Barriers and facilitators of Patient-Public Engagement for health system improvement in Sub-Saharan Africa: A systematic scoping review.

Introduction: Patient-Public Engagement (PPE) is central to most community and public health interventions. There are reports on PPE's impact on improving health and health systems. Yet, PPE initiatives are infrequent in Sub-Saharan Africa (SSA). A key step to enhancing engagement is identifying facilitators and barriers of PPE. Evidence synthesis of PPE's effect on improving health systems is lacking. This study seeks to address this knowledge gap. Methods: This review (Protocol published) followed Arksey and O'Malley's guidelines for conducting and reporting scoping reviews. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 on Scopus, Medline (Ovid), CINAHL and Embase databases was conducted. A thematic framework synthesis was employed. Results: Eighteen articles from ten Sub-Saharan African countries met the inclusion criteria of studies focusing on patient, public, citizen or community consultation/engagement/involvement in health services in Sub-Saharan Africa; as well as on barriers and facilitators for health systems improvement. The identified barriers and facilitators for health systems improvement were categorised onto a framework comprising individual-level, community-level and macro/strategic-level factors. Previous reviews on PPE have not focused on barriers and facilitators and its effect on improving health delivery in SSA, yet important for any successful PPE implementation. Barriers and facilitators of PPE largely differ from one health system level to another. Conclusion: Policymakers need to consider the individual and community level contextual factors that influence PPE for effective implementation. Adopting context-specific approaches at all health system levels rather than a one-size-fit-all approach is recommended.