What do we know about the working environment in healthcare services, its effects and improvement strategies in sub-Saharan Africa? Protocol for a rapid literature review

<b>Background</b>: Sub-Saharan Africa faces critical health workforce shortages, hindering Universal Health Coverage and Sustainable Development Goals. The region has the lowest density of doctors and nurses globally, exacerbated by brain drain. A poor work environment significantly impacts healthcare staff motivation, performance, and service quality.<b>Rationale</b>: Beyond traditional incentives, improving physical spaces and addressing issues like harassment and violence in their various dimensions are crucial. A positive work environment boosts productivity, aids talent recruitment/retention, and enhances organizational performance and user satisfaction. Addressing these challenges through improved working conditions, harassment and violence prevention is vital for strengthening health systems and achieving better health outcomes.<b>Objectives and review question</b>: This study aims to examine the working environment's effects on healthcare workers and users. More specifically, (i) to describe the working environments in healthcare services, (ii) to explore the effect of specific environments on healthcare workers, (iii) to explore the effect of specific environments on healthcare users, and (iv) to identify knowledge gaps and research needs. The review question has been developed following the Participants, Concept and Context framework with no restriction of participants and context. The core question is framed as follows: <i>“According to the available literature, what do we know about the working environment in healthcare services, its effects and improvement strategies in sub-Saharan Africa?”</i><b>Methods</b>: This study is exploratory and consists in a rapid review (RR) of peer-reviewed and grey literature. We shall use the RR approach 1 described by Smela et al., modified to include grey literature. This review will follow the six recommended key stages, including (i) framing of the research question, (ii) search of relevant literature, (iii) screening of identified literature, (iv) data extraction, (v) assessing certainty and the risk of bias, (v) data collation, and (vi) appraising the certainty of evidence. 5 databases, including PubMed, CAIRN, Google Scholar and DOAJ. ReliefWeb and WHO library will be searched for grey literature. Details on the process from literature search to final document selection will be summarised in Prisma flow chart. The charted data will be summarised in graphic, narrative and tabular ways.