Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context

Abstract Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) realizing its associated vision ‘Health for All’. International emergencies such as coronavirus-19 (COVID-19) pandemic underscore importance PHC underpinning equity, including via access to routine essential services emergency responsiveness. This review synthesizes current state knowledge about impacts, implementation enablers barriers, gaps across three main components conceptualized 2018 Astana Framework. A scoping design was adopted summarize evidence from a diverse body literature with modification accommodate four discrete phases searching, screening eligibility assessment: database search PubMed PHC-related reviews multi-country analyses (Phase 1); website key global synthesis reports 2); targeted searches peer-reviewed relating specific 3) emerging insights COVID-19 context 4). Evidence 96 included papers were analysed deductive themes corresponding PHC. Findings affirm that investments improve equity access, healthcare performance, accountability systems outcomes. Key include equity-informed financing models, system governance frameworks differentiate multi-sectoral more service-focussed care, mechanisms strengthen linkages between policymakers, civil society, non-governmental organizations, community-based organizations private sector entities. Although about, experience in, continues grow, critical are evident, particularly country-level, context-specific governance, financing, workforce, service coordination mechanisms. An agenda guide future country-specific research is outlined.