Exploring barriers and facilitators of providing maternal healthcare in Africa: systematic review protocol.

Abstract

<h4>Introduction</h4>Maternal health remains a critically neglected issue in low-resource countries and represents a significant public health concern. Maternal mortality in these regions is ten times higher than in high-income countries. Sub-Saharan Africa bears the highest maternal mortality ratio globally. The persistently high maternal mortality rate is attributed to the myriad professional, social, and economic challenges healthcare providers face, which impede their ability to deliver optimal maternal healthcare. Given the central role of healthcare professionals in maternal health, understanding the barriers and facilitators they encounter is essential to improving maternal health outcomes. This systematic review aims to synthesise the existing literature on the challenges and enablers of providing maternal healthcare in Africa.<h4>Method</h4>The review will involve a comprehensive search using databases such as MEDLINE, CINAHL, Google Scholar, and PubMed, accessed through the City St. George's University library. The search strategy will be refined with input from the school librarian to ensure thoroughness. Search terms will include Medical Subject Headings (MeSH) terms like "Barriers OR challenges," "Facilitators OR Enablers," "maternal health," and "Africa," alongside relevant keywords. Boolean operators "AND" and "OR" will expand the search scope, with inclusion criteria limited to English-language articles published between 2010 and 2025 with available abstracts, studies conducted in African countries, and qualitative articles addressing barriers and/or facilitators of maternal healthcare. The SPIDER framework will guide the research question, adhering to PRISMA guidelines for systematic reviews, while STARLITE principles will report on the literature search process. The selected studies will be appraised using the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies.<h4>Result</h4>Data will be analysed thematically following the approach outlined by Thomas and Harden (2008), presenting findings as an interpretive summary.<h4>Conclusion</h4>This review will enhance the existing evidence on the challenges and opportunities faced by maternal healthcare providers in delivering better services across Africa.<h4>Ethics and dissemination</h4>No formal ethical approval is necessary since this study does not involve collecting primary data. The findings will be shared via a peer-reviewed journal article and presented at conferences.<h4>Systematic review registration</h4>(PROSPERO) CRD42025634335.