From evidence to action: rebuilding the bridge for primary health care reform in Asia

Strengthening Primary Health Care Through Evidence-Informed Policy and Practice
Regional Roundtable, Saw Swee Hock School of Public Health, National University of Singapore | 9–10 December 2025

A regional conversation on PHC transformation

Across Asia, primary health care (PHC) is being asked to do more than ever. Countries are responding to rising non-communicable diseases, ageing populations, persistent inequities, fiscal pressures, and the long shadow of COVID-19. At the same time, many health systems remain fragmented across public, private, and informal providers, with decentralised governance making implementation complex.

Against this backdrop, policymakers, researchers, implementers, and development partners from six countries in the region  and other key contributors gathered at the Saw Swee Hock School of Public Health, National University of Singapore, on 9-10 December 2025 for the Regional Roundtable on Strengthening Primary Health Care Through Evidence-Informed Policy and Practice. Co-hosted by Results for Development, Saw Swee Hock School of Public Health, National University of Singapore, the Asia Pacific Observatory, and Sustainable Health Innovations Singapore, the dialogue asked how health policy and systems research can align with policy cycles, implementation realities, and reform agendas so evidence shapes PHC decisions in real time.

Country perspectives: shared ambitions, different pathways

The roundtable brought together perspectives from Bangladesh, India, Indonesia, Pakistan, the Philippines, and Singapore. Despite differences in system design, participants identified a striking convergence: PHC reform is rarely constrained by lack of ambition. Rather, reform is constrained by misalignment between evidence and policy cycles, financing and service delivery goals, and national strategy and subnational realities.

Singapore, as co-host, offered a practical example of long-term, evidence-informed PHC reform. Discussions on Healthier SG, capitation-based financing, regional health clusters, team-based care, and the Health District at Queenstown model illustrated evidence-informed prevention, population health management, and community-based care. The Queenstown site visit showed how health, social care, technology, urban design, and community engagement can be integrated in a place-based model for healthy ageing.

Bangladesh highlighted the challenge and opportunity of a system where private and informal providers deliver a large share of PHC, while a strong HPSR ecosystem can support more coherent integration of these actors. India offered important lessons on managing PHC reform at federal scale, where national programmes must be adapted across states with varied capacities, provider markets, workforce availability, and data systems. Its experience with public-private engagement, digital health platforms, and state-level innovation provides a useful learning base for other decentralised health systems.

Indonesia shared lessons from convening donors, civil society, universities, and government around PHC reform, while noting vulnerability to funding shocks. Pakistan’s post-devolution experience showed the value of consortia for inter-provincial learning. The Philippines highlighted growing HPSR infrastructure, while noting challenges around electronic medical records, contracting, and private sector engagement.

What did we learn?

Five messages stood out.

1. The main constraint is not the absence of evidence, but the limited capacity to translate evidence into timely, decision-ready policy and implementation choices. Evidence must be synthesised, communicated, and embedded in the moments when decisions are made.
2. PHC reform is a governance and political economy challenge. Evidence that does not account for fiscal cycles, electoral timelines, administrative feasibility, or local government capacity is unlikely to influence reform.
3. Private sector engagement is unavoidable. Across Asia, PHC systems already depend heavily on private providers, yet evidence on what works in public-private engagement remains mixed. Private sector partnerships are not peripheral to PHC reform; they are central to how mixed health systems function. Participants stressed that governments must shift from control to stewardship — with strategic purchasing and adaptive contracting replacing rigid regulation with greater emphasis on data-sharing.
4. Decentralisation creates both opportunity and risk. Subnational governments are closest to communities, but often lack analytic capacity, data access, and institutional mechanisms to use evidence routinely.
5. Digital tools are important enablers, but not solutions in themselves. Without governance, interoperability, and trust, digital investments risk reinforcing fragmentation rather than solving it. Technology must be paired with workforce readiness and clear data governance.

From dialogue to action

The roundtable concluded with a strong commitment to practical next steps. Participants identified the need to strengthen institutional ownership of evidence translation within government, establish PHC reform units and embedded analytics teams, and create policy research fellowships that place researchers inside government systems.

These priorities are captured in the roundtable’s proposed actions, which set out practical steps for translating the dialogue into sustained collaboration. They include creating PHC evidence repositories and databases of HPSR funders; strengthening subnational analytic capacity through university–government fellowships that embed researchers within government systems; convening peer-learning workshops on data analytics, advocacy, health financing, and private sector negotiation; supporting HPSR forums in India, Pakistan, and the Philippines; and exploring a Pan-ASEAN policy research fellowship programme.

The accompanying report, Strengthening Primary Health Care Through Evidence-Informed Policy and Practice, provides a fuller account of the country perspectives, shared challenges, and recommendations emerging from the Singapore roundtable.

Toward a regional learning architecture

The Singapore roundtable reaffirmed that strengthening PHC is not only a technical agenda; it is a learning agenda. Evidence can guide reform, but only when institutions demand it, incentives support its use, and relationships build trust between researchers, policymakers, implementers, and communities.

As countries across Asia redesign PHC for ageing, chronic disease, equity, and resilience, the task ahead is to move from producing more evidence to building systems that can use evidence well. That will require sustained regional collaboration, stronger country-led learning platforms, and practical mechanisms that connect research with reform.

The bridge between evidence and action will not build itself. But the Singapore dialogue showed that across Asia, the foundations are already being laid.

Dr. Priya Balasubramaniam is a public health practitioner and clinician scientist with extensive experience in health systems research, implementation, and strategic programme development across South and Southeast Asia and Africa. Her work spans universal health coverage, private sector engagement, and digital health innovation, with a focus on strengthening mixed health systems in low- and middle-income countries.

Dr. Kiesha Prem is an infectious disease modeller and Assistant Professor jointly appointed at the Saw Swee Hock School of Public Health at the National University of Singapore (NUS) and the London School of Hygiene & Tropical Medicine. Kiesha leads the Southeast Asia Regional Collaborative for Health (SEARCH), a Gates Foundation–supported network focused on raising leadership and building regional learning capacity in strategic purchasing for primary healthcare.