Dual Practices in Primary Health Care in India: A Scoping Review

Background: Dual practice, defined as simultaneous engagement of public sector health care providers in private clinical practice, is a common phenomenon in low- and middle-income countries, including India. In primary health care (PHC) settings, dual practice has implications for service availability, quality of care, provider behaviour, equity, and governance. However, evidence on its nature, regulation, and consequences in Indian PHC remains fragmented. Objective: This scoping review aims to systematically map and synthesise the available evidence on dual practices in primary health care in India. Secondary Objectives: • To describe the nature and forms of dual practice among PHC providers • To examine regulatory and policy approaches addressing dual practice • To assess reported impacts on service delivery, quality of care, equity, and governance PCC Framework: • Participants: Primary health care providers in public sector facilities (Medical Officers, contractual doctors, AYUSH practitioners, and other PHC-level providers) • Concept: Dual practice (simultaneous public employment and private clinical practice) • Context: Primary health care settings in India (Sub-Centres, PHCs, HWCs / Ayushman Arogya Mandirs, Urban PHCs) Methods: The review follows the Arksey and O’Malley methodological framework and will be reported according to PRISMA-ScR guidelines. Electronic databases (PubMed, Embase, ScienceDirect) and grey literature sources will be searched. Eligible studies include qualitative, quantitative, mixed-methods research, policy documents, and programme reports relevant to dual practice in Indian PHC. Expected Outcomes: This review will provide a comprehensive synthesis of evidence on dual practices in primary health care in India, inform workforce governance and regulatory policy under the IPSI project, and identify critical gaps for future research. Sources of support: This scoping review will be conducted under the IPSI Project, funded by the Bill & Melinda Gates Foundation through Johns Hopkins University. (https://jhu-ipsi.com/). Conflicts of Interest: None declared.