Health service readiness for implementing the National Sickle Cell Anaemia Elimination Mission in Chamarajanagar District, Karnataka, India: a cross-sectional mixed-methods protocol.

INTRODUCTION: Sickle cell disease (SCD) remains a major public health challenge in India, disproportionately affecting tribal populations. In 2023, the Government of India launched the National Sickle Cell Anaemia Elimination Mission (NSCAEM) to strengthen screening, diagnosis and long-term care. However, evidence on the readiness of health facilities to implement SCD-specific services under NSCAEM is limited, particularly in tribal and resource-constrained settings. This protocol outlines a systematic assessment of health-system readiness for NSCAEM implementation in a predominantly tribal district of Karnataka. METHODS AND ANALYSIS: This study will adopt a cross-sectional, facility-based, mixed-methods design in Chamarajanagar District, Karnataka, conducted between September 2024 and March 2027. All public health facilities involved in SCD screening, diagnosis, referral or management, across primary, secondary and tertiary levels, will be included. Quantitative data will be collected using an adapted WHO Service Availability and Readiness Assessment toolkit, incorporating indicators for SCD diagnostics, medicines, emergency care, counselling and referral systems. The adapted toolkit was developed through expert consultation and piloted at four facilities. Readiness will be assessed using tracer indicators and summarised through domain-specific scores and a composite Service Readiness Index, with a planned sensitivity analysis comparing equal-weighted and expert-weighted domain scores. Qualitative data will be collected through approximately 15-20 key informant interviews and a stakeholder validation workshop to contextualise quantitative findings and explore implementation challenges. Descriptive and comparative analyses will be undertaken, with triangulation of quantitative and qualitative results. ETHICS AND DISSEMINATION: Ethical approval for this study has been obtained from the Institutional Ethics Committee of JSS Academy of Higher Education and Research, Mysuru, Karnataka (Reference: JSS/MC/PG/217/2024-25). Findings will be disseminated through policy briefs to district and state health authorities, stakeholder workshops, community forums and peer-reviewed open-access publications.