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Background Hand hygiene (HH) is the primary measure in the prevention of health care–associated infections; however, from published studies, compliance of health care workers (HCWs) to HH guidelines is low. There is currently no review on HH compliance rates in developing countries, specifically sub-Saharan Africa (SSA), or the barriers to compliance. We therefore, through a narrative review, sought to identify the compliance with and the barriers to HH in SSA. Methods From 3 databases, we performed a search of peer-reviewed studies from SSA, conducted among HCWs, published in the English language between 2005 and 2017. Only studies that reported HH compliance and/or barriers were included. Results A total of 278 articles were identified, and the final sample of 27 articles was analyzed in full length. Overall, the HH compliance rate was estimated to be 21.1%, and doctors had better compliance irrespective of the type of patient contact. The main barriers identified were heavy workload, infrastructural deficit (eg, lack of water, soap, hand sanitizers, and blocked/leaking sinks), and poorly positioned facilities. Conclusions HH compliance is poor among SSA HCWs. There is a need for more reports of HH compliance in SSA, and emphasis needs to be placed on surgical wards in which surgical site infections—the most common form of health care—associated infections in SSA—are most likely to occur. Barriers identified in this review are consistent with the findings of studies conducted elsewhere; however, it appears that heavy workload, infrastructural deficit, and poorly positioned facilities are more likely in developing countries.