Transforming Primary Health Care in India through Ayushman Arogya Mandirs: A Systematic Synthesis of the Evidence

Abstract

India’s push to strengthen primary health care gained significant momentum in 2018 with the launch of Health and Wellness Centres (HWCs) under the Ayushman Bharat initiative- one of the world’s largest efforts to reposition primary care around comprehensive, community-based services characterized by equity, well-being, preventive care innovation and community wellbeing. Envisioned as accessible community-level platforms for preventive, promotive, and basic curative care, HWCs have expanded rapidly, though evidence on their real-world performance has remained scattered.

This systematic review, conducted in line with PRISMA 2020 guidelines, synthesised evidence from eight major databases and key grey-literature sources published between 2018 and 2025. Thirty-eight studies met the inclusion criteria. Collectively, the findings show that HWCs and Ayushman Arogya Mandirs (AAMs) have improved access to essential primary-care services, particularly in underserved settings, with consistent gains in NCD screening, digital health use, and community engagement. At the same time, persistent challenges most notably workforce shortages, infrastructure gaps, uneven implementation across states, and limited awareness of promotive services continue to shape outcomes.

Overall, the evidence indicates that HWCs and AAMs have laid a strong foundation for comprehensive primary health care in India. Sustained investment in people, systems, and community participation will be critical to consolidate these gains and offers lessons of wider relevance for countries pursuing universal health coverage. However, despite this scale and ambition, evidence on their real-world functioning and performance remains evolving, presenting a valuable opportunity for learning and feedback to inform policy refinement, strengthen implementation, and further enhance the role of HWCs and AAMs in advancing equitable primary health care in India.