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

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BACKGROUND: Non-communicable diseases (NCDs) account for a large and growing share of global mortality, with the highest burden in low- and middle-income countries (LMICs). The World Health Organization and global partners emphasise strengthening primary health care (PHC) as a central pathway toward universal health coverage (UHC). The WHO Package of Essential Noncommunicable Disease Interventions (PEN) for PHC explicitly positions "integration of NCD management into primary health care" as an important step, particularly in LMICs. Despite the wide policy endorsement, evidence suggests there are ongoing gaps in integrating essential NCD care into PHC across Africa. METHODS: This protocol follows PRISMA-P guidance for systematic review protocols. The review will include peer-reviewed and grey literature (English) from 1 January 1990 to 31 December 2025 that focuses on implementation strategies for integrating NCD care into PHC in sub-Saharan Africa (SSA). Narrative synthesis will be conducted using established guidance for narrative synthesis and SWiM reporting, where meta-analysis is not feasible. Study quality will be appraised using the Mixed Methods Appraisal Tool (MMAT) to accommodate heterogeneous designs. ETHICS AND DISSEMINATION: Ethical approval is not required because the review will use publicly available data only. Findings will be disseminated through peer-reviewed publications and conference presentations. REGISTRATION: This protocol was registered with PROSPERO (CRD420261354803). https://www.crd.york.ac.uk/PROSPERO/view/CRD420261354803. PROTOCOL REPORTING STANDARD: This protocol is prepared in accordance with PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) 2015, which provides a minimum set of items for transparent reporting of systematic review protocols. AMENDMENTS: Any protocol amendments (e.g., eligibility criteria refinements or database additions) will be documented with date, rationale, and impact on methods, and updated in the PROSPERO record and the final manuscript.