# Implementation strategies and economic considerations for point-of-care ultrasound in Low- and Middle-Income Countries: A scoping review

## TL;DR

This review explores how point-of-care ultrasound can be effectively and affordably implemented in low- and middle-income countries.

## Contribution

The study provides a synthesis of implementation strategies and economic evaluations for POCUS in low- and middle-income countries.

## Key findings

- Successful strategies include thorough planning, stakeholder collaboration, and expanded training.
- Common barriers include limited infrastructure and equipment shortages.
- Economic evaluations show potential cost savings but require more comprehensive assessments.

## Abstract

Point-of-care ultrasound (POCUS) is increasingly adopted as a diagnostic tool in low- and middle-income countries due to its accessibility and comparatively low costs. This review aims to synthesise successful implementation strategies for POCUS and evaluate existing literature on its associated cost implications. We conducted a scoping review following recommendations of the Joanna Briggs Institute’s manual for evidence synthesis and the PRISMA-Scoping review guidelines. The search included five databases (PubMed, Ovid Medline, Embase, Cochrane Library and CINAHL) identifying original research published before 30th of April 2025 addressing POCUS implementation or economic evaluation in low- and middle-income countries. The Consolidated Framework for Implementation Research and the associated Expert Recommendation for Implementation Change (CFIR-ERIC) matching tool were applied to assess implementation strategies which improve implementation processes. Six studies focusing on implementation strategies were identified, five of which were conducted in sub-Saharan Africa. An additional six economic evaluations were included, mainly from Africa and South Asia. Implementation studies were primarily small-scale, single-country interventions with infrequent use of needs assessments prior to implementation and limited long-term follow-up. Common barriers included limited infrastructure, equipment shortages and delays in delivering intervention services. The CFIR–ERIC tool identified supportive strategies such as thorough planning, close collaborations involving several stakeholders, expanded training efforts and infrastructure, and continuous re-evaluations of interventions. Economic evaluations were methodologically diverse, often indication-specific and focused on cost analysis. Evidence on POCUS implementation and economic evaluation in low- and middle-income countries was diverse. Strategies such as thorough planning, close and equitable partnerships, and continuous re-evaluation and adaptation of interventions were identified as supportive of successful implementation. While potential cost savings to health systems have been reported, future efforts should prioritise comprehensive evaluations of POCUS implementation programmes that incorporate patient-centred economic evaluations assessments.