Health gender equality and poverty reduction as integrated pathways to achieving SDG 3 in sub–Saharan Africa

Abstract Sub-Saharan Africa faces an unprecedented convergence of health disparities, entrenched poverty, and persistent gender inequality that collectively undermines progress toward Sustainable Development Goals. This narrative review synthesizes evidence of the interlinkages between health, gender equality, and poverty reduction, demonstrating that these domains are bidirectionally connected through both structural determinants and dynamic feedback mechanisms. The region bears disproportionate disease burdens, with maternal mortality ratios averaging 536 per 100,000 live births and over 90% of global malaria deaths, whereas approximately 60% of adults living with HIV are women. Out-of-pocket health expenditures trap vulnerable households in poverty cycles, with gender-based discrimination systematically restricting women’s access to health care, education, and economic opportunities. The synthesized Health-Gender-Poverty Nexus Model illustrates how macro-level institutional factors interact with gendered norms, economic marginalization, and weak health systems to produce intergenerational inequities. Evidence from exemplary African interventions, including Kenya’s multisectoral adolescent pregnancy prevention initiative, Rwanda’s integrated community health worker systems, and conditional cash transfer programs, demonstrate that cross-sectoral approaches addressing health, gender equality, and poverty simultaneously achieve synergistic population-level impacts substantially exceeding siloed interventions. However, substantial barriers, including weak political will, financing constraints, and governance fragmentation, impede systematic implementation. This review identifies critical research gaps in gender-disaggregated health data, longitudinal causal analyses, climate change-health intersections, and digital health equity. Achieving SDG 3 in Sub-Saharan Africa requires institutionalizing multisectoral governance mechanisms, enhancing domestic resource mobilization through gender-responsive budgeting, and strengthening the implementation capacity for integrated service delivery based on locally relevant evidence and community participation.