Transforming thalassaemia care in India through virtual capacity building: Evolution of a national training initiative using extension for community healthcare outcomes model

BACKGROUND AND OBJECTIVES: India has one of the world's highest burdens of thalassaemia, with 10,000-15,000 births annually and a carrier prevalence of 3%-4%. Services for prevention and comprehensive care remain fragmented, especially in rural regions. To address gaps in provider knowledge and practice, Extension for Community Healthcare Outcomes (ECHO) India, in collaboration with the Post Graduate Institute of Child Health and state partners, launched a virtual tele-mentoring programme in Maharashtra, Madhya Pradesh and West Bengal. MATERIALS AND METHODS: We conducted a mixed-methods evaluation using a convergent parallel design. Data included pre- and post-training knowledge assessments, post-session feedback surveys and hub reflection meetings. A logical model and Moore's framework guided outcome assessment across participation, satisfaction, knowledge, competence and reported changes in practice. RESULTS: Following a national training-of-trainers workshop in April 2023, state hubs were established and peer-reviewed modules developed. From October 2023 to March 2025, 73 ECHO sessions were conducted across the three state hubs, with curricula tailored to different participant groups (eight modules for medical officers and six for paediatricians). Paediatricians showed a mean knowledge gain of 15.8% (p < 0.001) and medical officers 11.4% (p = 0.001). Over 70% rated sessions highly relevant, and over 90% intended to apply learning. Reported behaviour changes included improved interpretation of complete blood counts, more systematic referral and promotion of antenatal screening. CONCLUSION: This first multicentre evaluation demonstrates that ECHO tele-mentoring strengthens thalassaemia care in India, improving provider competence and catalysing systemic and policy-level change. The model is scalable for integration into primary health systems across low- and middle-income countries.