Monitoring Visit Report: Cooperative Orthotic Prosthetic Enterprise (COPE) Comprehensive Orthotic Service Development in Lao PDR

The project received a $1,429,568 grant from World Learning through the Cooperative Agreement DFD-A-00-08-00260-00 with USAID/DCHA/DRG. The three-year program, which began on December 1, 2010, and ended on November 30, 2013, has specific objectives to identify and promote appropriate orthotic components, review and improve current orthotic training and orthotic training materials, and engage existing orthopaedic workshops/service centers on increasing skill and activity level for orthotic and prosthetic production. The project is working directly with five Lao PDR government rehabilitation facilities, including the Centre for Medical Rehabilitation (CMR) Vientiane, Provincial Rehabilitation Centre (PRC) Champasack (Pakse), Provincial Rehabilitation Centre (PRC) Savannakhet, Provincial Rehabilitation Centre (PRC) Xieng Khuang, and Provincial Rehabilitation Centre (PRC) Luang Prabang. Key findings from the project include the lack of follow-up and outcome studies of patient groups treated, the high cost of the outreach program (COPE Connect), poor retention of trained Prosthetist and Orthotist (P&O) staff, and the need for improved reporting on quarterly progress reports. Recommendations for the project include working closely with government counterparts to strengthen staff retention and decision-making on treatment choice and quality of services, adjusting the annual work plan to incorporate key modules on follow-up and impact of treatment interventions, and providing guidance on completing indicator tables correctly. The project aims to improve the quality of orthotic service delivery, which is currently below expectations of graduates of accredited P&O Training Schools. Lao PDR is a landlocked country in South East Asia with a land mass size slightly larger than the state of Utah. The country has a diverse geography, with the Mekong River extending along most of its border with Thailand, Vietnam to the East, China and Burma to the North and Northwest, and Cambodia to its South. Agriculture accounts for half of the country's gross national product and 80 percent of employment, with only 4.01 percent of the land being tillable. The country has been a country in conflict for much of its modern history, with independence from France gained in 1955, and involvement in the Vietnam War. The incidence of UXO-related injuries is on the decline, with 99 people killed or injured in 2011 and 41 in the first eight months of 2012. Many survivors are left with devastating injuries, including amputations, which require orthotic and prosthetic services. The project aims to address the needs of these individuals and improve the quality of orthotic service delivery in Lao PDR. The project has made progress in developing comprehensive orthotics services in Lao PDR, but there are still challenges to be addressed. The project has worked with government counterparts to strengthen staff retention and decision-making on treatment choice and quality of services. The project has also adjusted its annual work plan to incorporate key modules on follow-up and impact of treatment interventions. However, there is still a need for improved reporting on quarterly progress reports and the quality of orthotic service delivery remains below expectations. The project has also faced challenges in retaining trained P&O staff, with poor retention rates reported. The project has implemented mentoring and training programs to address this issue, but more needs to be done to improve staff retention. The project has also faced challenges in implementing the outreach program (COPE Connect), which is costly and has limited reach. Overall, the project has made progress in developing comprehensive orthotics services in Lao PDR, but there are still challenges to be addressed. The project continues to work with government counterparts and local partners to improve the quality of orthotic service delivery and address the needs of individuals with disabilities in the country.