Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: A systematic review protocol

Type 2 diabetes is a major global public health challenge, particularly in the African region. Though evidence exists on pharmacological agents and non-pharmacological interventions in maintaining blood glucose concentration, the healthcare systems' ability to meet patients' needs may be inadequate. The management of non-communicable diseases, particularly diabetes, has been postulated to depend on functioning health systems. This systematic review will, therefore, summarize the current evidence on existing health systems interventions in primary health settings for type 2 diabetes care and health outcomes in West Africa and will explore the impact of these system-level interventions on service availability, accessibility and quality, as well as individualized outcomes such as glycemic control, disease awareness and treatment adherence. The review will be conducted according to the reporting guidance in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The health system framework by Witter et al., 2019 will guide the system-level interventions and the search strategy to be explored in this review. This framework was designed to integrate the six building blocks of the World Health Organization (WHO) health systems framework and it delineates how they work synergistically to improve specific health outcomes. We will search the following databases PubMed, Google Scholar and Cumulated Index to Nursing and Allied Health Literature (CINAHL) between January 2000 to January 2024. We will also search Cairn.info for articles published between January 2005 to January 2024. The Cochrane Collaboration tool for assessing Risk of Bias will be implemented in each included study. We will conduct a narrative synthesis and make comparisons across findings using Excel-generated tables. In Conclusion, this systematic review will outline the existing system-level interventions that aim to or already improve type 2 diabetes services in primary health settings in West Africa and will offer suggestions for the strengthening and co-production of successful interventions that can be generalized to the entire sub-region.