Road to Eliminating Out-of-Pocket Payment in Sub-Saharan Africa, Elucidating the Role of Primary Care Health Workforce: A Scoping Review Protocol

ntroduction: Despite multi-decade reforms aimed at Universal Health Coverage (UHC), out-of-pocket (OOP) expenditure remains a primary barrier to healthcare access in Sub-Saharan Africa (SSA). While macro-level financing policies are well-documented, the agency of the "street-level" health workforce in navigating these policies at the point of care is under-researched. This scoping review aims to map the perceptions, experiences, and discretionary practices of primary care workers that mitigate or exacerbate OOP payments in Sub-Saharan Africa. Methods: Following the Arksey and O'Malley (2005) framework, a comprehensive search of PubMed, Scopus, and Google Scholar will be conducted for studies published between 2012 and 2025. Data extraction will focus on the frontline practices of primary care staff. Analysis will be guided by Street-Level Bureaucrat Theory, examining how worker discretion, resource scarcity, and client interactions shape the implementation of financial risk protection. Discussion: The findings will provide a critical lens on the "implementation gap" in health financing, shifting the focus from top-down policy design to the frontline actors who ultimately determine the financial burden faced by patients.