The Exceed Research Network has marked its 10th anniversary with a new position paper calling for a more coordinated, context-aware and systems-based approach to global prosthetic and orthotic service provision.
The paper, titled Provision of Global Prosthetics and Orthotics Services: A Position Paper on Systems, Context, and Pathways for Shaping Collaborative Progress, is presented as more than a review of P&O services. It is a call for action for clinicians, researchers, engineers, educators, service providers, policymakers, funders and user communities working to improve access to prosthetic and orthotic care worldwide.
For the IMEA region, the message is highly relevant. Across the Middle East, Africa and many low- and middle-income settings, prosthetic and orthotic access is shaped not only by clinical skill or device availability, but by workforce capacity, service models, financing, regulation, trade, culture, data, policy and long-term sustainability.
The paper’s central message is clear: innovation alone is not enough.
What is the Exceed Research Network?
The Exceed Research Network is an international and interdisciplinary research network focused on improving prosthetic, orthotic and wider rehabilitation service provision, especially in global and resource-limited contexts.
The network brings together clinicians, academics, engineers, educators, service providers and researchers who work across borders to strengthen evidence, improve service models and support better outcomes for people who use prosthetic and orthotic devices.
Its work is closely aligned with the wider global movement to improve access to rehabilitation and assistive technology. This includes the goals of organisations such as the World Health Organization, the International Society for Prosthetics and Orthotics, ATscale, the Global Partnership for Assistive Technology, GAATO, the Global Alliance of Assistive Technology Organizations, and education-focused organisations such as Human Study e.V..
The Exceed Research Network is important because it does not look at P&O services only through the lens of products or technology. Instead, it examines the full system around the user: education, workforce, clinical practice, service delivery, regulation, financing, evidence, context and lived experience.
That systems perspective is particularly important for countries where P&O services are still developing, fragmented, underfunded or dependent on imported components and short-term projects.
Why the paper matters for IMEA
For IMEA CPO readers, the position paper arrives at an important time.
Across the region, demand for prosthetic and orthotic services is being driven by multiple factors, including trauma, conflict-related injury, diabetes, stroke, congenital conditions, road traffic accidents, paediatric disability, ageing populations and the growing recognition of rehabilitation as an essential health service.
Yet access remains uneven. In some countries, services are concentrated in capital cities. In others, public hospitals, military rehabilitation centres, NGOs, humanitarian organisations, private clinics and charitable providers work in parallel, often with different standards, funding models and component supply chains.
The Exceed Research Network paper highlights that improving global P&O access requires action across several connected areas:
- Strengthening local education and workforce development
- Building sustainable and integrated service models
- Supporting appropriate technology pathways
- Addressing regulatory, procurement and trade barriers
- Investing in collaborative and user-engaged research
- Keeping cultural context, equity and sustainability central to policy and practice
This is a useful framework for the IMEA region because it recognises that a prosthetic or orthotic device is never just a product. It is part of a long-term rehabilitation pathway that includes assessment, prescription, fabrication, fitting, training, follow-up, repair, replacement and user support.
Nachiappan Chockalingam and the role of clinical biomechanics
Among the co-authors and contributors associated with the position paper is Professor Nachiappan Chockalingam, widely known as Nachi Chockalingam, a clinical scientist and biomedical engineer recognised for his work in clinical biomechanics, assistive technology, rehabilitation research and global P&O policy.
Professor Chockalingam’s background is particularly relevant to the themes of the paper. His work has connected biomechanics, medical engineering, diabetic foot research, footwear science, allied health research, telehealth, assistive technology and rehabilitation systems. He has also been involved in global assistive technology work and has contributed to the development of the WHO Standards for Prosthetics and Orthotics.
For IMEA readers, his contribution reflects an important shift in the profession: prosthetics and orthotics increasingly require collaboration between clinical practice, engineering, biomechanics, education, public health and policy.
This is especially important in settings where clinicians and technicians must make complex decisions with limited resources. A device must be biomechanically appropriate, clinically safe, culturally acceptable, affordable, maintainable and realistic within the local service environment.
Why innovation alone is not enough
The paper’s message that “innovation alone is not enough” is especially important in today’s P&O landscape.
Digital scanning, CAD-CAM, 3D printing, microprocessor components, advanced materials and artificial intelligence are becoming increasingly visible across prosthetics and orthotics. These technologies may improve access, efficiency, documentation and customisation when used well.
However, they cannot replace the need for skilled CPOs, trained technicians, appropriate clinical pathways, service funding, outcome measurement and long-term follow-up.
For example, a 3D-printed orthosis may fail if the clinician has not assessed the patient properly. A digitally designed socket may not improve outcomes if local repair services are unavailable. A high-end prosthetic component may be inappropriate if the user cannot access maintenance, replacement parts or follow-up care.
Appropriate technology must therefore be judged by more than novelty. It must be judged by whether it improves real outcomes in the context where it is used.
For IMEA service providers, this means asking practical questions:
- Is the technology clinically appropriate for the user?
- Can local staff be trained to use and maintain it?
- Are materials and spare parts available?
- Is the cost sustainable beyond a pilot project?
- Does the service model include follow-up and repair?
- Is the technology suitable for local terrain, climate, footwear, work and culture?
- Are users involved in design and evaluation?
This is where the Exceed Research Network’s systems approach becomes valuable.
Workforce development must remain the foundation
One of the paper’s most important priorities is local education and workforce development.
In prosthetics and orthotics, workforce capacity is not simply a staffing issue. It directly determines whether people receive safe, effective and timely care. Without trained professionals, even the best components and technologies cannot deliver reliable outcomes.
Many countries in the IMEA region still face shortages of prosthetists, orthotists and trained technicians. Some rely on expatriate staff, visiting missions or donor-supported programmes. Others have strong clinical teams but limited access to continuing professional development, postgraduate education, modern fabrication systems or professional recognition.
A stronger workforce agenda should include:
- Accredited local P&O education
- Technician training and career pathways
- Continuing professional development
- Clinical mentorship and supervision
- Regional training partnerships
- Recognition of P&O within national health systems
- Collaboration between universities, rehabilitation hospitals and service providers
- Research opportunities for clinicians and technicians
This is also where networks such as the Exceed Research Network can make an important contribution. By connecting global researchers, educators and clinicians, they can support evidence sharing, capacity building and collaborative problem-solving.
Service models must be sustainable and integrated
Another major theme is the need for sustainable and integrated service models.
Many P&O programmes in low-resource settings have historically depended on short-term missions, donations or isolated projects. These can provide immediate benefit, but they may not create lasting service capacity unless they are connected to local systems.
Sustainable P&O service models require:
- Local ownership
- Reliable component supply
- Trained clinical and technical staff
- Transparent funding or reimbursement
- Quality standards
- User follow-up systems
- Repair and maintenance pathways
- Data collection and outcome measurement
- Integration with rehabilitation, primary care and disability services
For people using prosthetic and orthotic devices, sustainability is not an abstract policy term. It determines whether a broken foot can be replaced, whether a child’s orthosis can be adjusted as they grow, whether a socket can be reviewed after weight change, and whether a patient can return for follow-up without travelling for days.
Regulation, procurement and trade barriers affect patient outcomes
The paper also highlights the importance of regulation, trade and policy.
This is a major issue for IMEA countries where many P&O components, materials and tools are imported. Customs delays, high duties, inconsistent classification of assistive products, weak procurement systems or unclear medical device regulation can directly affect patient access.
A delayed prosthetic component means a delayed return to school, work, mobility and independence. A shortage of liners, joints, resins, feet, knees, thermoplastics or orthotic materials can limit what clinicians can prescribe.
Effective regulation should protect users from unsafe or poor-quality products, but it should also support access to essential assistive products. Governments and procurement agencies need to recognise prosthetic and orthotic components as part of essential rehabilitation and assistive technology systems.
This aligns with wider global efforts to improve access to assistive technology through the WHO Assistive Technology agenda and the work of ATscale.
User-engaged research is essential
The Exceed Research Network also calls for collaborative, user-engaged research.
This is vital because many P&O interventions used in low- and middle-income settings are still under-researched in the contexts where they are delivered. Evidence from high-income settings may not fully reflect the realities of rural travel, informal employment, heat, humidity, dust, footwear habits, stigma, gender barriers, family support, conflict displacement or limited follow-up services.
User engagement helps research ask better questions.
For example, a user may judge a device not only by gait parameters, but by whether they can wear it at work, pray comfortably, walk on uneven ground, use public transport, attend school, avoid skin breakdown, manage heat and sweat, or afford repairs.
Research that includes users, families, clinicians, technicians and local service providers is more likely to produce evidence that improves real-world outcomes.
Moving from evidence to action
The 10th anniversary of the Exceed Research Network is an opportunity to reflect on what has been learned, but also to ask what must happen next.
For the global P&O community, the pathway forward should include:
- Stronger national rehabilitation and assistive technology plans
- Workforce investment at clinician and technician levels
- Better links between education, research and service delivery
- Appropriate technology pathways for different resource settings
- More transparent procurement and regulatory systems
- Better data on need, access, outcomes and service quality
- Greater involvement of device users in policy and research
- Regional collaboration across countries facing similar challenges
For the IMEA region, this means recognising prosthetics and orthotics as part of health, education, employment, social inclusion and humanitarian response.
IMEA CPO takeaway
The Exceed Research Network position paper is a timely reminder that global P&O access cannot be solved by technology alone.
For clinicians and technicians, it reinforces the value of clinical judgement, user-centred practice and context-specific solutions. For educators, it highlights the need for stronger local training and research capacity. For suppliers and innovators, it challenges the market to support sustainable service systems rather than only selling devices. For policymakers, it shows that prosthetics and orthotics must be included in national rehabilitation, assistive technology and disability inclusion planning.
As the global P&O community moves from evidence to action, the Exceed Research Network’s message is clear: lasting progress depends on systems, context, collaboration and the meaningful involvement of the people who use prosthetic and orthotic services.
- Exceed Research Network members
- World Health Organization Rehabilitation
- World Health Organization Assistive Technology
- WHO Standards for Prosthetics and Orthotics
- International Society for Prosthetics and Orthotics
- American Academy of Orthotists and Prosthetists
- ATscale, the Global Partnership for Assistive Technology
- GAATO, the Global Alliance of Assistive Technology Organizations
- Human Study e.V.
- BAPO, British Association of Prosthetists and Orthotists
- ISPO UK