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Prosthetics NGO takes first steps towards user-pays model

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Since 1994, the Cambodian School of Prosthetics and Orthotics has offered free services to amputees. Charlotte Pert

Prosthetics NGO takes first steps towards user-pays model

At the Cambodian School of Prosthetics and Orthotics in Stung Meanchey, the walls are lined with disembodied plastic hands, arms, feet, legs. More lie in piles in the corners. Patients in the physical therapy room take their first wobbly steps with their new artificial limbs. Out back in a workshop, builders in white lab coats use plastic molds to produce new limbs and braces.  

Since 1994, the non-profit group, funded primarily by donations from the Japan-based Nippon Foundation, has provided patients with prosthetics equipment, physical therapy training and equipment repair services free of charge.

But in August, in a bid to reduce reliance on donor funding, the organisation is set to open Cambodia’s first private prosthetics clinic – which will feature higher quality medical equipment and physicians – and begin to export some of the products manufactured on site, such as its low-cost prosthetic feet.

“We want to get some profit from the business for people who can afford it, and bring their money to support the service here for people who cannot afford it,” said Odom Teap, 40, a certified prosthetist and business manager for Exceed, the UK non-profit that manages CSPO. The group also has clinics and training programs in Sri Lanka, the Philippines, Indonesia and Myanmar.

The clinics take in anyone, but most patients come from poor or rural areas. Physicians assess their disability – whether it be a missing limb, a disfigured one or a form of paralysis – measure them up for a brace or artificial limb, and then provide them with physical therapy training so they can learn how to use their new appendages. In some cases, costs for transportation, lodging and meals are compensated.

The services offered at the new private clinic will be more or less the same, says Teap, but of a higher quality. 

“For the fee-paying patient, they will be given more options to choose their prosthetic or orthotic device – they can have lighter prosthesis, nicer, or ones with more mechanical stability, any prosthesis that is possible to meet their needs with. For example, ones [specifically designed] for running or swimming,” he said. 

Teap said that right now in Cambodia, there are three other NGOs offering free prosthetics services and, including Exceed’s, a total of 11 clinics in the country. There are no other private, high-quality prosthetic services offered here, he said. 

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Prosthetics come in all shapes and sizes. Charlotte Pert

But the new services will not be for penny-pinchers. “[The price] depends on the type of devices, materials and components to produce it. In the world of prosthetics and orthotics, devices are not cheap. For example, one below-knee prosthesis can cost from $1,200 to $5,000, or even be more expensive depending on the needs of the patient,” said Teap. 

Despite a decline in the number of landmine-related casualties – down from 1,249 in 1999 to 140 last year – there is still plenty of demand for prosthetics in the Kingdom, with CSPO providing physical therapy training and new limbs to more than 350 disabled Cambodians a month.

According to Teap, workplace and road accidents are now the leading cause of new disabilities and amputations, along with cerebral palsy and diabetes. 

The group’s transition to a for-profit model is a preemptive move. As Cambodia continues to develop and donors take their money elsewhere, social services groups like CSPO, whose total annual costs hover around a million dollars, must find new sources of money or risk losing funding, he said. 

Teap said that while CSPO’s main donors haven’t yet indicated that they would be pulling funding anytime soon, they feel that the pattern among other NGOs here losing donor money means they need to have a backup plan.

“One of our strategic goals is sustainability,” said Teap. “Some NGOs have already handed over services to the government [due to lack of funding], but the government still cannot afford to provide services to people with disabilities, so some of their services collapsed.”

Exceed debuted its for-profit funding model with a private prosthetics clinic in Manila that opened last year. The Phnom Penh private clinic will be their second.

“The Manila clinic numbers were initially quite small, but we worked hard to raise awareness within the rehabilitation community, and the throughput of clients is starting to build quite quickly,” said Ken McCrea, chief executive of Exceed Social Enterprise, the for-profit arm of the group. 

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A worker manufacturers an orthotic aid. Charlotte Pert

Exceed is not the only group hoping to aid Cambodia’s handicapped while trying to reduce reliance on donor money. A number of vocational training groups for disabled people – such as the Cambodian Handicraft Association, Yodicraft, Watthan Artisans Cambodia and the National Centre of Disabled Persons – are funded either fully or in part by profit made from the sale of handicrafts made by the disabled.

Sophal Ear, associate professor of diplomacy and world affairs at Occidental College in Los Angeles and author of the book Aid Dependence in Cambodia: How Foreign Assistance Undermines Democracy, said the social enterprise is often a superior model to traditional non-profits.

“It means taking from the rich and giving to the poor,” he said. “More care is being provided, and it’s more sustainable. There is social good being provided as long as the non-profit is getting the money. [However], you don’t want the NGO to forget its mission and start catering only to the rich.”

In response to concerns that the private clinic might lessen the quality of services provided to the poor, Teap said: “We don’t want to see poor people that are not taken care of or not given priority for their treatment … We want to see the poor people still continue to receive appropriate and acceptable services at the rehabilitation centres. Private service is one of the mechanisms for the organisation to [be sustainable], in terms of trying to maintain available services, retain staff in the profession and so on,” he said.

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