Reimagining primary health care: a historical and contemporary scoping review of community-based primary health care models and innovations

Abstract

Objectives Community-based primary health care (CBPHC) has long underpinned health service delivery in resource-limited settings. However, demographic shifts, increasing chronic disease burdens, and digital transformations challenge its sustainability. This review synthesizes historical and contemporary evidence on CBPHC to assess effectiveness, identify limitations, and outline future directions toward universal health coverage (UHC). Methods Using the Arksey and O'Malley framework, we conducted a scoping review of global literature from 1975 to 2025 across PubMed, Scopus, Web of Science, Google Scholar, and grey sources. Data were thematically analyzed into categories capturing evolution, achievements, challenges, and future directions. Results A total of 134 documents were reviewed. CBPHC improved access to essential services, particularly maternal and child health, infectious disease control, and health promotion. Programs led by community health workers and volunteers strengthened systems but faced persistent barriers such as attrition, limited funding, and weak integration. Case studies from Nepal, Ethiopia, Brazil, and Rwanda showed improved maternal and child outcomes and pandemic preparedness and resilience. Emerging challenges include syndemics, demographic shifts, and urbanization. Conclusions CBPHC remains vital for advancing universal health coverage. Its sustainability depends on evolving into a diagonally integrated, people-centered, and digitally enabled model supported by equitable investment in governance, workforce training, and community engagement.