Evaluating the Effects of Capacity Building Initiatives and Primary Care Networks in Singapore: Outcome Harvesting of System Changes to Chronic Disease Care Delivery

Int J Environ Res Public Health. 2023 Jan 25;20(3):2192. doi: 10.3390/ijerph20032192.


The high tertiary healthcare utilisation in Singapore due to an ageing population and increasing chronic disease load has resulted in the establishment of primary care networks (PCNs) for private general practitioners (GPs) to provide team-based, community care for chronic diseases. A total of 22 PCN leaders and programme managers from 10 PCNs participated in online group discussions and a survey. Outcome harvesting was used to retrospectively link the intended and unintended outcomes to the programme initiatives and intermediate results (IRs). The outcomes were generated, refined and verified before shortlisting for analysis. About 134 positive and 22 negative PCN outcomes were observed since inception in 2018. By establishing PCN headquarters and entrusting PCN leaders with the autonomy to run these, as well as focusing policy direction on GP onboarding, GP engagements and clinical governance, the programme successfully harnessed the collective capabilities of GPs. Developments in the organisation (IR1) and monitoring and evaluation (IR4) were the top two contributors for positive and negative outcomes. Sustainable practice and policy changes represented 46% and 20% of the positive outcomes respectively. Sustainable positive outcomes were predominantly contributed by funding, clear programme policy direction and oversight. Conversely, most negative outcomes were due to the limited programme oversight especially in areas not covered by the programme policy.

Keywords: Healthier SG; PCN; ancillary services; chronic disease management; chronic disease registry; outcome harvesting; team-based care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Capacity Building*
  • Delivery of Health Care
  • Primary Health Care*
  • Retrospective Studies
  • Singapore

Grant support

This research was an unfunded collaborative initiative between the Agency of Integrated Care (AIC), the Ministry of Health and Saw Swee Hock School of Public Health (SSHSPH) at the National University of Singapore (NUS), all of which are Singapore-based institutes. The article processing charge was funded by SSHSPH.