Implementation strategies for integrating non-communicable disease care into primary healthcare settings in sub-Saharan Africa: A systematic review

Résumé

This sytematic review synthesised evidence on implementation strategies for integrating non-communicable disease (NCD) care into primary healthcare (PHC) in Sub-Saharan Africa (SSA), the barriers and facilitators influencing implementation, the effects on service delivery and patient outcomes, and implications for scale-up and sustainability. Our review followed PRISMA 2020 guidelines using the Population-Exposure-Outcome (PEO) framework. Studies were identified through searches of PubMed/MEDLINE, African Journals Online, and Google Scholar. We included English-language studies published between 1 January 1990 and 31 December 2025. Methodological quality was appraised using the Mixed Methods Appraisal Tool (MMAT). Narrative synthesis followed the Synthesis Without Meta-analysis (SWiM) guideline. From 22,959 records initially identified, 46 studies met the inclusion criteria. The Studies were conducted in 14 SSA countries. Six implementation-strategy clusters were identified: task-shifting and task-sharing; integrated chronic care models; workforce capacity-building, training and educational outreach; digital health and decision-support tools; community- and group-based delivery; and guidelines, protocols, and quality-improvement packages. Barriers to implementation included workforce shortages, supply-chain interruptions, weak guideline operationalisation, and limited digital infrastructure. Engaged frontline leadership, supportive organisational climate, integration with existing HIV chronic care platforms, drug revolving funds, and community partnerships were the most consistent facilitators. Implementation strategies were associated with improvements in service delivery, provider knowledge and competence, and selected clinical outcomes (notably blood pressure control), but effects on diabetes control, retention, and longer-term sustainability were less consistent. Implementation strategies that integrate NCD care into PHC in SSA can deliver meaningful gains in access, provider capability, and clinical control, but their effects depend on health-system foundations and sustained leadership. Scaling up integration will require investment in workforce, supply chains, and information systems, embedded leadership, alignment with existing HIV chronic care platforms, and iterative, context-adapted design. These priorities are central to progress towards Sustainable Development Goals 3.4 and 3.8.

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