Children with congenital deficiencies and amputations of the lower limbs in Uganda typically do not have access to quality prosthetic limbs first, because of the use of imprecise, conventional, manual processes and second, because of the severe lack of professionally trained prosthetists in the country. In this context, the proposed project aims to integrate scientific and technological innovation in 3D printing technology with business and social enterprise models in order to make the process of producing prosthetics in Uganda more efficient and effective.
More specifically, the project team will endeavour to increase the accuracy of fit of prosthetics by semi-automating the process of production using an infrared laser scanner to scan and capture biometric data, customized software to manipulate and edit the data, and a 3D printer to produce a viable, lower-limb socket for use. We anticipate that this process will simplify the current conventional method of production by reducing the number of steps required to create prosthetic limbs as well as improving on the materials used in the production process. Part of the project also involves training current and new prosthetic technicians on the use of 3D printing technology. Taken together, these activities will allow more access to assistive devices for more children who need them through hospital services at CoRSU.
The International Monetary Fund (IMF) estimates the total population of people with disabilities in Uganda is 2.46 million.1 Estimates also indicate that there are 250,804 children aged 0-18 with various disabilities in Uganda. This disability group is largely comprised of children who have been victims of violence caused by civil unrest, instigated by the Lord's Resistance Army in the northern part of the country as well as those who have succumbed to bone diseases such as poliomyelitis (polio) or osteomyelitis (bone infection), requiring amputations.2 As such, this project will endeavour to provide customized services to this marginalized group of children who are currently being missed in the traditional health system.Government Policies, Priorities and Plans in Uganda
Uganda has demonstrated its commitment to the promotion and protection of the rights of people with disabilities through adoption and implementation of national and international policies and legal instruments that specifically concern these individuals. Most notable is the National Policy on Disability in Uganda which provides a framework for the enactment of rights of people with disabilities.3
Specifically concerning health, the Ugandan government has put in place the Uganda National Minimum Health Care Package (UNMHC) to ensure that people, including people with disabilities, receive essential, primary health care services. However, despite the development of such policies and programs, challenges still remain: the high cost of health services and assistive devices, negative attitudes toward people with disabilities and their families, inaccessible infrastructure and equipment designs, and long waiting times to receive services, particularly prosthetic devices.4
The major concerns of this project are in line with ministry policies around equal rights for people with disabilities, equal access to health care services for people with disabilities and lowering costs of health care services, such as the provision of assistive devices.Prosthetics Production in Low/Middle-Income Countries Generally and in Uganda Specifically
In low and middle-income country contexts, access to well-fitted, functional, and affordable prosthetics is extremely limited. For children with disabilities in particular, the lack of available prosthetics makes it difficult - if not impossible - for them to play and learn thus dramatically reducing the quality of their lives. More recent studies have underscored that assistive technologies significantly impact the independence and participation in society by people with disabilities. That such impacts are not just felt by disabled individuals themselves is highlighted by the ways assistive technologies also reduce the need for formal support services and reduce the time and physical burden of caregivers.5 For these reasons, increasing the availability of well-fitting prosthetics for children in low and middle-income country contexts is of paramount importance.
Health institutions in low and middle-income countries have been increasing the production of prosthetics but have been hampered by two main factors; first, the availability of professionally trained prosthetic technicians/prosthetists, and second, the speed at which well-fitting prosthetics can be produced. Studies conducted by the World Health Organization (WHO) indicate that while the current supply of technicians falls short by approximately 40,000, it will take about 50 years to train just 18,000 more skilled prosthetic professionals.6
In Uganda in particular, there are approximately 12 trained prosthetic technicians serving a population of over 250,000 children. A contributing factor to this low number of professionals in the country was the discontinuation of formal prosthetics education in 1974. Although, in recent years, the Ministry of Health in Uganda has revived educational training programs and been endeavouring to increase support to prosthetic and orthotic production services and trainee programs, progress has been slow and much like that of other developing nations as described above.7
Furthermore, in Uganda, current processes for making prostheses involve multiple, time-consuming and manual steps, including the plaster casting of the residual limb, creating a positive mold from the plaster cast, and then using this positive mold to create a custom socket fitted to the individual. This prosthetic production method is time-intensive as plaster materials take considerable time to dry, cure, and harden (a number of days). More importantly, the current procedure also increases the possibility of producing a poorly-fitting device as there is much room for error in a manual process. In low and middle-income country contexts, the speed at which a prosthetic device can be produced is critical in that it can often determine whether or not a patient will actually receive it. Many patients are only able to afford a single visit to orthopaedic centres where prosthetics are produced. If they cannot be produced quickly enough, within one or two days at the most, many patients return home, leaving behind their incomplete prosthetic.
Incorporating the use of 3D printing technology into the process of producing prosthetics in low and middle-income countries will address these issues by speeding up the process and training new prosthetic technicians more quickly.
1 International Monetary Fund. (2005). Uganda: Poverty Reduction Strategy Paper. Retrieved from:
https://www.imf.org/external/ pubs/ft/scr/2005/cr05307.pdf, August 24, 2013.
2 Uganda Bureau of Statistics. (2001). Uganda Demographic Health Survey Report. Kampala, Uganda: Government of Uganda.
3 Ministry of Gender, Labour and Social Development Uganda. (2006). National Policy on Disability in Uganda. Retrieved from:
4 Ministry of Gender, Labour and Social Development Uganda. (2006). National Policy on Disability in Uganda. Retrieved from:
5 WHO-USAID. (2011). Joint Position Paper on the Provision of Mobility Devices in Less Resourced Settings. Valetta, Malta: WHO.
6 Strait, E. (2006). Prosthetics in Developing Countries. Retrieved from:
http://www.oandp.org/publications/ resident/pdf/DevelopingCountries.pdf, August 25, 2013
7 USAID. (1998). Uganda Prosthetic/Orthotic Needs Assessment - Leahy War Victims Fund Report. Retrieved from:
http://pdf.usaid.gov/pdf_docs/PDABS677.pdf, September 18, 2013