Combined heat and power (CHP) in a single and integrated device is concurrent or synchronized production of many sources of usable power, typically electric, as well as thermal. Integrating combined heat and power systems in today’s energy market will address energy scarcity, global warming, as well as energy-saving problems. This review highlights the system design for fuel cell CHP technologies. Key among the components discussed was the type of fuel cell stack capable of generating the maximum performance of the entire system. The type of fuel processor used was also noted to influence the systemic performance coupled with its longevity. Other components equally discussed was the power electronics. The thermal and water management was also noted to have an effect on the overall efficiency of the system. Carbon dioxide emission reduction, reduction of electricity cost and grid independence, were some notable advantages associated with fueling cell combined heat and power systems. Despite these merits, the high initial capital cost is a key factor impeding its commercialization. It is, therefore, imperative that future research activities are geared towards the development of novel, and cheap, materials for the development of the fuel cell, which will transcend into a total reduction of the entire system. Similarly, robust, systemic designs should equally be an active research direction. Other types of fuel aside, hydrogen should equally be explored. Proper risk assessment strategies and documentation will similarly expand and accelerate the commercialization of this novel technology. Finally, public sensitization of the technology will also make its acceptance and possible competition with existing forms of energy generation feasible. The work, in summary, showed that proton exchange membrane fuel cell (PEM fuel cell) operated at a lower temperature-oriented cogeneration has good efficiency, and is very reliable. The critical issue pertaining to these systems has to do with the complication associated with water treatment. This implies that the balance of the plant would be significantly affected; likewise, the purity of the gas is crucial in the performance of the system. An alternative to these systems is the PEM fuel cell systems operated at higher temperatures.