Social determinants of health interventions to advance health equity in sub-Saharan Africa: A systematic review and meta-analysis

Abstract

Introduction: Health inequities in sub-Saharan Africa are among the world’s largest, driven by social determinants of health. This systematic review and meta-analysis aimed to synthesise the evidence on the effectiveness of social determinants of health interventions on health outcomes and equity in sub-Saharan Africa. Methods: We followed PRISMA 2020 guidelines and registered the protocol with PROSPERO (CRD420251135108). We searched six databases (MEDLINE, Embase, Global Health, African Index Medicus, Cochrane CENTRAL, Web of Science) from 1 January 2000 to 31 October 2025 for randomised controlled trials and quasi-experimental studies of social determinant interventions in sub-Saharan Africa. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 and ROBINS-I tools. We conducted random-effects meta-analyses and assessed evidence certainty using the GRADE approach. Results: We included 18 studies (115,029 participants) across seven countries. Cash transfers significantly reduced adverse health outcomes, including mortality (six studies, n=17,697, RR: 0·70, 95%CI: 0·64–0·76; I²=0%, P<0·0001, high certainty) and improved school attendance (RR: 1·28, 95%CI: 1·18–1·39; high certainty). Women’s empowerment interventions reduced intimate partner violence (RR: 0·55, 95% CI: 0·38–0·79; high certainty) and improved economic outcomes (SMD: 0·67, 95%CI: 0·48–0·86; high certainty). Education interventions reduced helminth infections (RR: 0·68, 95% CI: 0·59–0·78; high certainty) and increased health knowledge (SMD: 0·58, 95% CI: 0·42–0·74; moderate certainty). Most interventions had equity-positive effects. Conclusion: Social determinants of health interventions can significantly improve health and reduce inequities in sub-Saharan Africa. The evidence is strongest for cash transfers and education interventions. Our findings align with previous global reviews but provide Africa-specific evidence. Limitations include the small number of included studies, their concentration in a few countries (mainly South Africa and Kenya), heterogeneity across intervention types, and the lack of a formal assessment for reporting bias; the conclusions should therefore be interpreted cautiously. These findings support the need for increased investment in social determinants approaches to achieve health equity.