Asia is ageing. Can primary care keep up?

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 the alternatives are fragmented or absent.

Between 2015 and 2050, the share of the world’s population aged over 60 is expected to nearly double, from 12 per cent to 22 per cent, and Asia’s 65-plus population is projected to nearly triple — from 414 million in 2020 to 1.2 billion by 2060 — pushing its share of the world’s older population above 60 per cent. The Global Burden of Disease Study (2021) estimates that older adults accounted for nearly 2 billion cases of non-communicable diseases (NCDs) globally, with over 800 million disability-adjusted life years lost and an estimated 34.68 million deaths annually.

The challenge is not simply one of resources, but of how health systems are organised and what is expected of primary care. 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 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. 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 the absence of a clear anchoring role, coordination remains weak, and responsibility for long-term care is diffuse.

In Thailand and Singapore, 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 South Asia, including India and Bangladesh, care for older adults continues to rely heavily on families, with formal systems playing a limited role. In many urban settings, older adults bypass primary care and go directly to hospitals. This is often attributed to a 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 the alternatives are fragmented or absent. This places pressure on already strained health systems while shifting financial and caregiving burdens onto households. Many primary care systems face shortages of trained personnel, limited geriatric expertise, and weak multidisciplinary models of care.

Health systems in Asia differ in their financing arrangements and social norms. But the recurrence of tensions around system readiness suggests that the underlying issues are structural rather than incidental. Resolving them will require moving beyond a narrow conception of primary care as first-contact treatment and connecting the different elements of care into a coherent whole. Achieving this will depend on clarifying institutional roles, aligning incentives, and building systems of accountability. 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