Primary Healthcare Innovations in India: Synthesis from a systematic review

Primary healthcare (PHC) serves as the first point of contact for individuals seeking care. However, the PHC system in India faces significant systemic challenges compounded by multiple disease burdens the population faces. The Astana Declaration highlighted the importance of building a comprehensive and resilient healthcare system, focused on an individual rather than a disease. While Health and Wellness Centers (HWCs) are being developed towards universal health coverage (UHC) as a part of the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), several gaps still exist. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study involved developing a theoretical PHC framework, creating search strategies across databases (like MEDLINE, OVID, and CINAHL), and screening them. The review encompassed health innovations and included studies from 1990 to 2019. Relevant quantitative and geographically focused study designs were included, focusing on innovations that improve the efficiency, effectiveness, quality, sustainability, and economy of primary care services. A total of 239 impact evaluations were included and analyzed. The majority of these evaluations were journal articles (237), with one report and one working paper. The impact evaluations primarily focused on single innovations, although there were also 10 multilayered studies and 7 studies with multiple arms. Out of the 239 innovations, 24 were randomized controlled trials (RCTs) conducted in controlled settings. The studies predominantly took place in rural communities (53%), followed by mixed urban-rural, urban, and tribal communities. Foundations were primary funders (35.6%), with community health worker-delivered interventions, digital service innovations, and supportive mentoring programs being the key supported interventions. This systematic review offers valuable insights into the challenges and opportunities in Indias PHC system. The findings can inform policymakers, researchers, and healthcare stakeholders in improving primary healthcare delivery and addressing the evolving healthcare landscape in India.