Barriers to Diagnostic Microscopy Competency Development in Sub-Saharan African Health Professions Training: A Scoping Review

This project comprises a scoping review that systematically maps the published evidence on barriers to diagnostic microscopy competency development in health professions training programmes across sub-Saharan Africa (SSA). Accurate light microscopy remains the reference standard for the diagnosis of malaria, haematological disorders, and urinary tract pathology across SSA. However, assessments conducted under the WHO External Competency Assessment of Malaria Microscopists (ECAMM) programme have repeatedly documented that diagnostic error rates among practising microscopists remain unacceptably high, with species misidentification rates of 20-40% and false-negative rates exceeding 15% reported across multiple countries. These competency gaps are increasingly understood to be attributable to structural deficiencies in pre-service training rather than cognitive limitations of individual practitioners. Despite this, no systematic review has comprehensively mapped the specific barriers that constrain microscopy competency development within health professions training institutions in the region. The purpose of this scoping review is to: (1) identify, categorise, and synthesise the barriers to diagnostic microscopy competency development documented in the published literature; (2) map these barriers against the three WHO ECAMM competency domains (parasite detection, species identification, and parasite quantitation); and (3) translate the identified barriers into a functional requirements framework for technology-based microscopy training solutions, particularly virtual microscopy platforms. The review follows the Arksey and O'Malley (2005) scoping review framework, refined by Levac et al. (2010), and is reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Six electronic databases and grey literature sources are searched for studies published between January 2000 and June 2026. Narrative synthesis with thematic analysis is used to categorise barriers and derive the requirements framework. Expected outcomes include: a thematic map of barriers organised by category (equipment, specimens, curriculum, faculty, assessment, practice, standardisation, technology, and funding); a barrier-to-ECAMM domain mapping showing which competency domains are most affected by specific training deficiencies; and an evidence-derived requirements framework specifying the functional characteristics that a virtual microscopy training platform must possess to address the identified barriers. These outputs are intended to inform the design of technology-based interventions for microscopy training in resource-limited settings and to guide future country-level situational analyses of microscopy training infrastructure.