Gaps and pathways in long-term care systems in South-East Asia: a comparative analysis of India, Sri Lanka and Thailand

Background Population ageing in the South-East Asia Region is increasing demand for long-term care (LTC), yet evidence on how to design and scale LTC systems in resource-constrained settings remains limited. This study examines system-level factors shaping the development of LTC and identifies policy-relevant pathways to strengthen LTC systems. Methods We conducted a rapid comparative policy analysis of India, Sri Lanka and Thailand, purposively selected to represent different stages of LTC system development. Peer-reviewed and grey literature published between 2013 and 2025 were identified through structured searches of PubMed and the WHO Institutional Repository for Information Sharing (IRIS), supplemented by policy and programme documents. Data from 68 sources were extracted and analysed using a structured framework covering governance, financing, workforce, service delivery and accountability. A comparative thematic approach was applied to identify cross-country patterns, enabling factors and system constraints. Results LTC systems across the Region remain underdeveloped and heavily reliant on informal care, with limited cross-sectoral coordination. Cross-country differences were associated with institutional stewardship, pooled financing, workforce formalization and implementation capacity. Thailand demonstrates a more integrated model, embedding LTC within universal health coverage through decentralised governance, structured caregiver support and community-based service delivery. India and Sri Lanka show partial progress but continue to face inconsistent governance, limited financing mechanisms and constrained workforce capacity. Conclusions Strengthening LTC systems in low- and middle-income countries requires phased reforms anchored in primary health care, supported by clear governance arrangements, sustainable financing and expanded caregiver support. Embedding LTC within existing health system platforms may offer a feasible and scalable pathway for advancing equitable and person-centred care in ageing societies.