Strengthening India’s Primary Health Centres through Quality Improvement: A Scoping Review

Abstract Strengthening the quality of primary care services is central to achieving the targets set under Sustainable Development Goal 3. In India, primary health centers (PHCs) serve as the first point of contact for basic healthcare services; however, the extent and focus of evidence-based quality improvement (QI) initiatives within the PHCs remain unclear. This scoping review aims to study the landscape of QI initiatives operationalized in Indian PHCs and identify existing gaps in the literature to strengthen primary care. The study was conducted using Arksey and O’Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, Embase, and Google Scholar were searched using predefined keywords for studies describing QI interventions in Indian PHCs. Studies conducted in referral facilities or private settings were excluded. Data were extracted using the Epicollect-5 software and synthesized using a logic framework aligned with the World Health Organization health system building blocks and Universal Health Coverage dimensions. Of 769 records screened, 12 studies met the inclusion criteria. Half of the initiatives focused on maternal and child health, while less than a tenth addressed noncommunicable diseases. Rapid-cycle methods were used in half of the studies. All interventions addressed governance and leadership, whereas less than a fifth focused on health financing. Reported outcomes predominantly reflected improvements in effectiveness, with limited attention to efficiency. Structured QI initiatives in Indian PHCs remain limited in number, with most focusing on maternal and child health. Thus, this study highlights the need to broaden efforts to include efficiency, financing, and noncommunicable disease care in QI practices across Indian PHCs to strengthen primary care.