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President's Forum


An open letter to SMA was published in the Forum Page of the Straits Times of 3 July 1998 inquiring about the training of staff dispensing medicine in clinics. SMA took that opportunity to explain to the public the details of the healthcare assistants training programme. The open letter and the replies are published here in N4 to N6 of this month’s SMA News for your information. It is pertinent here to give more details about the training programme and how it relates to the overall provision of healthcare in Singapore.

Certified by ITE

The healthcare assistant training programme is certified by ITE (Institute of Technical Education) to train healthcare workers at technician level. It was developed jointly with the assistance of various professional bodies and the Ministry of Health 8 years ago. The Association of Private Medical Practitioners (which was subsumed into SMA 4 years ago) and the private hospitals were instrumental in initiating the programme. More than $250,000 was provided by the State through the Skills Development Fund in 1994 to develop training materials for this programme.

Aims of the programme

The programme aims to train healthcare assistants to provide healthcare for inpatients, outpatients and home-bound patients. There are 2 main components of the programme. The first is the 1-year supervised work experience in which they have to formally complete under supervision a series of defined procedures. The other component consists of attendance of a basic healthcare module of 56 hours and another relevant modules of between 50 to 50 hours. An ITE certificate is awarded upon completion of the above two components and passing written as well as practical examinations (refer page 372). The training is subvented by the Skills Development Fund. Successful candidates of the Homecare module when developed would also qualify for special skilled workers status endorsed by the Ministry of Manpower.

Key concepts

There are two key concepts of this technician-level training. The first is to define in practical terms the skills needed and the level of competence expected. Training is then geared to ensure that the defined standards are met. The skills standard for example of the outpatient programme for clinic assistants are arrived at by a bottom-up process through a DACUM (develop a curriculum) exercise where the actual tasks they were performing were documented. The skill standards thus cut across traditional boundaries of healthcare vocations. For example, in medical clinics, they are trained to be multi-tasking to fulfil the roles of the receptionist, nurse-aide, dispenser and medical technician at different times during the work-day.

The second key concept is that healthcare assistants function at an appropriate level in the healthcare team assisting but at the same time being supervised by other more highly trained professionals. The result is that as a whole, value is added to the team. The ambulatory care in Singapore is now mostly delivered through small teams of one doctor and two or three clinic assistants scattered throughout the island. Many private hospitals are also using healthcare assistants as part of the ward teams under the supervision of staff nurses. They perform defined duties to assist staff nurses in administrative, basic nursing and other duties.

Thus, the more highly trained staff is not called upon to perform tasks that health care assistants can reasonably perform. A staff nurse in a hospital ward would thus not be bogged down by clerical work that can be better perform by ward assistants. The result is better professional nursing care to the patient.

One additional advantage of the healthcare assistants is that they can be more multi-tasking. It is often not appreciated that other trained staff are also more focused in their training. Thus, while pharmacy technicians may be able to perform as well in tasks related to dispensing, their training is not broad-based to include other duties shouldered by clinic assistants. It is for this reason therefore that many doctors still send their staff nurses to attend the Healthcare Assisting Programme for out-patient care to be formally trained in other than nursing duties in clinics.

Shared care

The Ministry has announced that Singapore is developing clinical guidelines for improved management of various diseases. Shared care programmes are earnestly implemented by restructured hospitals to ensure patients receive only medical attention appropriate to their needs at the hospital and the rest of the care is shared by the ambulatory care doctor. Likewise, there is a sharing of tasks between the highly trained professionals and the healthcare assistants. The skill standards of healthcare assistants that have already been defined by the curriculum planning efforts of ITE define the roles that they can optimally play in our healthcare system.