Description of features of hardship areas in Sub-Saharan Africa: A scoping review protocol

Healthcare access and workforce retention in hardship areas across Sub-Saharan Africa (SSA) remain critical challenges, despite the foundational role of primary healthcare (PHC) emphasized in the Alma-Ata Declaration of 1978. The region struggles with the lowest ratio of healthcare workers per population, particularly in rural and remote areas, exacerbating health inequities. However, there is a lack of consensus on what constitutes a hardship area. This scoping review aims to map the definitions and features of hardship areas in SSA and develop a unified typology to inform the distribution of these regions. Ultimately, this framework will assist in designing tailored incentives to attract and retain skilled healthcare professionals where they are most needed.