Highlights•Public-patient engagement is crucial for health and health systems improvement but lacking evidence synthesis in Sub-Saharan Africa.•Enhancing engagement requires identifying key barriers and facilitators to PPE implementation.•Barriers and facilitators of PPE in Sub-Saharan Africa largely differ from one health system level to another.•Adopting context-specific approaches at all health system levels rather than a one-size-fit-all approach is critical for engagement in the sub-Saharan African context.•Policymakers need to consider individual and community contextual factors that influence PPE for effective implementation.