This review examines the presence, concentrations, and implications of pharmaceutical products in hospital wastewater across Africa. A systematic literature search was conducted to identify relevant studies published between 2000 and 2024. The review highlights the prevalence of various pharmaceuticals including antibiotics, analgesics, antiretrovirals, and other commonly prescribed medications in hospital effluents. Concentrations of these compounds vary widely across different regions and pharmaceutical classes, with some reaching levels of potential environmental concern. The review discusses the geographical distribution of studies, comparing findings with global data and exploring the unique challenges faced in the African context. Limited wastewater treatment infrastructure, inadequate regulatory frameworks, and the lack of routine monitoring emerge as key challenges. Environmental and health implications, including the potential for antimicrobial resistance and ecological impacts, are critically examined. The review underscores the need for more comprehensive studies across the continent, improved treatment technologies adapted to local conditions, and stronger policies to address this growing environmental and public health concern in Africa. Recommendations for future research, policy development, and practical interventions are provided to guide efforts in mitigating the impact of pharmaceutical contamination in African hospital wastewater.