Health System Readiness for the Implementation of Primaquine-Based Malaria Elimination Strategies in Sub-Saharan Africa: A Scoping Review

This scoping review will examine health-system readiness for the implementation of primaquine-based malaria elimination strategies in sub-Saharan Africa. Malaria continues to place a substantial burden on the region, and primaquine has an important role in reducing *Plasmodium falciparum* transmission and preventing relapse of *P. vivax* and *P. ovale*. However, the successful and safe implementation of primaquine depends on health-system capacity, including G6PD testing, trained healthcare workers, reliable medicines and diagnostic supplies, appropriate policies and guidelines, monitoring systems, and sustainable financing. The purpose of this review is to map and synthesize the available evidence on the capacity and preparedness of health systems to implement primaquine-based malaria elimination strategies in sub-Saharan Africa. The review will identify existing health-system capacities, implementation barriers, enabling factors, and gaps in the available evidence. A scoping review methodology will be used, guided primarily by the Joanna Briggs Institute (JBI) approach and informed by the frameworks of Arksey and O’Malley and Levac et al. The review will follow the Population–Concept–Context (PCC) framework and will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Relevant evidence will be identified through searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL, Global Health, the Cochrane Library, and selected grey-literature sources. Evidence available from database inception to 31 August 2026 will be considered. Two reviewers will independently screen eligible records and chart relevant data. Findings will be analyzed descriptively and thematically using the six World Health Organization (WHO) health-system building blocks: leadership and governance, health workforce, service delivery, health information systems, access to essential medicines and diagnostics, and health financing. The review is expected to provide a comprehensive overview of the current state of health-system readiness for primaquine implementation across sub-Saharan Africa. It will highlight strengths and weaknesses in health-system capacity, identify barriers and facilitators to implementation, and demonstrate geographical, methodological, and evidence gaps. The findings are expected to support policymakers, national malaria programmes, health-system managers, researchers, and other stakeholders in planning and strengthening systems for the safe, effective, and sustainable implementation of primaquine-based malaria elimination strategies.