What does this research mean for the field?

Incorporating epidemic preparedness into existing primary healthcare systems, alongside adaptive governance, digital tools, and community engagement, significantly improves health equity and system resilience during short-term epidemic responses in hard-to-reach areas of sub-Saharan Africa. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This review aims to consolidate evidence on how health systems in sub-Saharan Africa respond to epidemics in hard-to-reach areas and their implications for health equity and resilience.

May 30, 2026Open Access

Short-term health system responses to epidemics across hard-to-reach areas in sub-Saharan Africa: a scoping review

Key Points

This review aims to consolidate evidence on how health systems in sub-Saharan Africa respond to epidemics in hard-to-reach areas and their implications for health equity and resilience.
A scoping review was conducted following PRISMA-ScR guidelines.
Four databases and grey literature were searched for relevant studies published from 2012 to 2022.
Data were thematically extracted and analyzed using a modified Donabedian framework.
Fifteen studies were included, focusing on COVID-19, Ebola Virus Disease, and other infections.
Identified weaknesses included shortages of healthcare workers and poor leadership.
Countries demonstrating adaptive governance and community engagement improved health responses.

Abstract

Abstract Background Epidemics and disease outbreaks continue to threaten public health security in sub-Saharan Africa (SSA), disproportionately impacting impoverished and hard-to-reach populations. Although many country-specific studies exist, few syntheses have examined short-term health system responses to epidemics in hard-to-reach areas of SSA and their effects on health equity and resilience. This scoping review consolidates regional evidence on structural and policy-relevant lessons for enhancing health system preparedness and epidemic management in resource-limited settings. Methods A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Four electronic databases (PubMed, Cochrane Library, CAB Direct, and Google scholar) and grey literature sources for studies published between 2012 and 2022. Eligible studies reported short-term (immediate or early-phase) health system responses to epidemic-prone infectious diseases in SSA. Data were extracted thematically using Excel and analysed using a modified Donabedian framework encompassing structures, processes, and outcomes. Results Fifteen studies met the inclusion criteria and examined responses to Coronavirus 2019 (COVID-19), Ebola Virus Disease (EVD), and other epidemic-prone infections. Common weaknesses identified included shortages of trained healthcare workers, limited financial resources, poor leadership and coordination, and weak information systems. However, countries such as Rwanda, Ethiopia, Nigeria, and Uganda demonstrated adaptive governance, decentralised coordination, and the use of digital tools to improve surveillance, communication, and service delivery. Strong community engagement helped reduce stigma and increased adherence to control measures, especially in rural and underserved areas. Countries that incorporated epidemic response into existing primary healthcare and routine services achieved better equity and system resilience. Conclusion The scoping review underscores strong evidence for incorporating epidemic preparedness into the broader health system. Policy focus areas include enhancing leadership and governance, establishing swift response mechanisms at subnational levels, and utilising technology for real-time data and coordination. Regional collaborations like those facilitated by the Africa CDC can improve collective resilience. Going forward, policies should prioritise not just emergency response but also ongoing investment in flexible, learning health systems that can withstand shocks while consistently providing essential services.

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