Effectiveness of community-based health education interventions in fragile and conflict-affected settings in Sub-Saharan Africa: a systematic review

Abstract Background In Sub-Saharan Africa, health service delivery is constantly disrupted in fragile and conflict-affected settings (FCAS), necessitating creative solutions to sustain vital health education and service consumption. In these situations, community-based health education (CBHE) has been extensively used as a tactic to raise health awareness and encourage healthy habits. Its overall efficacy and impact mechanisms, however, are still not fully synthesized. Objective This systematic review aimed to assess the effectiveness of CBHE interventions in improving health knowledge, service utilization, and health outcomes in FCAS in Sub-Saharan Africa, and to explore the mechanisms and contextual factors influencing their effectiveness. Methods A systematic review with thematic synthesis of eighteen studies was carried out. A thorough search of PubMed/MEDLINE, Scopus, Embase, CINAHL, Cochrane Library and Google Scholar was conducted and Grey literature search was done for relevant studies. Included were studies that examined CBHE interventions provided in fragile and conflict-affected environments by community health workers (CHWs), peer educators, traditional birth attendants (TBAs), and informal community organizations. Results Community-based interventions consistently improved health knowledge across maternal, child health, and infectious disease domains. The primary delivery methods were CHWs, peer educators, and TBAs. Accessibility, cultural tolerance, and trust were major factors in their efficacy. Service utilization increased when community actors were integrated into formal health systems, while fragmented or exclusionary methods decreased efficacy. However, systematic limitations including instability, poor coordination, and supply chain interruptions hindered the conversion of better knowledge into long-term health outcomes. Conclusion CBHE and informal community health systems improve knowledge and strengthen resilience in fragile settings through trusted local actors. However, their impact on health outcomes remains constrained without stronger system integration and sustained structural support.