Methodology for country-level investment case for P&O

低收入和中等收入国家（LMIC）的人口通常对当地供应不足的假体和矫形器有很高的需求，尽管根据国际法，人们有权获得这些假体和矫形器（P&O）服务（Harkins等人，2013）。这导致福利的巨大损失和人类潜力的丧失。例如，辅助技术全球伙伴关系（ATScale）认为，提供辅助技术的投资回报率为9比1，特别是假肢为3500万人带来的潜在经济收益超过1.5万亿美元，不包括健康和更广泛的社会福利。然而，尽管ATScale等举措为P&O提供了全球性的案例，但最终必须在国家一级采取行动，因此LMIC政府是关键的利益相关者。因此，需要的是在国家一级为P&O建立一个投资案例的框架，同时还要有一个国家规划框架纲要，以及至关重要的一个可行的计划，为在资源极其匮乏的环境中发展和可持续经营高质量服务提供资金。一个应该正面面对的特别困难是LMIC环境中数据质量差，民事登记往往有限，生命统计数据不完整或缺乏;许多医疗保健活动发生在监管不力的私人诊所和医院。我们的目标是为投资案例和国家计划的制定一个框架。我们建议集中讨论孟加拉国的情况。根据世界银行的数据，孟加拉国是南亚的中低收入国家，二零一九年人均国内生产总值为1856美元。根据Ali（2014年）的数据，孟加拉国残疾人的累计经济成本为11.8亿美元。在推动孟加拉国P&O需求的其他原因中，该国的道路交通事故率非常高，每年每10万人口中有15.3人死亡，尽管车辆拥有率极低（世卫组织，2018年）。主管1发表了12篇关于孟加拉国公共卫生和医疗保健筹资方面的论文，因此对该国很熟悉。一位前斯特拉斯克莱德博士生现在在政府的内部研究机构和智库孟加拉国发展研究所工作，因此我们与国内相关机构保持着良好的联系。

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.