Resilience Strategies for Strengthening Maternal Health Systems in Sub-Saharan Africa After COVID-19: A Scoping Review

Abstract

Background: The COVID-19 pandemic affected the delivery of maternal health services worldwide, with sub-Saharan Africa (SSA) being the hardest hit due to existing health system challenges. Exploring maternal health systems response to the pandemic is essential for strengthening resilience and progressing toward Universal Health Coverage (UHC). Methods: A scoping review was conducted following the guidelines of Arksey and O’Malley and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) reporting criteria. Major databases, including PubMed, Web of Science, and Google Scholar, were searched for studies published from 2020 to 2026. Titles/abstracts and full texts were screened independently by two reviewers using predefined eligibility criteria, with discrepancies resolved through discussion. Eligible studies analyzed the delivery of maternal health services and health systems responses to COVID-19 in sub-Saharan Africa. Results: The search yielded 1,248 studies; after the selection process, 15 studies met the eligibility criteria. The results showed that maternal health services were heavily disrupted, with decreased attendance at antenatal clinics and fewer deliveries occurring in facilities. To build resilience, health systems used strategies like community-based services, task shifting, telemedicine, and rapid workforce training to enhance provider capacity. Discussion: Findings show that short-term adaptive strategies in response to COVID-19 were the primary factors influencing health system resilience after the crisis. Innovations in workforce training and service delivery played a crucial role in maintaining care. Ongoing inequities emphasize the need for more inclusive, equity-focused resilience strategies. Conclusion: Maternal health systems in sub-Saharan Africa require consistent investment in primary healthcare, institutionalization of digital health innovations, equitable funding, and integration of maternal health issues into emergency preparedness systems to enhance resilience. These measures are essential to ensure continuity of care during future health crises.