Context. Palliative care should be a component of COVID-19 management to relieve suffering, improve patient outcomes and save cost.Objectives. We aimed to identify and critically appraise the palliative care recommendations within COVID-19 case management guidelines in African countries.Methods. The study employed systematic guideline review design. All guidelines from any country in Africa, of any language, published between December 2019 and June 2020 were retrieved through online search and email to in-country key contacts. We conducted a content analysis of the palliative care recommendations within the guidelines and appraised the recommendations using African Palliative Care Association standards for providing quality palliative care.Results. We retrieved documents from 29 of 54 African countries. Fifteen documents from 15 countries were included in the final analysis, of which eight countries have identifiable PC recommendations in their COVID-19 management guidelines. Of these eight, only one country (South Sudan) provided comprehensive palliative care recommendations covering the domains of physical, psychological, social and spiritual wellbeing, two (Namibia and Uganda) addressed only physical and psychological wellbeing while the remaining five countries addressed only physical symptom management.Conclusions. Comprehensive palliative care which addresses physical, psychological, social and spiritual concerns must be prioritized within case management guidelines in African countries. J Pain Symptom Manage 2021;61:e17?e23. ? 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.