Multilevel determinants of primary care access for selected mental health conditions among adults in West Africa: a scoping review

Despite growing recognition of the increasing global mental health burden, treatment gaps persist in many LMICs. In West Africa, access to primary care for mental health conditions such as stress-related disorders, anxiety, depression, schizophrenia, bipolar disorder, and substance use disorder remains constrained by multiple interrelated barriers. Although individual studies have explored determinants of access to care, there has been limited synthesis of the factors influencing primary mental health care across West Africa. To identify factors influencing access to primary care for selected mental health conditions (depression, bipolar disorders, schizophrenia, anxiety disorders, stress disorders, and substance use disorders) among adults in West Africa. Using the Arksey and O’Malley review approach, five electronic databases (PubMed, Embase, PsycINFO, Cairn.info, and Google Scholar) were searched for studies published between 1st January 2002 and 31st January 2026. Studies were eligible if they involved adults living with mental health conditions or their caregivers (population), reported factors influencing primary care access for these conditions (concept), and were conducted in any of the 15 Economic Community of West African States (ECOWAS) countries (context). Records were screened by two independent reviewers using Rayyan. Data were extracted and analysed thematically using a conceptual framework derived from Levesque et al.’s access model and Leichter’s contextual framework. This review adheres to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting standards. After removing duplicates, 1,929 titles and abstracts were screened, resulting in 41 articles eligible for full-text review. Following full-text screening, 26 eligible studies (reported across 29 publications) were included in the final analysis. The included studies identified determinants of primary care access across three interacting domains: patient-level (perceptions of care, care-seeking behaviour, healthcare reaching, healthcare payment, and healthcare engagement), primary healthcare facility-level (approachability, acceptability, availability and accommodation, affordability, and appropriateness), and contextual factors (social norms, cultural beliefs, traditions, and socioeconomic status). Appropriateness of care and healthcare engagement were the most reported domains. Access to primary care for mental health in West Africa is shaped by multiple, interrelated factors across patient, facility, and contextual levels. Effective interventions must be multifaceted, culturally sensitive, and contextually relevant.