# State-church partnerships as an innovative strategy in healthcare delivery for universal health coverage in sub-Saharan Africa: a scoping review

## TL;DR

This review explores how partnerships between governments and churches in sub-Saharan Africa help improve healthcare access and support universal health coverage.

## Contribution

The paper provides a scoping review of state-church partnerships in healthcare delivery for UHC in sub-Saharan Africa.

## Key findings

- Faith-Based Organizations provide 30% to 70% of healthcare services in some regions, improving access and equity.
- Partnerships face challenges like funding constraints and service quality variability.
- Best practices include government collaboration, community engagement, and capacity-building.

## Abstract

Universal Health Coverage (UHC) remains a critical goal in sub-Saharan Africa (SSA), where healthcare systems face significant challenges. State-Church Partnership have emerged as an innovative strategy to address gaps in healthcare delivery, leveraging the extensive networks of Faith-Based Organizations to provide essential services, particularly in remote areas.This scoping review aimed to examine the existing models of State-Church Partnerships in healthcare delivery within SSA, their impact on UHC advancement, the challenges these partnerships face, and the emerging best practices. This review followed Arksey and O’Malley’s framework and the PRISMA-ScR guidelines. We systematically searched peer-reviewed databases, including PubMed, Web of Science, Scopus, and CINAHL, for relevant studies published from inception until December 2024. Data were extracted and analyzed thematically using NVivo 12 to identify key themes related to state-church partnership models, their impact on UHC, implementation challenges, and emerging best practices. The review included eight studies which revealed that FBOs contribute between 30% and 70% of healthcare services in some regions, improving access, affordability, and equity. They play a critical role in maternal and child health, HIV/AIDS prevention, and health workforce training. However, challenges such as funding constraints, service quality variability, and limited policy integration hinder their effectiveness. Emerging best practices include enhanced government collaboration, community engagement, and capacity-building initiatives. In conclusion, State-Church Partnerships are vital in strengthening healthcare systems and achieving UHC in SSA. To maximize their impact, formalized policy frameworks, sustainable financing mechanisms, and quality assurance measures are essential. Strengthening state-FBO collaboration can bridge healthcare gaps and ensure equitable healthcare access.