Asia is ageing. Can primary care keep up?

This transition is reshaping how health systems must function. Systems built for episodic care are now expected to manage long-term conditions that require continuity and coordination, but they remain poorly designed to do so. Older adults need care that is ongoing, coordinated across providers, and responsive to declining function. Across South and Southeast Asia, many are instead left navigating fragmented services, exposing a growing gap between need and provision. 

This suggests that the challenge is not simply one of resources, but of how health systems are organised and, crucially, of what is expected of primary care. Strong primary health care systems can address the health needs of ageing populations. Personal health services offered at primary health care facilities can manage NCDs. The presence of primary health care facilities close to communities enables continuous care and easier access to individuals with mobility issues. Yet, primary health care systems in many countries in South and Southeast Asia are not able to perform this role. In many settings, primary care continues to function as first-contact clinical care or as a platform for public health outreach. At the same time, it is increasingly expected to coordinate across clinical services, long-term care, and social support. These expectations have expanded without a clear definition of responsibilities or the capacity to meet them.

This matters because ageing-related needs extend beyond clinical treatment. They include rehabilitation, long-term support, and assistance with daily functioning, services that are typically organised separately across health ministries, social welfare systems, and local governments, with limited mechanisms for alignment. In this context, primary care is uniquely positioned to serve as a point of continuity, linking these different elements of care over time. In the absence of a clear anchoring role, coordination remains weak, and responsibility for long-term care is diffuse. Patients move across providers, but no part of the system is accountable for managing their overall trajectory.

Countries in the region have responded in different ways. In settings such as Thailand and Singapore, where long-term care is more closely integrated within the health system, primary care is expected to act as a gateway to a broader continuum of services. In others, including Malaysia and Indonesia, responsibilities are split between health and social welfare sectors, often resulting in parallel systems with limited coordination. Across much of South Asia, including India and Bangladesh, care for older adults continues to rely heavily on families, with formal systems playing a more limited role.

The consequences are evident in care-seeking patterns. In many urban settings, older adults bypass primary care and go directly to hospitals. This is often attributed to lack of awareness, but it may reflect something more fundamental: a lack of confidence in primary care’s ability to manage complex, long-term needs.

When primary care is not seen as capable of providing sustained care, hospitals become the default point of access — not because they are best suited to meet long-term needs, but because alternatives are fragmented or absent. This places pressure on already strained health systems while shifting financial and caregiving burdens onto households.

These pressures are compounded by persistent capacity constraints. Many primary care systems face shortages of trained personnel, limited geriatric expertise, and weak multidisciplinary models of care. Services such as home-based care and palliative care remain unevenly available. At the same time, fragmented data systems, with limited patient tracking or interoperable records, make it difficult to ensure continuity, particularly for patients navigating multiple providers over time.

To be clear, these challenges do not play out identically across countries. Health systems in the region differ in their histories, financing arrangements, and social norms. But the recurrence of similar tensions around coordination, utilisation, and system readiness suggests that the underlying issues are structural rather than incidental. What is needed, therefore, is not simply more attention to ageing, but a more grounded understanding of how health systems, particularly primary care, must evolve in response.

This will require moving beyond a narrow conception of primary care as first-contact treatment. Its future role lies in connecting the different elements of care, such as clinical services, long-term support, rehabilitation, and social protection, into a more coherent whole. Achieving this, however, will depend on the often less visible work of reform, like clarifying institutional roles, aligning incentives, and building systems of accountability. It also raises difficult but necessary questions. What governance arrangements enable meaningful integration across sectors? What financing models support continuity rather than episodic care? And what forms of data infrastructure are needed to sustain a life-course approach to health?

Asia’s ageing is inevitable. Whether its health systems adapt to it is a matter of policy choice. What is at stake is not only the well-being of older adults, but the sustainability of care itself.

The writers are health systems researchers at CSEP, New Delhi. Views are personal