Improving access to prosthetic services in Western Nepal: a local stakeholder perspective

Abstract

Purpose

Evidence of effective strategies to improve access to assistive technology (AT) like prostheses is limited, especially in rural and remote areas of low- and middle-income countries where unmet needs are the greatest. This study aimed to identify barriers and facilitators to accessing prosthetic services in rural areas of western Nepal and explore strategies to improve access from the perspective of local stakeholders.

Method

Semi-structured interviews were conducted with 13 service providers and consumers. Barriers and facilitators of access were highlighted and potential solutions to overcome access barriers were explored using thematic analysis of transcripts.

Results

Six themes concerning barriers and facilitators arose: awareness and literacy of prosthetic services, attitudes and belief systems, financial supports, geographical access, health system and referral processes, as well as service provider capacity and regulation. Six themes regarding potential solutions were also identified: awareness campaigns, procurement pathways, referral pathways, subsidised and shared costs of AT, professional support networks and development opportunities, as well as task shifting and sharing.

Conclusions

While facilitating interventions support access to prosthetic services, they remain insufficient to overcome several barriers that continue to inhibit this access. Nevertheless, real opportunities to alleviate barriers and address the unmet need exist and must be explored.

Implications For Rehabilitation

• It is advised that rehabilitation professionals, particularly those delivering prosthetic services in rural and remote settings of Nepal, consider piloting alternative service delivery strategies which utilise resources accessible to them in order to overcome several existing barriers to AT access e.g., task shifting.

• Rehabilitation professionals in Nepal have the opportunity to support others working in low-resources settings to expand professional development opportunities through online and digital platforms.

• Gathering and sharing data on the current state of prosthetic and AT service delivery within Nepal is highly valuable to the development of the prosthetic rehabilitation profession and ultimately equity in access to appropriate AT.

• Proposed interventions identified within this study can potentially serve to guide stakeholders in rural and remote settings of other LMICs in developing strategies to overcome barriers to AT access suitable to their context.

Keywords:

• Disability
• assistive technology
• accessibility
• prosthetics
• rural health

Acknowledgements

The authors wish to acknowledge Dr Manjula Marella of the Nossal Institute for Global Health for her support in reviewing the manuscript and providing her expertise in disability inclusion, The Oda Foundation, Kalikot, Nepal and the Prosthetic and Orthotic Society of Nepal for coordinating KIIs, and Dipa Baral for providing translations services during KIIs.

Author contribution

Conceptualisation, M.F. and W.P.; methodology, W.P.; formal analysis, M.F. and W.P.; investigation, M.F.; data curation, M.F.; writing – original draft preparation, M.F.; writing – review and editing, M.F., Y.N., and W.P.; supervision, W.P. All authors have read and agreed to the published version of the manuscript.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

This research received no external funding.