Annexes

Benson Kiptum

Joseph Gakunga

Gladys Koech

Seith Simiyu

Nelson Muoki

Michael Mbote

Dr. Nils-Odd Tonneyold

Dieter Juptner

Jean-Pascal Hons-Olivier

Sandra Sexton

Friedbert Kohler

Claude Tardif

Elena Morozova

Mohamed Bassiouny

Jerry Evans

Matt Rato

Prosthetist/Orthotist

Clinician

Formerly: Category I Prosthetist/ Orthotist

Clinical Services: clinical assessment, prescription, technical design, fabrication, and fitting of devices; monitoring outcomes.

Leadership: management of service units; advance models and/or methods of service delivery by integrating best available evidence, or new technologies; supervising and training clinical and non-clinical personnel; participation in community-based rehabilitation; advocacy for P&O services and professionals in professional organisations and government agencies.

Training, education, community demonstrations, awareness-building.

4 years of full-time study at university level. Curriculum includes: practical techniques for fitting/fabrication techniques across a wide range of prosthetic-orthotic device types.

Theoretical topics: clinical conditions, anatomy, physiology, pathologies, biomechanics, materials technology.

Clinic management: leading clinical teams, inventory management, budget management, training and supervision, occupational hazards, ethical code, research methods.

5-10 prosthetist/orthotist clinicians per million; though in HICs, it is usually 15-20 per million.

Each service point should have at least one qualified clinician, ideally Category I Prosthetist/Orthotist or an experienced Associate Prosthetist/Orthotist).

Each clinician can be expected to provide complete services to 300-600 users per year.

Prosthetist/Orthotist Technician

Non-Clinician

Formerly: Category III Prosthetic/Orthotic Technician/Bench Worker

Non-clinical services: Support (Associate) Prosthetists/Orthotists in device fabrication, assembly, maintenance, and repair. Expertise in material science, technical procedures, and safe practices, but does not have clinical contact with users (i.e. making fitting adjustments or alignments).

Not involved in direct services to the user. However, in LMICs, lack of capacity often means Prosthetist/Orthotist Technicians are also directly working with patients, typically under the guidance of a Prosthetist/Orthotist / Associate Prosthetist/Orthotist.

2 years of formal structured or 4 years of on the job/in-house training.

Curriculum includes practical technical training and basic understanding of material science and safety procedures.

Each clinician should be supported by 2 non-clinicians; thus 10-20 non-clinicians are needed per million.

In decentralised units with a shortage of clinicians, increasing the ratio of non-clinicians can effectively extend the service team.

ICRC

Switzerland

www.blogs.icrc.org/inspired/2019/05/05/affordable-feet-icrc-agilis-prostheses

LegWorks

USA

www.legworks.com

ICRC

Switzerland

www.icrc.org/en/doc/assets/files/other/icrc-002-0913.pdf

BMVSS offers free prosthetic devices through a broad network of service points across India and through partners in other countries. All users are fitted within one day.

Supported by private and public donors, including the Ministry of External Affairs of the Government of India.

In 1993, ICRC developed a low-cost polypropylene prosthetics solution, which won the ISPO Blatchford Prize for innovation because of its suitability for deployment in LMICs.

Until 2019, it was supplied by Swiss-based CR Equipment. In 2019, ICRC has switched to Alfaset, a non-profit arm of manufacturer Rehab Impulse, also Swiss-based.

ICRC’s prosthetic solution is deployed in ICRC-supported rehabilitation centres, as well as being available for purchase by other providers and service centres.

BMVSS centrally manufactures partially formed prosthetic limbs and other components in its manufacturing centre in Jaipur, India. The intermediary product, made from rubber and polypropylene, is then heated and formed into the final prosthetic device at the site of fitting. The device features a low-cost non-articulated foot and shank. It cost USD 50 to produce.

BMVSS’s Jaipur Foot component revolutionised foot componentry when it was released because it was low-cost, had a flexible keel and was able to be used appropriately in an Indian context (permitted squatting, cross-legged sitting, and used with sandals). The overall Jaipur lower-limb solution is shown to be unsatisfactory biomechanically, but continues to be deployed because of the low cost.

HI does not produce its own components and deploys modular components from a range of international suppliers. In partnership with Proteor, HI has developed an emergency prosthetic limb that can be fitted to any user to enable temporary mobility in conflict zones.

HI has also been conducting implementation research in the digital fabrication of orthotics and prosthetic sockets, testing for acceptability, cost-effectiveness of these technologies in various LMIC settings.

500 Miles

(Est. 2007)

www.500miles.co.uk

• Sponsors the training and accreditation of 18 prosthetists/orthotists.

• Offers free P&O services and devices at the Kamuzu central hospital in Lilongwe as well as through community outreach services.

• Provide funds to users who have to travel for transport and accommodation.

• Funding comes from government, and support from other local partners and donors.

• Has fitted over 3,500 users.

• Sponsored the training and accreditation of 18 prosthetists/orthotists at ISPO-accredited training schools.

CURE

(Est. 1996)

www.cure.org

• International Christian FBO.

• Establishes and operates orthopaedic paediatric charitable hospitals, and offers a full range of care from surgical treatment to rehabilitation and fitting of mobility devices.

• Specialised programmes focused on birth defects and neuro-orthopaedic disorders such as club foot, spina bifida and hydrocephalus.

• Although medical and surgical interventions are provided free of charge, mobility devices are typically paid for OOP.

• Performed over 213K orthopaedic operations on paediatric patients.

Puspadi Bali

(Est. 1999)

www.puspadibali.org

• Non-profit organisation that focuses on providing mobility devices and rehabilitation services to persons with disability.

• Services include outreach to remote islands to identify and refer amputees and build awareness, production of lower limb P&O devices, provision of wheelchairs, and advocacy for policy reform at local and national levels.

• P&O devices are provided free of charge.

• Provide services to 580 people every year, 400 of which are for P&O devices: 160 TF, 100 TT, and repair for ~200 users).

• Around 65% of the 20 staff are physically-disabled.

Range of Motion Project

(Est. 2005)

www.rompglobal.org

• Non-profit organisation that provides support to develop local capacity (training prosthetists and local manufacturing), providing medical care to those with physical disability, and developing and deploying innovative prosthetic technologies.

• Engages in advocacy and awareness-building activities.

• 9,249 patient visits, with 3,345 devices delivered since establishment.

Amparo

(Est. 2014)

Germany

www.amparo.world

• Commercially available in Europe, North America and Asia.

• Acceptability pilot/clinical trial in Kenya: results expected in 2020.

Prosfit

(Est. 2013)

Bulgaria

www.prosfit.com

• Commercially available globally.

• Sockets meet ISO standards and are regulated as medical devices in Europe, Australia, and Singapore

• Clinical investigation conducted in 2015.

• Clinical trials in Syria, Togo, and Madagascar in 2016 showed viability of solution and to improve prosthetist productivity; albeit cost of 3D printing is much higher than traditional socket fabrication methods and not yet economically feasible.

• Trial in Middle East in 2018-2019 combined telehealth approaches and PandoFit that enabled task-shifting to local physiotherapists to fit 40 amputees in a challenging environment.

• Prosfit is launching a capacity building project in East Africa that offers training on the PandoFit solution, infrastructure development, tele-health, data collection, and policy recommendations. First phase is estimated to fit 200-250 users and will cost EUR 0.5-EUR 1 million.