Biophotonics point-of-care diagnostics in low-resource settings: a South African perspective

Point-of-care (POC) diagnostics based on photonics and biophotonics technologies hold transformative potential for healthcare delivery in peri-urban and underdeveloped settings, combining optical sensitivity with portability, rapid readout, and minimal consumable requirements.

We aim to synthesize design considerations and recent advances that align photonics-based POC devices with the World Health Organization's ASSURED/REASSURED framework, emphasizing affordability, sensitivity, ease of use, rapidity, robustness, equipment-free operation where possible, deliverability, and the added priorities of real-time connectivity and environmental sustainability.

We examine implementation evidence from sub-Saharan Africa, highlighting gaps in field validation, quality assurance, and sustainability identified by recent scoping reviews, as well as the persistent need for context-adapted usability and training strategies. Advances covered include miniaturized optical biosensors (fluorescence, Raman, and photothermal modalities), smartphone-integrated microscopy and spectroscopy, low-cost LASER/LED illumination systems, and multiplexed lateral-flow/optical hybrids, all tailored for low-resource constraints.

We discuss how digitization and connected diagnostics (including data standards, mobile health integration, and secure cloud reporting) amplify clinical impact, enable surveillance, and support task-shifting in primary care, aligning with South Africa's National Digital Health Strategy. We also survey regional innovation capacity, with examples of locally focused development and prototyping that demonstrate pathways to regional manufacturing and deployment.

We conclude with recommendations for regulatory-science partnerships, human-centred design, interoperable digital pipelines, and investment in field-based validation and manufacturing to translate photonics innovations into resilient, equitable POC solutions across South Africa and the wider sub-Saharan context.