Organisational readiness, facilitators and barriers to the uptake of intravenous iron for the treatment of maternal anaemia in Nigeria: a mixed-methods pre-implementation assessment

BackgroundMaternal anaemia remains a leading cause of maternal morbidity and mortality in low- and middle-income countries (LMICs), with Nigeria bearing a disproportionate burden. Although treatment with intravenous (IV) iron formulations such as ferric carboxymaltose offer clinical advantages over oral iron, their uptake in routine maternal care in LMICs is limited. ObjectiveThis study critically assessed organisational readiness and identified context-specific facilitators and barriers to the adoption of IV iron therapy for maternal anaemia in Nigeria, using a mixed-methods pre-implementation design. MethodsThe study was conducted across six diverse healthcare facilities in Lagos, Nigeria. The validated Organisational Readiness for Implementing Change (ORIC) survey was administered to 74 healthcare providers in the facilities. Qualitative data were collected through 16 key informant interviews and 11 focus group discussions, guided by the Consolidated Framework for Implementation Research. ResultsHigh levels of organisational readiness were observed in the six facilities. Mean ORIC scores were 56.8 for pregnancy and 56.6 for postpartum (maximum score: 60), with no significant differences across facility types or healthcare cadres (p>0.05). Change commitment and change efficacy subscales showed consistently high scores (23.7/25 and 33/35 respectively). Key facilitators included perceived effectiveness of IV iron, relative advantage over other alternatives, compatibility with existing workflows and policies, and strong provider motivation. Primary barriers were cost concerns beyond the project period, risk of side effects, infrastructure and resource limitations, and low patient awareness. The facilitators identified in this study appeared to buffer against structural barriers, maintaining high readiness despite resource constraints. ConclusionNigerian health facilities demonstrate substantial organisational readiness to adopt IV iron for maternal anaemia. Strategic implementation planning--addressing cost, infrastructure, and education will be critical to translating readiness into sustained practice. These findings offer transferable insights for scaling maternal health innovations in resource-constrained settings and contribute to global implementation science.