Health systems solutions to prosthetic service delivery obstacles in a low-resource setting

Abstract

Background: Lower limb prostheses improve functioning and quality of life after amputation. The challenges in prosthetic service provision in South Africa have been researched. However, possible solutions have not been explored. Objectives: This article presents obstacles to prosthetic services in the Eastern Cape province of South Africa, and suggests research and development, health systems and clinical care solutions to alleviate these obstacles. Method: Using a pragmatic approach, current evidence, unpublished research, grey sources and author expert opinion are presented in an integrated manner to show the barriers and recommendations for solutions in five key areas that are budget, supply chain and stock barriers, poor continuity of care, insufficient human resource numbers and skills, unrecorded demand for services, and geographical stumbling blocks. Results: Tender documents, ring fencing budgets and appointing professional procurement officers are recommended to address supply chain barriers. Conscientious record keeping and an audit of appointment practices are recommended to enhance continuity of care. Outreach clinics, compulsory community service and skill shifting should be explored in response to geographical barriers and shortage of human resources. Early screening and referral might decrease waiting times. Innovative manufacturing strategies such as 3D printing and direct socket manufacturing should be researched. A database can assist with predicting new device-repair and replacement needs. Conclusion: Prosthetic service delivery is a complex open system, and a systems approach should be followed when implementing any of the suggested solutions. Contribution: The suggested solutions might assist in alleviating the barriers experienced in prosthetic service delivery in low-resourced settings.