Guides Tackle Challenges Facing O&P Services

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The state of prosthetics and orthotics services is in serious need of attention in low-income countries, where the services have remained in a stagnant or declining condition for years. This fact is no secret, and the issue was examined at length in a comprehensive, multi-year study that involved 35 national and international organizations connected to O&P services.

Endorsed by the International Society for Prosthetics and Orthotics (ISPO) and financed and facilitated by Landmine Survivors Network (LSN), United Nations Mine Action Service (UNMAS), and the Swiss Agency for Development & Cooperation (SDC), the Prosthetics and Orthotics Program Guide and Project Guide were designed to lay out a "common approach for organizations implementing aid projects--a summary of good practices built for the service user so that the maximum number of persons can access P&O services," according to the guide's authors.

The Program Guide outlines 54 features deemed as keys for the condition of long-term, sustainable, and efficient services, as well as external factors that directly influence the success of a service provision. As detailed by the authors, the Program Guide was based on the following points:

  • The overall goal of an O&P program is to enable the full and effective participation and inclusion in society by persons with disabilities--a basic human right.
  • O&P programs must work closely with other rehabilitation services in an integrated and holistic approach to disability in order to achieve the previous point.
  • O&P programs must be built for and around the service user, who must be consulted in the different phases of planning and running of services. The service user also must have a role in the monitoring and evaluation of these programs.
  • O&P programs must be planned so the maximum number of persons can access O&P devices of acceptable quality.

"This was a highly collaborative and consultative effort," said LSN Director of Rights and Advocacy Kirsten Young from Geneva, Switzerland. Until recently, there had been a lack of significant collaborative planning among the key organizations on an international level." The guides were launched in April 2007 at a presentation supported by the International Committee of the Red Cross (ICRC) on behalf of LSN.

O&P Donations Find a New Home

Clearinghouse to provide a one-stop giving and receiving venue for prosthetic and orthotic donations.

The United States National Member Society of the International Society for Prosthetics and Orthotics (U.S. ISPO) and MedShare International have partnered to establish the Prosthetic & Orthotic Componentry Clearinghouse (P.O.C.C., pronounced pahk-see, rhymes with foxy). P.O.C.C. has been created to allow people to make tax-deductible donations for new and clean used prosthetic and orthotic goods while in turn giving access to these components to those providing P&O services to people in need. 

"P.O.C.C. will create a critical mass of components that can then be used to increase their availability to those without access to them otherwise...and be a means for the numerous organizations performing P&O humanitarian outreach to receive severely needed components," says Rob Kistenberg, MPH, CP, FAAOP, chair of U.S. ISPO.

The clearinghouse will use the OPIE system, developed by O&P Digital Technologies, Gainesville, Florida, to keep track of its inventory and shipments. "Utilizing the OPIE web-based inventory system has given us the ability to not only track everything in our inventory, but also to partner with nongovernmental organizations (NGOs) across the country so that they too can contribute and gain access to P.O.C.C.," Kistenberg adds.

The P.O.C.C. project is working in conjunction with the Barr Foundation, the MSPO Program in the School of Applied Physiology at the Georgia Institute of Technology (Georgia Tech), O&P Digital Technologies, and the Digital Resource Foundation for Orthotics and Prosthetics (DRFOP). "It is anticipated that more organizations will become a part of P.O.C.C. as the program grows," Kistenberg said.

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Key issues and challenges noted in the guides included national ownership; the ability to sustain services; a lack of political will needed to affect change; and a lack of donor support.

The guides' authors state that these are working documents and do not claim to be complete. "There needs to be evidence-based sections," Young said. "The guides are a holistic approach to what a program should look like... They are not guidelines; they are a way of thinking, a way to approach a project without thinking of it as just a checklist." A questionnaire will be distributed in the spring of 2008 to those involved with new and fledgling programs to see how the documents were used.

The authors advise that the guides, which are aimed to stimulate discussion of the state of O&P services in low-income countries, be used by O&P organizations and agencies implementing programs as a reference for setting goals, training staff, defining strategies, and as a tool for discussions with the government and other partners.

The Project Guide presents ideas for "time-limited" plans intended to offer support to the permanent features outlined in the Program Guide . For example, the project "must make sure that the local P&O programs are built on, and well-integrated into, a country's infrastructure. Supporting organizations need to see their projects through the perspective of the local program," according to a presentation by Claude Tardif of the ICRC.

Included among the 35 organizations and agencies involved with the collaborative effort was the United Nations Children's Fund (UNICEF); World Health Organization (WHO); Center for International Rehabilitation (CIR); Mercy Ships; and Veterans for America (VFA), formerly the Vietnam Veterans of America Foundation. The guides have been translated into Spanish and French, and an Arabic version will following pending funding.

To view the Program Guide and Project Guide visit