Despite decades of healthcare provider training and investment, rates of utilization and capacity to appropriately plot the partograph and use it to make critical decisions remain sub-optimal in Sub-Saharan Africa. The objective of this review was to synthesize evidence of existing challenges and opportunities of partograph utilization in labor monitoring in Sub-Saharan Africa from existing literature. PUBMED, Cochrane Library of Trials, Google Scholar, and ScienceDirect databases published between January 1, 2013, and July 31, 2023, for studies reporting opportunities and challenges of utilizing the partograph in labor monitoring in Sub-Saharan Africa, were searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the identification of eligible studies. We utilized a Consolidated Framework for Implementation Research to interpret findings. The review protocol was registered under PROSPERO-CRD42023452882. Twenty-eight high-quality studies identified from a total of 452 in eight countries in Sub-Saharan Africa were analyzed in this review. Opportunities identified included 1) the partograph's uncontested potential to reduce maternal and neonatal mortality facilitated by good support supervision, formal and on-the-job training, active mentorships, and ongoing supervision, and the availability of enabling policies, standards, and protocols on partograph use; 2) the availability of partographs in health facilities. Gaps and challenges identified included 1) lack of inadequate training and tool complexity, 2) availability of different labor monitoring tools other than the partograph, 3) lack of motivation and feedback, 4) unavailability of the partograph in some health facilities, 5) shortage of staff in busy facilities, 6) lack of support supervision, 7) lack of protocols, 8) inappropriate motivation leading to 9) lack of commitment, negative attitude, negligence, careless partograph completion, or non-use. The challenges, opportunities, and lessons learned from this review on partograph utilization in labor monitoring will help develop suitable implementation strategies to guide the introduction and scale-up of the labor care guide in Sub-Saharan Africa if we are to avoid similar challenges.