Public Health and Epidemiology: Open Access
Road to Eliminating Out-of-Pocket Payment in Sub-Saharan Africa, Elucidating the Role of Primary Care Health Workforce: A Scoping Review Protocol
Abstract
Julius Cudjoe, Wisdom Kwabla Atatsi, Bernard Kwabena Adjei and Seyram Gockel Ashong
Introduction Despite multi-decade reforms aimed at Universal Health Coverage (UHC), out-of-pocket (OOP) expenditure remains a primary barrier to healthcare access in Sub-Saharan Africa (SSA). While macro-level financing policies are well- documented, the agency of the “street-level” health workforce in navigating these policies at the point of care is under- researched. This scoping review aims to map the perceptions, experiences, and discretionary practices of primary care workers that mitigate or exacerbate OOP payments in Sub-Saharan Africa.
Methods Following the Arksey and O’Malley (2005) framework, a comprehensive search of PubMed, Scopus, and Google Scholar will be conducted for studies published between 2012 and 2025 [1]. Data extraction will focus on the frontline practices of primary care staff. Analysis will be guided by Street-Level Bureaucrat Theory, examining how worker discretion, resource scarcity, and client interactions shape the implementation of financial risk protection.
Discussion The findings will provide a critical lens on the “implementation gap” in health financing, shifting the focus from top-down policy design to the frontline actors who ultimately determine the financial burden faced by patients.