Evaluating the Primary Care Plan for Migrant Workers in Singapore: Perspectives from Healthcare Workers after Two Years of Implementation

Abstract

Migrant workers are an integral part of the labor force in Singapore, yet their healthcare needs only received focused attention with the rollout of the Primary Care Plan (PCP) in 2022. This study gathered perspectives from healthcare workers (HCWs) on the implementation of the PCP, two years after its introduction. Semi-structured individual interviews were conducted with purposively sampled HCWs from the largest anchor operator appointed to implement the PCP, using a topic guide formulated using the Consolidated Framework for Implementation Research (CFIR). A thematic analysis was performed to identify themes on facilitators, barriers, and suggestions for improving the implementation of the PCP. Interviewees highlighted the affordability of primary care, the accessibility of migrant worker clinics, the mandated enrollment of migrant workers, and the availability of a diverse group of HCWs speaking migrant workers’ native languages as facilitators to the implementation of the PCP. Low co-payment affecting sustainability, lack of awareness of the PCP by HCWs from other public healthcare institutions, lack of attention to social determinants of health among migrant workers, and lack of integration of the PCP into secondary and tertiary care were cited as barriers to the implementation of the PCP. Interviewees suggested tiered co-payments, health promotion targeting migrant workers, as well as efforts to improve the living conditions of migrant workers to enhance the provision of primary care for migrant workers. The perspectives of healthcare workers, as the primary implementers, offer crucial insights into the facilitators, barriers, and potential improvements for the PCP. These inputs are essential for the ongoing refinement and success of the PCP. We strongly encourage policymakers and anchor operators to work collaboratively in co-developing service improvement initiatives that enhance the quality and accessibility of primary care for migrant workers. Additionally, future research should focus on conducting comprehensive needs assessments among migrant workers, ensuring that primary care services are tailored to their unique health needs and cultural contexts, thereby improving overall health outcomes.