, oral care, cardiovascular
disease, diseases of the nervous system, and skin diseases.
Research, teaching, and training are also conducted there.
After-hours care: Numerous public and private hospitals offer
round-the-clock emergency care, and
Hospitals: General care is delivered at regional hospitals. In 2010,
there were more than 11,000 beds in 30 hospitals (15 public and
15 private, including specialty centers, community hospitals, and
chronic care hospitals).
Mental health care: It provides psychiatric, rehabilitative, and
counseling services for children, adolescents, adults, and the
elderly, as well as long-term care and forensic services
Long-term care and social supports: Voluntary welfare
organizations and private operators manage long-term care
services for the elderly. 
Singapore
 Singapore
The major strategies to ensure quality of care

Singapore’s Ministry of Health conducts an annual patient satisfaction survey to gauge patient satisfaction
levels and expectations regarding public health care institutions. The survey assesses waiting times, care
coordination, and other health service attributes

Public and private hospitals, clinics, laboratories, and nursing homes are required to submit
applications to the ministry for licensure. Physicians wishing to practice in Singapore must secure a
position with a health care institution and register with the Singapore Medical Council, which
maintains the official Register of Medical Practitioners. Physicians are required to fulfill continuing
medical education requirements administered by the Medical Council. For institutions, prelicensing
inspections are conducted to ensure standards.

The National Health System Scorecard uses internationally established indicators to compare performance.
The Public Acute Hospital Scorecard measures institution-level performance, and similar scorecards for
providers are being rolled out in primary care facilities and community hospitals. Public health care
institutions are monitored to ensure compliance with the standards of service and key deliverables defined
by the scorecards.
 Singapore
Person-centeredness

Singapore’s Agency for Integrated Care was created in 2009 to bring about a patient-focused integration of primary
care with intermediate- and long-term care. The agency, which operates at the patient, provider, and system levels,
advises patients and families on appropriate health care services and helps them navigate the health system. 
Another is the expansion and improvement of health care capabilities at the community level.

Another significant role for the Agency for Integrated Care is that of ensuring integration of health and social
services for elderly and disabled populations. The agency coordinates and facilitates placement of individuals with
nursing homes, community providers, day rehabilitation centers, and long-term care facilities; facilitates treatment
at home by managing referral of patients to home care services; and assists people with applying for available
financial assistance.
 Singapore
The status of electronic health records

• Singapore is building a sophisticated national electronic health record system. The system
collects, reports, and analyzes information to aid in formulation of policy, monitoring of
implementation, and sharing of patient records. The long-term goal is to allow medical
professionals to access clinical data on patient treatment and safety.8
• When fully developed, the system will allow data to be accessed and viewed in appropriate
formats by medical professionals, patients, and researchers. Data will come from public hospitals’
and polyclinics’ electronic medical record systems, among other sources. There are plans to
enable patients to view and possibly contribute to their personal health records in the near
future.
 Singapore
Waiting Time for Admission to Ward Beds Occupancy Rate (BOR)

Urgent Care Clinic at Alexandra Hospital (AH), and Emergency Medicine Departments (EMD) at Changi General Hospital (CGH), Khoo
Teck Puat Hospital (KTPH), National University Hospital (NUH) (Adults), Ng Teng Fong General Hospital (NTFGH),Sengkang General
Hospital (SKH), Singapore General Hospital (SGH), and Tan Tock Seng Hospital (TTSH). KK Women’s and Children’s Hospital, and National
University Hospital (NUH) (Children) are excluded
 Singapore
Waiting Times for Registration and for Consultation at Polyclinics
Singapore
Ethiophia
HEALTH WORKFORCE
 Singapore Ethiophia
Human Resource Development (HRD) has been a key
component in the successive HSDPs. It has been one of the key
Practicing Physicians 2.0 Per 1000 population, 2014 components in HSDP III with the main objective of improving
the staffing level at various levels as well as to establish
Doctors 8819 (1:629)
(excluding specialists) implementation of transparent and accountable Human
Resource Management (HRM) at all levels.
Nurses 12994 (1:427)

Populatin in 2014 is 5.54 millions people

 Ethiophia

The available professionals at the end of HSDP III compared to the HSDP III targets shows that the target has been met
for community level and most of MLHP. The number has also significantly increased compared to the levels in the
previous HSDP. However, there is still major gap in highly skilled professionals like Medical doctors, midwives and
anesthesia professionals.
Ethiophia
HEALTH INFORMATION SYSTEMS
 Health information system
Singapore
• Singapore is one of the wealthiest country in the
world.
• Life expectancy at birth is 82.3
• Infant mortality is 2.7 per 1000 live birth
• The Ministry of health work to ensure the quality
and affordable basic medical service for all.
• All healthcare facilities are also required to maintan
a good standard of medical/clinical service under the
licensed of the Private Hospitals & Medical Clinic
(PHMC).
• Then Ministry continuously work actively promote
the preventive health programme as high standard
of living, clean water and hygiene to achieve better
health
Ethiopia
• Communicable diseases like HIV/AIDS, TB,
malaria, respiratory infection, and diarrhea
remain a serious challenge in Ethiopia. High
fertility rates, and low contraceptive prevalence
continue to  to drive a rapidly increasing
population in Ethiopia.
• The Ministry of Health (MOH) is implementing
changes to various aspects of the healthcare
system :
• 1. Increasing decentralized management of its
public health system.
• 2. Reforming agencies such as Ethiopian Food
and Drug Administration (EFDA) and the
Pharmaceutical Supply Agency (PSA).
 Health information system
Ethiopia
Singapore
ACCES TO ESSENTIAL MEDICINES
 Medical Products and Technologies

Singapore Ethiopia
•Singapore’s Health Product Act to regulate the drugs, • Ethiopian Food and Drug Administration (EFDA) ; responsible for

medical device and other health product to meet promoting and protecting public health by ensuring the safety

appropriate safety and quality. and quality of products and health services.

•All pharmaceutical and medical device must be registered • EFDA has digitized the importation and registration of health

in Accounting and Corporate Regulatory Authority (ACRA) commodities to Ethiopia using the below listed programs:

before they can be sold in Singapore. • i-Register: is used by importers for application of market
•The registration product conducted through the online authorization and product registration (new products, request
Medical Device Information and Communication System registration exceptions and renew existing registrations). 

(MEDICS)
• i-Import: is an online application uses for importers to apply for
and receive permits to import all health commodities.
FINANCING
 Financing in Singapore
• Publicly financed health care:
• Private health insurance
 Publicly financed health care
 Twin philosophies  individual responsibility and affordable health
care for all.
 Government subsidies of up to 80 percent of the total cost of care
provided in public hospitals and primary care polyclinics.
 savings and insurance programs known as the “3Ms” system—for
Medisave, MediShield, and Medifund
Medisave is a mandatory medical savings program MediShield is a low-cost catastrophic health insurance
that requires workers to contribute a percentage of scheme to help policyholders meet the medical
their wages to a personal account, with a matching expenses from major or prolonged illnesses that their
contribution from employers. Medisave balance would not be sufficient to cover

Medifund is the government endowment fund set up to aid the

indigent. The fund covers citizens who have received treatment
from a Medifund-approved institution and have difficulties
affording their medical expenses despite government subsidies,
Medisave, and MediShield coverage
Private health care insurance
• Available from for-profit insurers to supplement MediShield coverage.
• Called Integrated Shield Plans, they are funded from individuals’
Medisave accounts.
• Singaporeans also have the option of purchasing other types of
private insurance, although premiums for these cannot be paid for
with Medisave funds.
 Financing in Ethiopia
• The federal and regional governments
• Grants and loans from bilateral and multilateral donors
• Non-governmental organizations
• Private contributions
LEADERSHIP / GOVERNANCE
Leadership/governance in Singapore

Singapore’s Ministry of Health has overall

responsibility for health care, setting
policy direction, managing the public
health care system, and ensuring quality
of care and responsiveness of the health
system to residents’ needs.

The Ministry of Health regulates the

health care system through legislation
and enforcement. Among its core
regulatory functions are licensing
health care institutions under the
Private Hospitals and Medical Clinics
Act and conducting regular inspections
and audits
Three main regulators in the system:
•Minister of Health (MOH) oversees the provision and regulation of healthcare
services. Specifically, it is in charge of promoting health education, monitoring the
accessibility and quality of healthcare services, preventing and controlling diseases,
allocating resources and specialists and administrating required licenses for
healthcare establishments.
•Central Provident Fund (CPF) is a comprehensive and compulsory social security
savings plan. It ensures working Singaporeans and permanent residents (PRs) to
support themselves in the old age.
• Monetary Authority of Singapore (MAS), as Singapore’s central bank, regulates the
financial aspect of insurance sector. The Insurance Department of MAS administers
the insurance Act, which protects the interests of policyholders and regulates
insurers’ activities, including registration and licensing requirements. Periodically,
MAS provides directions and practice notes for regulating insurance activities.
Leadership/governance in Ethiopia
STRENGTH AND LIMITATION
 STRENGTH
Singapore Ethiophia
High coverage High coverage
The major strategies to ensure quality of care Accelerated training of Health professionals
Person-centeredness Expansion of the health Program where 38,000 health
workers were recruited throught out Ethiopia to provide
health services to a large proportion of the rural
population effectively reduce child mortality
Provide various kinds of health services
Efficient
The government guarantees the affordability of health
services for entire population trough the subsidy system
and medisave
Relatively small regions makes the government can
guarantee optimal health system for population and
good distribution of doctor
 LIMITATION
Singapore
The government does not directly regulate private
medical care cost
Lack of resource transferring between individuals may
result in less reasonable in healthcare treatment
allocation
Ethiophia
Low utilization of health services
In equitable distribution of health professional
Access to modern health care is very limited, and in
many rural areas it is virtually nonexistent. 90% of the
population of Ethiopia in rural areas has access to a
healthcare facility within a two-hour walk
WHICH COUNTRY HEALTH SYSTEM DO
YOU PREFER ?
 SINGAPORE VS ETHIOPIA?
SINGAPORE

Singapore has a good health system and always maintain the quality
of health system. Singapore become a 6th in the World Health
Organization ranking of the health systems in 2000. health systems in
Singapore used a person-centeredness, so they provide various kinds of
health services and the insurance guarantee entire life.