Rethinking Health System Readiness for Frailty Management: Frontline Perspectives from Indonesia and Malaysia

Frailty is a major concern for healthy ageing, reflecting declining functional capacity and increased vulnerability. Beyond clinical implications, frailty raises questions about how health systems recognise vulnerability, allocate responsibilities, and ensure equitable care. These challenges align with the Sustainable Development Goals (SDGs). Health system readiness refers to the capacity of health systems to adapt policies, infrastructure, and operational processes to integrate frailty care into routine service delivery. In low- and middle-income contexts, frailty remains insufficiently embedded within health system frameworks, limiting coordinated responses. This study examines how readiness for frailty care is understood and enacted by frontline healthcare professionals. Using a qualitative design, five focus group discussions were conducted (March-July 2024) across healthcare settings in Indonesia and Malaysia. Nineteen participants, representing nursing, medicine, physiotherapy, and pharmacy, were purposively recruited. Data were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis supported by NVivo. Analytical rigour was enhanced through investigator triangulation, team-based coding, and member checking. Four interrelated themes reveal systemic gaps. Frailty remains largely invisible in policy and clinical frameworks; professional roles are fragmented and weakly coordinated; care responsibilities are displaced to families and communities; and structural resource constraints limit implementation. These findings indicate uneven readiness. Strengthening readiness requires alignment across governance, service delivery, and workforce capacity to address inequities in the distribution of care responsibilities. Frailty thus emerges as a critical lens for evaluating health system governance in ageing societies.