How NGOs Across IMEA Are Holding Back the Development of the Orthotic & Prosthetic Industry

NGOs across IMEA (India–Middle East–Africa) have done undeniable good in orthotics and prosthetics—especially in conflict zones and low-income settings. But there’s also a harder conversation most people avoid: in many places, the way NGO projects are structured is quietly holding back the long-term development of a sustainable O&P industry.

Across IMEA, thousands of amputees and people with severe musculoskeletal conditions would have no device at all without NGO-run clinics, mobile missions, and humanitarian projects. Yet at the same time, many local O&P entrepreneurs, private clinics, and manufacturers will tell you—in private—that the very same ecosystem is making it harder to build modern, stable, local industries.

This isn’t about “good NGOs vs bad NGOs.” It’s about structures, incentives, and unintended consequences.

1. The “Free Device” Trap: How Short-Term Humanitarian Logic Kills Local Markets

In many IMEA countries, large NGOs and donor programs offer free or heavily subsidised orthoses and prostheses. Ethically, this feels right. Practically, it often:

Undercuts local clinics that must charge realistic prices to survive
Trains patients to expect zero or token payment
Makes private investment in O&P centres, fabrication labs, and local manufacturing look irrational

A local clinic offering a quality transfemoral prosthesis for a fair price cannot compete when an NGO runs a project in the same city providing “free limbs for all amputees this month.” The result:

Clinics delay investment in better equipment, staff, and digital workflows
Talented clinicians leave private practice to join short-term NGO missions with better salaries
Governments see NGO coverage and assume “the problem is being handled”, delaying reimbursement reforms

In theory, humanitarian work should be gap-filling. In practice, it often becomes the system.

2. Parallel Systems: NGO Islands vs National Health Systems

Many NGOs operate parallel service systems:

Their own clinic buildings
Their own patient registration
Their own supply chains and maintenance policies
Their own reporting and data, separate from the Ministry of Health

This parallelism creates several long-term problems:

No integration with national reimbursement or referral pathways
Patients move in an NGO world, not in the national health system. When the project ends, referrals and funding disappear.
No pressure on governments to build sustainable capacity
If amputees are “being seen” by a foreign-funded clinic, it’s easy for health planners to move O&P down the priority list.
Fragmented standards and training
NGOs introduce their own protocols, forms, and device choices—sometimes with minimal alignment to national standards or ISPO guidelines.

Instead of strengthening the system that will be there in 20 years, NGO projects often bypass it.

3. Donor Cycles vs Device Lifecycles

Orthoses and prostheses are long-term commitments: follow-up, repairs, socket changes, growth adjustments for children, component wear.

Donor funding, on the other hand, is typically:

12–36 months
Announcement-driven (“X number of limbs delivered”)
Focused on outputs, not 10-year outcomes

This mismatch means:

Many projects prioritise volume: as many devices as possible, as fast as possible
There is little budget for proper follow-up after the project closes
There’s no plan for who replaces components in 3–5 years

Clinics and patients are left with a question nobody wants to ask out loud:
“What happens when the donor logo disappears?”

Local private clinics and manufacturers could answer that question—but they can’t grow if the entire logic is built around short-term, grant-funded cycles.

4. Technology Choices That Freeze Local Innovation

NGOs often standardise on:

A single supplier’s knee joint, foot, liner, or modular system
A “donated” CAD/CAM or scanner platform
One specific type of workshop equipment or manufacturing method

Those choices are frequently driven by:

Donor relationships
Who offered discounts or bundles
Existing procurement preferences in Europe or North America

The consequences on the ground:

Local suppliers and small manufacturers are locked out of the procurement chain
Clinics are forced to use components that may be poorly adapted to local climate, maintenance, or patient lifestyles
There is little incentive to explore lower-cost local manufacturing, 3D printing, or region-specific innovations

In effect, a well-meaning NGO can freeze technology in a country around a particular imported ecosystem, regardless of whether it’s the best long-term fit.

5. Human Capital Drain: Training Without Anchoring

Many NGOs do invest in training local clinicians and technicians. This is positive—but often incomplete.

Common patterns:

Short workshops without structured curricula or recognised qualifications
Training linked to a project’s preferred devices, not broad clinical reasoning
The best local staff being “poached” into NGO salary structures while public or private clinics struggle to compete

So the system ends up with:

Skilled people who are tied to project-based jobs, not stable careers in local clinics
Ministries and universities who don’t own the training agenda
A talent market where clinicians chase short-term NGO contracts instead of building long-term practices or services

Instead of anchoring skills in national training institutions and local employers, capacity is held inside project bubbles.

6. Data That Doesn’t Belong to the Country

NGOs collect masses of data:

Patient counts
Device types
Amputation causes
Complication rates
Geographic coverage

But often this data:

Sits on project servers, donor dashboards, or international NGO systems
Is shared in summary form—if at all—with national authorities
Is not structured to feed into national health planning, reimbursement design, or local business planning

So governments and local entrepreneurs are flying blind:

They don’t really know true demand by region, device type, or age group
They can’t plan national O&P workforce needs
Local investors can’t model market size and growth with confidence

The paradox: the very organisations that claim to “support the system” may be holding the most actionable system-level data outside that system.

7. A Narrative That Keeps Local Actors “Junior”

The language around humanitarian O&P in IMEA often reinforces a hierarchy:

Western expertise → local “capacity building”
Imported components → local “assemblies”
Donor-funded centres → local “satellites” or “implementing partners”

This narrative subtly positions local clinicians, entrepreneurs, and manufacturers as permanently junior, rather than as future leaders of a mature regional industry.

When NGOs write tenders, reports, and press releases, they often highlight:

Their own brand
Their northern technical advisors
Their imported technologies

Local partners appear as “beneficiaries” or “implementers”, not as co-owners of the ecosystem. This becomes self-fulfilling: if you’re always an implementer in someone else’s project, it’s harder to stand up as a fully independent industry voice.

8. What a Better Model Could Look Like

NGOs don’t have to hold the industry back. With different design choices, they could accelerate it.

Some practical shifts:

1. From Free-For-All to Smart Subsidy

Use means-tested co-pays, not blanket free devices for everyone
Channel subsidies through local clinics and labs, not parallel centres
Make sure every dollar of external funding is building local business capacity, not replacing it

2. Co-Branded, Co-Owned Services

Co-brand patient centres with local clinics or universities
Embed NGO projects inside public hospitals or local private clinics, not in standalone islands
Design exit strategies from day one, with clear timelines and handover plans

3. Open Procurement, Local Supply

Allow local and regional suppliers to compete in NGO tenders
Include criteria for local content, maintainability, and spare parts availability
Support pilots with local 3D printing, local fabrication, and local component design

4. Data as a Public Good

Commit to sharing anonymised patient and device data with ministries and national registries
Co-develop national O&P indicators and dashboards
Use data not just to satisfy donors, but to enable national planning and private investment

5. True Capacity Transfer

Partner with local universities, professional associations, and regulators
Co-create formal training programs that outlive individual projects
Support the development of national standards, licencing, and reimbursement frameworks

9. Conclusion: From Humanitarian Islands to Sustainable Ecosystems

NGOs across IMEA have kept thousands of people walking, working, and living with dignity. That must be acknowledged and honoured.

But if the goal is not just to “fit X number of limbs” but to build a thriving orthotic and prosthetic ecosystem—clinicians, technicians, manufacturers, digital innovators, regulators—then the current humanitarian project model is not enough. In some cases, it is actively in the way.

The next phase of O&P development in IMEA will depend on:

Local ownership
Integrated systems
Smart, time-bound NGO support that creates space for sustainable public and private actors

The challenge for NGOs is clear:

Move from being the system, to being the catalyst.

Anything less risks leaving the region dependent, fragmented, and always waiting for the next project—while the real potential of its own people and industry remains underused.