BACKGROUND:
Universal health coverage is a global health agenda aimed at improving health outcomes, reducing poverty, and promoting economic reforms needed to transform the country's healthcare system by improving access, quality, and equity. Despite its laudable objectives, multifaceted challenges have been reported with the implementation in different African countries. African countries are making conscious efforts to achieve universal health coverage (UHC) through healthcare reforms to reduce out-of-pocket expenditure (OOP) and improve access to quality health services for their citizens.

METHODS:
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review synthesises evidence from electronic databases; Scopus, African Journal Online, PubMed and ScienceDirect, covering studies from 2000 to 2025. From a pool of 99 journal articles that met the inclusion criteria, 12 were identified as directly relevant.

RESULTS:
The review describes challenges involved in driving the UHC agenda and lessons learned from UHC implementation in African countries, specifically in Rwanda, Ghana, Kenya, South Africa, and Nigeria. Key drivers of reforms, such as healthcare financing reforms and multi-stakeholder initiatives, aimed at strengthening the healthcare system and improving health outcomes, were discussed. Common barriers to UHC in selected sub-Saharan African countries: structural, financial, political, and social factors were described.

CONCLUSIONS:
This paper supports policy reforms and decision-making towards universal health coverage, attainment, and sustainability in Sub-Saharan Africa.