From testing to treatment: a mixed-methods study assessing organisational readiness for intravenous iron for pregnant women with anaemia in Bangladesh

Anaemia affects over one-third of pregnant women in Bangladesh, leading to serious consequences such as maternal death and stillbirth. Yet, only about half of pregnant women are tested for anaemia, and few receive intravenous iron – a fast and effective treatment option. It remains unclear whether health facilities have the resources, and whether health workers are willing and able, to deliver these services. Embedded within a demonstration project, our study aimed to evaluate the organisational readiness of Bangladesh’s primary health care system to provide point-of-care anaemia testing and intravenous iron treatment for pregnant women. We employed a multi-phase, mixed-methods, parallel convergent design. Formative research included a baseline health facility readiness assessment (n=20). In the parallel process evaluation, health workers completed the Organisational Readiness for Implementing Change (ORIC) questionnaire (n=35), and a sample participated in qualitative interviews (n=21). Quantitative data were analysed descriptively, while qualitative data were analysed using inductive thematic analysis. We integrated findings across data sources to provide a comprehensive evaluation. We found high organisational readiness for implementing anaemia testing and intravenous iron treatment, with health workers demonstrating strong commitment and confidence in providing these services to pregnant women. However, sustaining both interventions beyond the demonstration project would require addressing resource constraints, including limited equipment and shortage of nurses and doctors. Ultimately, government support for implementation and resource provision will be essential to ensure the continued delivery of anaemia testing and intravenous iron treatment in Bangladesh’s primary health care system. Findings from our study may help inform government decision-making.