Bridging the gap between policy and practice in adolescent health services: evidence from Indian primary public health centers

BACKGROUND: India's 243 million adolescents (21% of the population) face nutritional deficiencies, sexual and reproductive health concerns, mental health disorders, and rising non-communicable diseases (NCDs). Despite policies like Rashtriya Kishor Swasthya Karyakram (RKSK), major implementation gaps remain across public health facilities. METHODS: This scoping review, guided by Arksey and O'Malley's framework and PRISMA-ScR guidelines, assessed adolescent health services at Health and Wellness Centers, Primary Healthcare Centers, and Sub-Health Centers from 2015 to 2025. Three electronic databases were searched, with standardized data extraction, expert consultation and thematic analysis mapped RKSK's four pillars. Study quality was appraised using the MMAT (2018 version). RESULTS: Out of 1,371 records, only 11 met the inclusion criteria. Just 12.5% of facilities provided dedicated adolescent services. A study by Prasad et al. in 2024 reported that only 12.5% of assessed facilities provided dedicated adolescent-specific services and 6% of HWCs offered adolescent care. Barriers comprised lack of privacy, staff shortages, provider bias against unmarried youth (25%), supply chain issues, weak referral systems, poor intersectoral coordination, cultural stigma, and the need for parental consent requirements. Opportunities exist through digital health (78% smartphone use among adolescents), Stakeholder consultation participants estimated adolescent smartphone access at about 78% in the Sikar district. Public-Private Partnerships (PPP), community engagement, and innovative service models. CONCLUSIONS: Despite strong policy frameworks, persistent gaps are evident, with malnutrition (27.4% stunted growth) and rising obesity rates highlighting the urgency. Strengthening services demands political commitment, adequate financing, and culturally sensitive approaches to transform adolescent health and leverage India's demographic potential.