Essential Features for LMICs

In 2017, the World Health Organization (WHO) in collaboration with the International Society for Prosthetics and Orthotics (ISPO) published the WHO standards for prosthetics and orthotics (P&O) for countries to use in developing or strengthening high-quality, affordable P&O services. 138 The report recommends the evaluation of suitability from three key aspects: 1) user acceptance, 2) economic viability, and 3) technical adequacy.

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Table 41: WHO standards for prosthetics and orthotics (P&O): recommendation on prosthetics technology selection

Criteria for determining the appropriateness of prosthetic and orthotic technologies, components, materials and working methods

1. User-related criteria – Products should:
   • Be comfortable, with a well-adapted interface between the body segment and the device
   • Be functional
   • Be easy to put on and remove
   • Not endanger user safety
   • Be durable
   • Have the best possible cosmetic appearance (e.g. Shape, finish, colour)
   • Be biocompatible (for example, not provoke allergic reactions)
   • Not be too heavy (in most cases, they should be light)
   • Be acceptable by and adaptable to most users, i.e., they should also:
     • Suit the user’s needs
     • Be culturally appropriate, and thus respecting the culture and lifestyle of individuals, which may include such aspects as walking barefoot, squatting and sitting cross-legged
     • Suit the climate (and, if necessary, be resistant to humid, wet conditions)
     • Suit the local terrain, and
     • Suit local working conditions
2. Economic criteria

   Products should be affordable by the system and/or the individual.

   • Technologies should be cost-effective and they should be:
   • Clinically effective
   • Allow for rationalization of production methods and swift fabrication
   • Not require many tools and machines or very advanced, expensive equipment
   • Require low service maintenance
   • Generate minimum waste, and
   • Made of readily available components and materials (on the local market and imported).

   Technologies should promote sustainable development by enhancing local entrepreneurship and making use of local markets, such as locally produced components or materials.

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3. Technical criteria
   • Technologies and working methods should be of proven, documented efficacy and safety.
   • Technologies and working methods should adhere to international standards.
   • Technologies should ensure biomechanically correct products that can be given proper alignment.
   • Products should be durable and have a long lifespan.
   • Products should be easily adjusted, maintained, and repaired (as far as possible by the users themselves).
   • Prosthetists and orthotists should have sufficient skill and knowledge to apply technologies and working methods; if this is not the case, training must be practically feasible and affordable.
   • Working methods should not be hazardous to personnel.
   • Materials should be easy to store.

Note: The priority of these criteria may vary according to the setting, but all should be considered.

Source: WHO Standards for Prosthetics and Orthotics, Part 2: Implementation Manual, 2017, https://iris.who.int/ bitstream/handle/10665/259209/9789241512480-part2-eng.pdf?sequence=2&isAllowed=y