Title: Short-term health system responses to epidemics across hard-to-reach areas in sub-Saharan Africa: A scoping review

Background Epidemics and disease outbreaks continue to threaten public health security in sub-Saharan Africa (SSA), disproportionately impacting impoverished and hard-to-reach populations. Although many country-specific studies exist, few syntheses have examined how health systems in SSA respond to short-term infectious disease outbreaks and how these responses affect health equity and resilience. This scoping review consolidates regional evidence on structural and policy-relevant lessons for enhancing health system preparedness and epidemic management in resource-limited settings. Methods A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Four electronic databases (PubMed, Cochrane Library, CAB Direct, and Google scholar) and grey literature sources for studies published between 2012 and 2022. Eligible studies reported short-term (immediate or early-phase) health system responses to epidemic-prone infectious diseases in SSA. Data were extracted using a modified Donabedian framework that encompasses structures, processes, and outcomes, and then thematically analysed using the WHO health system building blocks. Results Fifteen studies met the inclusion criteria, examining responses to COVID-19, Ebola Virus Disease (EVD), and other epidemic-prone infections. Common weaknesses identified included shortages of trained healthcare workers, limited financial resources, poor leadership and coordination, and weak information systems. However, countries like Rwanda, Ethiopia, Nigeria, and Uganda showed adaptive governance, decentralised coordination, and the use of digital tools to improve surveillance, communication, and service delivery. Strong community engagement helped reduce stigma and increased adherence to control measures, especially in rural and underserved areas. Countries that incorporated epidemic response into existing primary healthcare and routine services achieved better equity and system resilience. Conclusion The scoping review underscores strong evidence for incorporating epidemic preparedness into the broader health system. Policy focus areas include enhancing leadership and governance, establishing swift response mechanisms at subnational levels, and utilising technology for real-time data and coordination. Regional collaborations like those facilitated by the Africa CDC (1), can improve collective resilience. Going forward, policies should prioritise not just emergency response but also ongoing investment in flexible, learning health systems that can withstand shocks while consistently providing essential services.