Primary health care transformation and health equity in ageing societies: lessons from Singapore

Population ageing challenges the sustainability of universal health coverage (UHC), underscoring the need to transform primary health care (PHC). PHC adopts a whole-of-society approach to equitably address health needs across the care continuum in people’s everyday environments. Public policy is central to this transformation, aligning public health and primary care (PC) through governance, leadership, multisectoral collaboration, information systems, and sustainable financing. However, PHC research has mainly focused on clinical services, with little attention to policy analysis. This study examined the evolution of PHC policies in Singapore over the past four decades using the World Health Organization’s Operational Framework for PHC and identified equity-oriented policy strategies relevant to other ageing societies. Significant progress was made in the pillar of integrated health service delivery, whereas the pillars of empowerment of people and communities and multisectoral policy and action remain works in progress. The government plays a central role in policy development, resource stewardship, and budgetary commitments, accelerating reforms over the past decade. The recent policy shift towards place-based care is important for addressing the wider social determinants of health. To advance health equity, two key issues must be addressed: (1) the ‘multisectoral policy and action’ pillar, by strengthening local governance frameworks to coordinate the increasing involvement of multiple policy actors in PHC implementation and aligning financial models across sectors, and (2) the ‘empowered people and communities’ pillar, by embedding community participatory and asset-based approaches. As many countries face the dual challenges of an ageing population and rising healthcare costs, there is an urgent need to better integrate health service delivery. This policy analysis highlights the importance of developing strategies that support multisectoral collaboration and empower communities. Focusing on these three pillars is critical for achieving equitable health outcomes.