Improving integrated PHC systems can deliver UHC and SDG 3 across Sub-Saharan Africa. Despite adequate evidence based on local workforces, financial support of PHC systems and reliable service delivery, the current evidence of the effect of comprehensive approaches (workforce, financing and service delivery reforms) on PHC performance and population-level health outcomes is scattered. To conduct a systematic synthesis of all existing evidence assessing workforce, financing, and service delivery reforms in improving PHC performance and health outcomes for the population in Sub-Saharan Africa. A systematic review, conducted using PRISMA 2020 guidelines, was performed. The following databases were searched for Inclusion criteria studies conducted between January 2000 December 2024 (PubMed, Scopus, Web of Science, Embase, and select grey literature sources) containing a verification of an integrated PHC reform/initiative within Sub-Saharan African countries and population or health system outcomes. This resulted in an eligible study count of 30. Data extraction was completed with the standardized framework method and results were narrated based on the heterogeneity in study designs and measurement types. The implementation of integrated workforce reform delivered by way of increased access to health services is most frequently associated with increased PHC access, with particular emphasis on rural areas, by integrating task shifting and CHWs. Financing reform (e.g., national health insurance, results-based financing) delivered improved financial risk protection and access to PHC services but has demonstrated poor sustainability in but in donor-dependent systems. Strengthening integrated PHC in Sub-Saharan Africa requires coordinated reform across workforce, financing, and service delivery domains. Sustainable progress toward UHC depends on institutional capacity, domestic financing resilience, and equity-focused implementation strategies.

1. Agula, C., Bawah, A. A., Asuming, P. O., Kyei, P., & Biney, A. (2024). Impact of health system strengthening interventions on child survival in sub-saharan africa: a systematic review protocol. Systematic Reviews, 13(1), 15.
2. Amegah, A. K. (2020). Improving child survival in sub-saharan africa: Key environmental and nutritional interventions. Annals of global health, 86(1), 73.
3. Awoonor-Williams, J. K., Bawah, A. A., Nyonator, F. K., Asuru, R., Oduro, A., Ofosu, A., & Phillips, J. F. (2013). The ghana essential health interventions program: a plausibility trial of the impact of health systems strengthening on maternal & child survival. BMC health services research, 13(Suppl 2), S3.
4. Barber, S. (2007). Health system strengthening interventions: making the case for impact evaluation. Geneva: The Alliance for Health Policy and Systems Research.
5. Birhane, B. M., & Assefa, Y. (2025). Improving the quality of neonatal health care in ethiopia. Neonatal Outcomes-What About Sex, Race (ism) And Social Determinants of Health?.
6. Bolton, P., West, J., Whitney, C., Jordans, M. J., Bass, J., Thornicroft, G., . . . others (2023). Expanding mental health services in low-and middle-income countries: A task-shifting framework for delivery of comprehensive, collaborative, and community-based care. Cambridge Prisms: Global Mental Health, 10, e16.
7. De Savigny, D., & Adam, T. (2009). Systems thinking for health systems strengthening. World Health Organization.
8. Liu, J. X., Goryakin, Y., Maeda, A., Bruckner, T., & Scheffler, R. (2017). Global health workforce labor market projections for 2030. Human resources for health, 15(1), 11.
9. Newborns, W. (2020). reducing mortality. 2019. World Health Organisation. Available at: https://www. who.int/news-room/fact-sheets/detail/newborns-reducing-mortality. Accessed on, 4.
10. Onyeaghala, C. A., Nortey, M. A., Bai-Sesay, A. U., Hassan, A., Anyamene, E. L., & Tsikata, C. Y. (2025). Expanding differentiated service delivery from a hiv treatment model to a platform for broader healthcare in sub-saharan africa. Discover Public Health, 22(1), 860.
11. Organization, W. H. (2024). Achieving well-being: A global framework for integrating well-being into public health utilizing a health promotion approach. Author.
12. Organization, W. H., et al. (2018). A vision for primary health care in the 21st century: towards universal health coverage and the sustainable development goals (Tech. Rep.). World Health Organization.
13. Organization, W. H., et al. (2020). Operational framework for primary health care: transforming vision into action.
14. Popay, J., Roberts, H., Sowden, A., Petticrew, M., Arai, L., Rodgers, M., . . . others (2006). Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme Version, 1(1), b92.
15. Roberts, M. J., Hsiao, W., Berman, P., & Reich, M. R. (2008). Getting health reform right: a guide to improving performance and equity. New York.
16. Tesfa, D., Tiruneh, S. A., Azanaw, M. M., Gebremariam, A. D., Engdaw, M. T., Kefale, B., . . . Dessalegn, T. (2021). Time to death and its determinants among under-five children in sub-saharan africa using the recent (2010–2018) demographic and health survey data: country-based shared frailty analyses. BMC pediatrics, 21(1), 515.
17. UNICEF, U., et al. (2012). Levels & trends in child mortality, estimates developed by the un inter-agency group for child mortality estimation. New York: UNICEF.

Mami , D. \& Kallon, M. (2025). Strengthening Integrated Primary Health Care Systems in Sub-Saharan Africa: A Systematic Review of Workforce, Financing, and Service Delivery Reforms. International Journal of Humanities, Arts and Social Sciences, 11(1), 9-19. doi: https://dx.doi.org/10.20469/ijhss.11.20001-2