Methodology for country-level investment case for P&O

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Populations in Low and Middle Income Countries (LMICs) typically have a high need for protheses and orthoses which are locally underprovided, despite the right of people to these prosthetic and orthotic (P&O) services under international law (Harkins et al, 2013). This results in a huge loss of welfare and loss of human potential. For example the Global Partnership for Assistive Technology (ATScale) argues that there is a 9 to 1 return on investment from providing assistive technologies, and potential economic gains accruing to 35 million people in excess of USD1.5 trillion from prosthetics specifically, not including health and wider social benefits. However, although initiatives such as ATScale have made a global case for P&O, action ultimately has to take place at the national level and hence LMIC governments are critical stakeholders. What is needed, therefore, is a framework for building an investment case for P&O at the national level, together an outline national planning framework and, crucially a viable scheme for financing the development and sustainable operation of high quality services in what are extremely resource-poor settings. A particular difficulty which should be confronted head-on is the poor quality of data in LMIC settings, where civil registration is often limited and vital statistics are patchy or absent; and much healthcare activity takes place in poorly regulated private clinics and hospitals. Our aim to develop a framework for investment case and national plan development. We propose to focus on the case of Bangladesh. Bangladesh is a lower middle income country in South Asia with a GDP per capita of USD1856 in 2019, according to the World Bank. According to Ali (2014) the cumulative economic costs of disability in Bangladesh is USD1.18 billion. Among other reasons driving demand for P&O in Bangladesh, the country has a very high rate of road traffic accidents with more 15.3 deaths per 100,000 population each year, despite extremely low rates of vehicle ownership (WHO, 2018). Supervisor 1 has published 12 papers on aspects of public health and healthcare financing in Bangladesh and so has familiarity with the country. A former Strathclyde PhD student is now working at the government's internal research institute and thinktank, the Bangladesh Institute of Development Studies and so we have good contacts with relevant in-country institutions.