Publication:

Barriers and enablers to implementing point-of-care testing for anaemia diagnosis in pregnancy among healthcare workers in North Goa, India

Globally one fifth of the world’s population is affected by anaemia, with pregnant women being among the worst affected. In India, including Goa, anaemia prevalence among pregnant women has worsened per national family health survey (NFHS-5), prompting the launch of the Anaemia Mukt Bharat program. One key intervention was the provision of digital hemoglobinometers at sub-centres for point-of-care testing (POCT). Despite investments, implementation of POCT for anaemia diagnosis among pregnant women in Goa remains limited. This descriptive qualitative study was conducted in sub-centres of North Goa equipped with digital hemoglobinometers to understand enablers and barriers to POCT implementation. From December 2023 to April 2024, 11 in-depth interviews were conducted with healthcare workers and a state program officer. Data was analysed using thematic analysis guided by the consolidated framework for implementation research (CFIR). Three key enablers were identified: availability and benefits of digital hemoglobinometers, decentralized procurement, and strengthened health information systems. Healthcare workers valued the POCT devices for their ease of use and portability. However, barriers included staffing shortages, inconsistent supply of consumables, technical malfunctions, and limited opportunities for testing due to low patient follow-up. The lack of formal training and quality assurance also affects implementation. Digital hemoglobinometers have simplified anaemia testing at sub-centres, but administrative, logistical, and technical barriers hinder effective implementation. Addressing these challenges through consistent supply chains, formal training, and quality assurance can improve the utilization of POCT for diagnosing anaemia in pregnant women. Strengthening follow-up care and routine haemoglobin testing during antenatal visits is vital to reduce anaemia among this vulnerable population.