Factors Influencing Primary Healthcare System in the Achievement of Universal Health Coverage in the WHO‐AFRO Region: An Integrative Review

The primary health centres are designed to be the first line of contact with the public and the main target for achieving universal health coverage (UHC). However, despite global advancements in healthcare, Africa continues to face unacceptably high health outcome indices, underscoring the significant challenges in achieving UHC. This review synthesises evidence on the factors influencing the primary healthcare system, focusing on its role in achieving UHC within the WHO-Afro region. This is an integrative literature review. An extensive and systematic search for eligible literature was performed in eight databases between 2000 and 2024, including APA PsycINFO, CINAHL, Medline, Scopus, EmCare, Embase, Ovid Nursing and Gale Academic One File. The articles identified were critically appraised. A narrative synthesis of evidence was done to fully explore the review question. The findings were presented using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in-line with EQUATOR guidelines. Overall, 26 studies were included in the review. Six themes captured the factors influencing the PHC system in the achievement of UHC: (1) physical access to critical services, (2) availability of resources, (3) sociodemographic and cultural factors, (4) access to data and health information, (5) legislation and policy and (6) quality of care. This review highlights interconnected factors necessitating a holistic approach to optimising PHC effectiveness and driving progress towards achieving UHC. Integrating human, financial and infrastructural resources alongside community-driven strategies, equitable digital technologies and robust policy frameworks is essential to improving health outcomes and achieving UHC.