As South and Southeast Asia grapple with rising populations, shifting disease patterns, and persistent inequities in access to care, the region’s primary healthcare systems are coming under renewed scrutiny. From crowded urban clinics in Delhi and Dhaka to remote community health posts in Myanmar and Indonesia, the first point of contact between citizens and the health system is under pressure to do more with less.
Against this backdrop, CSEP India (Centre for Social and Economic Progress) is examining how primary healthcare in these countries is evolving, where it is failing, and what reforms could close critical gaps. Drawing on comparative analysis across multiple health systems, the initiative seeks to understand why some models of care are delivering better outcomes, how frontline services can be strengthened, and what lessons South and Southeast Asian nations can share with each other.
This article explores CSEP India’s findings and the broader regional landscape: the challenges of financing and workforce shortages, the promise of digital health and community-based models, and the policy choices that could determine whether primary care becomes a robust foundation for universal health coverage-or remains a fragile link in the health chain.
Strengthening the first line of care in South and Southeast Asia CSEP India calls for smarter spending and local innovation
Across South and Southeast Asia, analysts at the Centre for Social and Economic Progress (CSEP) India underline that primary healthcare systems are under pressure from demographic change, rising non-communicable diseases and climate-linked health shocks. Their latest work argues that traditional, input-heavy models are no longer sustainable and calls for public budgets to be reoriented towards smarter spending that rewards outcomes, not just infrastructure. This includes channeling funds to frontline facilities based on performance, expanding digital health records to track results and investing in community-based cadres that can prevent illnesses before they reach hospitals.
CSEP’s research highlights that local innovation emerging from district hospitals, sub-centres and community organisations is already reshaping service delivery, often at a fraction of the cost of large national schemes. Policy briefs point to a growing portfolio of experiments in:
- Task shifting to well-trained nurses and community health workers
- Teleconsultation hubs for remote and underserved islands and border areas
- Low-cost diagnostics developed with local universities and start‑ups
- Community surveillance using mobile-based reporting tools
| Country | Local Innovation Focus | Spending Shift |
|---|---|---|
| India | Digital health & task shifting | More funds to Health & Wellness Centres |
| Indonesia | Island telehealth networks | Primary care over hospital expansion |
| Vietnam | Community NCD screening | Preventive care incentives |
Why community health workers are the backbone of primary care in Asia Lessons from CSEP India on training pay and digital tools
Across India’s dense urban settlements and hard-to-reach rural hamlets, a quiet workforce of Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs) and Anganwadi workers is stitching together the first line of care. Findings from CSEP India’s field studies show that these frontline cadres are often the only consistent link between families and the public health system, shouldering tasks that range from immunization follow-ups to early detection of non-communicable diseases. Yet, gaps in structured training, irregular pay and fragmented digital systems remain persistent constraints. Experts interviewed by CSEP underline that when these workers are properly equipped and remunerated, they can absorb a large share of the demand that now overloads tertiary hospitals, especially for maternal health, childhood illnesses and chronic disease management.
Policy experiments tracked by CSEP India highlight three levers reshaping this workforce across South and Southeast Asia:
- Competency-based training that moves beyond one-off orientations to continuous, modular learning at village level.
- Predictable pay and incentives tied to measurable outcomes rather than ad hoc honoraria.
- Integrated digital tools that replace paper registers with real-time, multilingual apps for referrals and data reporting.
| Lever | Field Insight (CSEP India) | Impact on Primary Care |
|---|---|---|
| Training | Quarterly skill refreshers in one Indian state cut stock-out reporting errors by half. | More accurate drug planning and fewer treatment gaps. |
| Pay | Regularized stipends improved retention of ASHAs in difficult terrain districts. | Stable continuity of care for remote communities. |
| Digital tools | Mobile decision-support apps helped workers flag high-risk pregnancies earlier. | Timelier referrals to primary health centres and reduced complications. |
From clinics to continuity of care How CSEP India urges governments to integrate primary care into universal health coverage agendas
CSEP India is pressing policymakers across South and Southeast Asia to move beyond isolated clinic-based services and build systems that follow people through every stage of life. In policy briefs and country assessments, the organisation highlights how fragmented schemes, vertical disease programmes and short-term pilots undermine trust in public systems. Instead, it is calling for strong primary care networks that are fully embedded in national health financing reforms, with clear referral pathways and interoperable digital records. Its research underscores that universal health coverage (UHC) targets will remain out of reach unless first-contact care is recognised as a strategic asset, not an afterthought.
To support this shift, CSEP India is urging governments to align benefits packages, workforce planning and data systems around family-centred care. Policy recommendations emphasise:
- Capitation-based payment and blended financing to reward prevention, not just procedures.
- Team-based frontline services that integrate doctors, nurses and community health workers.
- Standardised digital health IDs enabling continuity of care across public and private providers.
- Robust regulation to ensure quality and equity in contracted primary care facilities.
| Focus Area | CSEP India Priority |
|---|---|
| Financing | Embed primary care in UHC benefit packages |
| Service Delivery | Continuity from home to clinic to hospital |
| Data & Digital | Linked records for life-course care |
| Governance | Clear accountability at local level |
The Conclusion
As policy debates over financing, workforce and digital integration intensify, the experience of South and Southeast Asia shows that primary healthcare is no longer a peripheral concern but the central arena in which the region’s health future will be decided. The choices governments make now-on strengthening first-contact services, building resilient community systems and investing in preventive care-will shape not only health outcomes, but also economic and social trajectories for decades to come.
For India, the lessons are clear. As this CSEP India analysis underscores, incremental reforms will not be enough: the region’s demographic pressures, rising non-communicable diseases and widening inequalities demand a decisive pivot towards robust, people-centred primary care. Whether through better governance of mixed health systems, smarter use of technology, or targeted support for frontline workers, the test will lie in translating policy intent into sustained action on the ground.
The coming years will reveal whether South and Southeast Asian countries can turn this moment of strain into an opportunity to rewire their health systems from the bottom up. On that outcome may rest the health security of nearly a third of humanity.