 This scoping review provides a comprehensive overview of the various formal responsiveness mechanisms mandated in national and provincial policies and guidelines in the western Cape province of South Africa. It examined the regulatory environment, evidence available on the functionality of these mechanisms and how they can be used to improve responsiveness in the healthcare system. The findings suggest that while some of these mechanisms are working effectively, there are still many barriers to overcome, such as resource and capacity constraints, unclear roles and responsibilities, and a lack of synergy between different mechanisms. Furthermore, there is no clear strategy for improving responsiveness at the system level. This article was authored by Tammy Southerns and Jill Olivier.