ATscale’s 2025 Annual Review presents encouraging evidence that assistive technology is moving higher on national and international development agendas. It also shows how far healthcare systems must still travel before people can reliably obtain the products and professional services they need.
An estimated 2.5 billion people currently require at least one assistive product. This figure is projected to exceed 3.5 billion by 2050. In low- and middle-income countries, between 65% and 95% of people requiring products such as wheelchairs, hearing aids, spectacles and prostheses remain without access. atscalepartnership.org
For the prosthetics and orthotics profession, the report’s central message is particularly important: access cannot be solved by distributing devices alone. Sustainable provision requires trained professionals, clinical services, financing, procurement systems, quality products, maintenance and long-term government ownership.
Almost 2.6 million people reached
ATscale reported that its programmes had reached nearly 2.6 million people with assistive technology by the end of 2025. Women and girls represented 46% of those reached.
The organisation engaged with 29 countries through 14 scale-up programmes, 12 foundational programmes and three humanitarian initiatives. Its work included product provision, screening, clinical assessment, fitting, maintenance, workforce development and system strengthening. atscalepartnership.org
The results demonstrate the potential of coordinated international investment. However, the distribution of beneficiaries also deserves attention from the O&P community.
Vision-related interventions accounted for approximately 2.4 million people, while the mobility category reached around 113,000. Prosthetics and orthotics were separately identified within the product data but represented only a relatively small part of the reported total.
This does not necessarily suggest that P&O is considered unimportant. It reflects the greater complexity of delivering individually assessed and fitted devices compared with high-volume products such as spectacles.
A prosthesis or orthosis cannot ordinarily be taken from a box and issued to a user. Provision may involve assessment, prescription, measurement or scanning, design, fabrication, fitting, alignment, functional training, review, adjustment and eventual replacement. Scaling P&O therefore requires investment in an entire clinical and technical pathway.
A systems approach to assistive technology
ATscale’s strategy is built around three connected pillars:
- Supporting country plans and strengthening national policies, services and financing
- Developing global tools, evidence and markets for affordable, quality products
- Building political support, public awareness and investment
This structure is highly relevant to prosthetics and orthotics.
Many countries have individual rehabilitation centres or charitable programmes capable of delivering good clinical work. Far fewer have a national system through which a person can be identified, referred, assessed, fitted and supported throughout the life of the device.
For O&P, a functioning system should include:
- Clear referral pathways from hospitals and community services
- Qualified prosthetists and orthotists
- Appropriate clinical and workshop infrastructure
- Reliable access to components and fabrication materials
- Quality and safety standards
- Public procurement and reimbursement mechanisms
- Follow-up, repair and replacement arrangements
- Patient outcome and service-delivery data
- Access for people living outside major cities
- Meaningful participation by device users
Without these elements, access remains dependent on geography, personal income or short-term charitable programmes.
Financing must cover services as well as products
One of the strongest themes in the review is the need to remove financial barriers.
ATscale supported work on domestic financing strategies and an investment-case methodology intended to help governments see assistive technology as a high-return social and economic investment rather than a charitable expense. It also advocated for AT to be protected within national budgets and insurance structures.
Azerbaijan, Georgia and Tajikistan recorded increases of more than 30% in their assistive technology budgets, while Senegal allocated approximately US$4.3 million to its General Directorate of Social Action. atscalepartnership.org
For O&P stakeholders, the crucial question is what these budgets actually purchase.
Funding only the physical device can create pressure to minimise assessment, fitting, training and follow-up. A clinically appropriate financing model should recognise the complete episode of care, including:
- Multidisciplinary assessment
- Device prescription
- Customisation or fabrication
- Components and consumable materials
- Fitting and alignment
- Gait or functional training
- Clinical review
- Adjustments and repairs
- Replacement caused by wear, growth or physical change
This is especially important for children, people with progressive conditions and amputees whose residual limbs may change substantially following surgery.
Workforce development remains essential
ATscale reported a cumulative total of 13,721 people trained, with participants including health personnel, community health workers, teachers, government representatives and members of organisations of persons with disabilities.
This wider workforce can help identify functional difficulties, provide basic information and connect people with services. However, it cannot replace appropriately qualified prosthetists, orthotists and rehabilitation professionals.
Increasing demand without developing specialist capacity may simply create longer waiting lists.
Countries need workforce plans that address:
- Accredited P&O education
- Clinical placements and supervised practice
- Continuing professional development
- Career structures and professional recognition
- Geographic distribution of practitioners
- Training for technicians and support personnel
- Retention within public rehabilitation services
- Digital skills and emerging manufacturing methods
Community-level workers can strengthen case identification and referral, while specialist clinicians remain responsible for assessment, prescription and device management.
Procurement must consider quality and lifecycle cost
ATscale’s 2025 Assistive Products Market Report covered 25 organisations, 170 suppliers and 200 products. The information is intended to support better procurement decisions, analysis of unmet demand and understanding of cost drivers.
The partnership also supported regional distribution hubs in Cambodia and Togo to shorten and localise supply chains. atscalepartnership.org
For P&O services, procurement based mainly on the lowest unit price can be a false economy. A cheaper component or material may generate higher costs if it causes frequent failures, remakes or additional clinical appointments.
Purchasers should evaluate:
- Product safety and regulatory compliance
- Suitability for local climate and working conditions
- Compatibility with established component systems
- Availability of sizes and replacement parts
- Warranty and technical support
- Practitioner training
- Repairability
- Expected service life
- Total cost of ownership
- Patient comfort and functional outcomes
Local or regional supply can improve availability, but localisation must retain appropriate material specifications, clinical governance and quality control.
Better O&P data is needed
ATscale supported the integration of assistive technology indicators into national information systems. Kenya’s National Assistive Technology Dashboard, for example, uses facility-level information from the national health information system to monitor service delivery.
Equivalent O&P data could help governments understand:
- The number of people requiring prosthetic and orthotic services
- Waiting times
- Device categories supplied
- Geographic inequalities
- First-fit and remake rates
- Repairs and replacements
- Patient outcomes
- Workforce capacity
- Gender and age differences in access
- The cost of delivering complete care
The relatively small O&P footprint visible in ATscale’s product results reinforces the need for more detailed data. If prosthetic and orthotic activity is not consistently recorded, it remains difficult to plan workforce numbers, allocate budgets or make the case for investment.
Humanitarian response must connect to long-term care
The review also highlights the integration of assistive technology into emergency preparedness. Following the March 2025 earthquake in Myanmar, four pre-positioned kits containing more than 2,000 products, including wheelchairs and crutches, were deployed.
Rapid access to mobility products is essential during a crisis. Prosthetic and orthotic care, however, frequently begins after the immediate emergency phase.
People with amputations, fractures, burns, nerve injuries and other trauma may require months or years of rehabilitation. Children require replacement devices as they grow, while adults may need socket changes, repairs and management of secondary complications.
Humanitarian P&O programmes should therefore be designed around continuity of care rather than a single device delivery.
What should the O&P profession take from the report?
ATscale’s results show that national leadership, financing, market development and data can expand access to assistive technology. For prosthetics and orthotics, the next step is ensuring that these systems reflect the clinical realities of personalised devices.
The profession should advocate for:
- Explicit inclusion of prostheses and orthoses in national priority product lists
- Funding for complete clinical pathways rather than devices alone
- Greater investment in accredited P&O education
- Recognition of maintenance and replacement as essential services
- Quality-based procurement
- Stronger national O&P data
- User participation in service and policy design
- Referral networks linking hospitals, rehabilitation centres and community services
- Responsible adoption of scanning, digital design and manufacturing technologies
- Long-term support following humanitarian emergencies
ATscale concludes that systems-based investment works, but continued progress will require government ownership, co-financing and collective action. It also emphasises that the voices of assistive technology users must shape policies and programmes. atscalepartnership.org
For the IMEA region, this is the central lesson. A prosthesis or orthosis should not be treated simply as an item to be purchased and handed over. It is part of an ongoing professional service intended to improve function, independence and participation.
- ATscale 2025 Annual Review – Executive Summary
- ATscale – Global Partnership for Assistive Technology
- ATconnect Assistive Technology Resources
- World Health Organization: Assistive Technology