Promoting Universal Health Coverage for Amputees through Social Enterprise and Engineering Innovation

这项提案的重点是将国际社会对全民健康保险(UHC)的承诺扩大到低收入和中等收入国家的肢体丧失患者。它建立在EPSRC和MRC资助的多学科研究的基础上，确定肢体丧失的流行率；服务使用者尝试获得和接受服务的体验，以及“适合用途”身体动力假体设计的创新。这项研究证明，需要进行更全面和结构性的保健系统改革，重点是发展一个为区域分布的服务网点提供服务的综合供应链系统。目前还没有制度来管理和规范从海外进口的设备和部件的质量和成本。国际捐助者在确定服务的地域和特点方面发挥了重要作用，重点是乌干达北部的内部冲突。自这场冲突结束以来，资金已经停止，资金不足的服务无法满足大量外国难民涌入西方以及道路交通事故、家庭暴力、癌症和糖尿病引起的日益增长的国内需求。乌干达卫生部提议利用公私伙伴关系加强卫生系统。我们的提案将设计和测试PPP模式，作为更综合和更分散的伙伴关系模式的基础，为截肢者提供全民健康保险。National Medical Stores是向公立医院供应物资的唯一供应商。除国家转诊医院外，它不向整形外科车间提供必要的医疗用品，使用这些设施的患者需缴纳使用费。联合医疗用品(JMS)是一家向非营利性部门提供医疗用品的老牌(非营利性)供应商。我们的建议重点是建立PPP平台，以支持国家一级物资管理的社会企业模式。这将包括对国际采购采取更加透明的做法，并努力通过当地制造减少对外国供应的依赖。我们将开发EPSRC团队设计的上肢插座的潜力，用于本地制造和任务转移。为了支持新冠肺炎期间的供应链管理，我们在波特堡地区转诊医院设计的一个模型的基础上提出了一个二级PPP。最近签署的PPP涉及与Knowledge for Change、一个注册的非政府组织和JMS建立的健康合作伙伴关系，将在靠近快速增长的难民营的公立医院设计和测试一个模式，以促进以服务为重点的供应链敏捷性。我们的长期目标是利用我们在假肢设计方面的创新，加上对需求的精细解析建模，来试验新的分布式假肢服务模式，这是我们与JMS合作的特点。我们建议试行公私伙伴关系模式，以帮助更有效地将外国援助与一种或多种新的服务模式相结合。在项目接近尾声时，我们将召集主要利益相关者一起开发一个更大规模的项目，探索如何在这项研究中吸取经验教训。我们的具体目标是：1.供应链创新：共同设计和测试公私合作伙伴关系方法对假肢部件和修复服务的可持续供应链整合的贡献。展示技术创新对假肢服务的作用：测试用户可调整的、可在当地修复的插座设计的本地制造和供应链进入的潜力。官方发展援助创新：为基于伙伴关系、社会企业和可持续性原则的海外发展援助新模式提供证据基础

This proposal is focused on extending the international commitment to universal health coverage (UHC) to people suffering limb loss in Low- and Middle-Income Countries. It builds on multi-disciplinary EPSRC- and MRC-funded research establishing the prevalence of limb loss; service-users' experiences of attempting to access and receive services and innovation in the design of 'Fit-For-Purpose' body-powered prostheses. This research has evidenced the need for more comprehensive and structural health systems change focused on the development of an integrated supply-chain system servicing regionally distributed service outlets. At present there is no system to manage and regulate the quality and costs of imports of devices and components from overseas. International donors have played a major role in defining the geography and characteristics of services with an emphasis on internal conflict in Northern Uganda. Since the end of this conflict funding has ceased and underfunded services do not meet needs resulting from significant foreign refugee flows into the West and growing domestic needs arising from Road Traffic Accidents, domestic violence, cancer and diabetes. The Ugandan Ministry of Health (MoH) has proposed the use of Public-Private-Partnerships in health system strengthening. Our proposal will design and test a PPP model as the basis for a more integrated and distributed partnership model to deliver universal health coverage for amputees. National Medical Stores is the sole provider of supplies into public hospitals. With the exception of the National Referral Hospital it is not supplying orthopaedic workshops with essentialsupplies and patients who do access these facilities are subject to user fees. Joint Medical Stores (JMS) is an established (not-for-profit) provider of medical supplies to the not-for profit sector. Our proposal focuses on building a PPP platform to support a social enterprise model for supplies management at national level. This will include a more transparent approach to international sourcing combined with efforts to reduce dependency on foreign supplies through local manufacture. We will exploit the potential of an upper limb socket designed by the EPSRC team for local manufacture and task-shifting. We propose a second-level PPP based on a model designed in Fort Portal Regional Referral Hospital to support supply chain management during COVID-19. A recently signed PPP involving an established health partnership with Knowledge for Change, a registered NGO and JMS will design and test a model to promote service-focused supply chain agility at a public hospital located in close proximity to fast-growing refugee camps.Our long-term aims are to use our innovations in prosthesis design, coupled with fine-resolution modelling of demand, to pilot new, distributed prosthesis service models, characterised through our collaboration with JMS. We propose to pilot a Public private partnership model to help support the more effective integration of foreign aid with one or more of the new service models. Towards the end of the project, we will bring together the key stakeholders to develop a larger scale project which will explore how we can build on the lessons learnt in this study.Our specific objectives are:1. Supply Chain Innovation: Co-design and test the contribution that a Public-Private-Partnership approach can make to sustainable supply chain integration for prosthetics componentry and repair services.2. Demonstrate the role that technological innovation can have on prosthetic services: Test the potential for local manufacture and supply-chain entry of a user-adjustable, locally repairable socket design.3. ODA Innovation: Generate the evidence-base for a new model for Overseas Development Assistance (ODA) based on principles of partnership, social enterprise and sustainability