Primary health care reforms: a scoping review

Area of Science:

• Health Systems Research
• Public Health Policy
• Healthcare Management

Background:

• Healthcare systems face increasing pressure from demographic shifts and evolving health needs.
• Primary health care (PHC) is fundamental to achieving Universal Health Coverage (UHC) and building sustainable health systems.
• Numerous countries are implementing PHC reforms to enhance population health outcomes.

Purpose of the Study:

• To systematically review the objectives, implementation strategies, challenges, and outcomes of primary health care reforms globally.
• To identify common intervention types and their impact on health system components.
• To synthesize evidence on factors influencing the success of PHC reforms.

Main Methods:

• A systematic review of literature from five major databases (PubMed, Scopus, Proquest, Embase, Science Direct).
• Application of the World Health Organization's Health Systems Framework for deductive content analysis.
• Adherence to PRISMA guidelines for transparent and rigorous reporting.

Main Results:

• 147 distinct interventions were identified, primarily focusing on service delivery and financing.
• Key reform objectives included expanding access, improving financing, scaling up family physicians, increasing health expenditure, and strengthening the PHC workforce.
• Interventions led to expanded public health coverage, better access and utilization of PHC (especially among low-income groups), broader social insurance, and improved service quality.

Conclusions:

• PHC reform success is contingent on alignment with political, social, and cultural contexts, and addressing social determinants of health.
• Strong governmental backing, stable management, decentralization, and regional capacity building are vital for sustainability.
• Gradual, evidence-based reforms with accurate forecasting, adequate resources, and lessons from international experience are recommended.