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Designing a pathway that no woman falls through.

On 4 March, partners from across clinical care, public health, diagnostics, government, and research gathered at the School for Data Science and Computational Thinking at Stellenbosch University for the SmartPath Roundtable: Architecting an Integrated Care Pathway for Maternal Anaemia.

The six-hour session brought together a deliberately diverse group – clinicians, policymakers, academia, community health leaders, and industry partners – to confront a persistent but preventable challenge: maternal anaemia. Despite being both detectable and treatable, too many women continue to fall through the gaps between screening, diagnosis, and care.

SmartPath, a collaborative initiative developed through the African STARS Fellowship at CERI by fellows Fezokuhle Khumalo, Joel Alukwe and Harries Molepo, seeks to address exactly this problem – not by introducing a single intervention, but by redesigning the entire pathway of care.

As Alukwe explains, the idea evolved quickly beyond its initial scope: “By the time a woman needs IV iron, the system has already failed her multiple times. That pushed us to rethink everything – to go earlier, and build one connected pathway from awareness through to treatment.”

 

Structuring the Conversation: From Problem to Pathway

The roundtable was designed not as a series of presentations, but as a working session.

The morning opened with framing discussions on the burden of iron deficiency and the SmartPath model, before moving into a multidisciplinary panel focused on a central question: why is the current system failing women – and what would it take to fix it?

What emerged quickly was a shared recognition that maternal anaemia is not a single-point failure, but a system-wide breakdown. “Maternal anaemia is a multi-level problem – it starts early, and frontline healthcare workers are often not trained to recognise the symptoms,” said Prof Vernon Louw, Executive Head of the Department of Medicine at the Faculty of Medicine and Health Sciences, University of Stellenbosch.

Across the panel, participants pointed to gaps at every stage – awareness, detection, monitoring, treatment, and follow-up.

“Iron deficiency develops long before pregnancy, but symptoms are often dismissed as normal,” noted Khumalo. “By the time women are diagnosed, the condition has often progressed.”

 

Where the System Breaks Down

A recurring theme throughout the discussion was that knowledge – or lack of it – sits at the centre of the problem. “The biggest problem is awareness,” said Nomonde Tengwa, Innovation Hub Lead at mothers2mothers. “Mothers are given iron tablets but don’t understand why they are important.”

This gap extends beyond patients. “Community health workers are the first point of care, but if they don’t understand the importance, they can’t communicate it,” she added.

Even communication itself presents challenges. “There isn’t even a word for iron in some languages,” Prof Louw noted, underscoring how deeply structural some of these barriers are.

At the clinical level, the limitations of current diagnostic approaches were also clear. “Haemoglobin testing is widely used, but it misses almost half of iron deficiency cases,” said Prof Louw. This means many women are only identified once anaemia is already advanced – a point echoed across both panel and SmartPath team insights.

 

From Detection to Action

If the problem is fragmentation, the proposed solution is integration. SmartPath is built around a simple but powerful idea: closing the loop – connecting awareness, diagnosis, treatment, and follow-up into a continuous system of care.

“When the loop works, it starts before pregnancy,” explained Khumalo. “From adolescent screening and awareness, through antenatal care, to community monitoring and escalation when needed.”

Central to this model is the role of point-of-care diagnostics. “Point-of-care testing would make a huge difference,” said Prof Louw. “If you can diagnose and act immediately, you don’t lose the patient.”

The current system often requires women to return for results – something many cannot do. “Patients are told to come back, but they don’t – they face long queues and lose a day of work,” he added.

SmartPath instead proposes a shift from a one-time prescription model to a continuous care pathway, supported by community health workers and structured follow-up.

 

Designing for Reality: The Breakout Sessions

In the afternoon, participants moved into breakout groups to stress-test the SmartPath pilot against real-world conditions.

The focus was practical:

• What would make this work in a busy antenatal clinic?
• What evidence would policymakers need?
• How could the model be sustained beyond donor funding?

These discussions surfaced the realities of implementation.

“Primary healthcare is already stretched – integration is key,” said Megan Marais from the Western Cape Department of Health. “If we want real change, we need to build on processes that already work.”

Participants emphasised the need to avoid adding complexity. “We don’t need to reinvent the wheel – we should use the resources we already have,” added Natasha Macey, Medical Advisor from Acino.

This directly shaped SmartPath’s evolving design. “The roundtable pushed us toward a leaner approach,” Harries Molepo noted. “Focusing on only the most essential data and steps, rather than overburdening already stretched systems.”

 

The Challenge of Implementation

While education and awareness were repeatedly highlighted, there was also a strong call to move beyond discussion. “We have the intellectual capacity and willingness in this room to solve this problem,” said Dr Benjamin Botha. “But education alone is not enough – we are at the interface of implementation.”

His conclusion captured a broader sentiment across the room: “Talk is cheap – implementation is what matters.”

Cost and sustainability also emerged as critical considerations. “Point-of-care testing is not yet part of the guidelines – so the question is, who pays?” noted Prof Tulio de Oliveira, Director of the Centre for Epidemic Response and Innovation (CERI).

At the same time, there was recognition that investment upfront could reduce long-term costs, particularly by preventing complications such as postpartum transfusions.

 

Looking Ahead

The immediate next step for SmartPath is the launch of a pilot in selected antenatal clinics, designed to generate evidence on feasibility, acceptability, and impact.

“The goal is to test this in real-world settings,” Harries Molepo explains, “and refine the model before any broader rollout.” If successful, the implications could extend far beyond maternal anaemia. “The core architecture – point-of-care diagnostics, decision support, and structured follow-up – is adaptable,” Molepo notes. “It could be applied to other conditions where care is currently fragmented.”

Ultimately, the SmartPath Roundtable made one thing clear: the challenge is not whether maternal anaemia can be addressed – but whether systems can be designed to do so consistently. Or, as Nomonde Tengwa put it: “We need to ensure the patient truly understands, before she leaves.”

Text: Katrine Anker-Nilssen

News date: 2026-04-08

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