Prostheses demand landscape

For millions of people in LMICs who need prostheses, major NGOs, social enterprises and surveyed governments provide approximately 25,000–30,000 units annually. The ICRC, the largest NGO in this field, supports prosthetic services across 28 countries, supplying around 23,000 units each year. Half of the surveyed governments also procure prostheses annually – for example, Cambodia purchases 4,000 units, while Georgia and Indonesia each procure 300 units.

NGO market

NGOs play an important role in LMICs. Often, NGOs set up prosthetic care in the context of humanitarian response and have continued to offer services thereafter. These NGOs generally operate under two primary models, either fully subsidised (e.g. ALTSO) or partially subsidized (e.g. ROMP).

We do not have a full picture of the aggregated volume as some NGOs like HI also buy through a decentralized system. The available data also show a steady or growing demand for prostheses.

The ICRC Physical Rehabilitation Programme appears to be the largest NGO buyer with 22,376 units in 2023 [16]. The largest markets for ICRC are South Asia, the Near and Middle East and East Africa.

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Figure 2: Units of prostheses provided by ICRC by region (2021-2023)

Bar chart

Image Description

Bar chart comparing the number of people (in thousands) across different regions for the years 2021, 2022, and 2023. Each region has three vertical bars, colored in shades of blue for each year. The regions listed from left to right are: Europe and Central Asia, Americas, West Africa, North and Central Africa, Southeast Asia, Near and Middle East, East Africa, and South Asia.

The values for each region and year are as follows:

Europe and Central Asia: 373 (2021), 308 (2022), 108 (2023)

Americas: 785 (2021), 522 (2022), 332 (2023)

West Africa: 1,215 (2021), 1,427 (2022), 1,399 (2023)

North and Central Africa: 1,663 (2021), 1,733 (2022), 1,409 (2023)

Southeast Asia: 2,305 (2021), 3,461 (2022), 3,491 (2023)

Near and Middle East: 4,870 (2021), 4,796 (2022), 4,356 (2023)

East Africa: 4,173 (2021), 4,539 (2022), 4,817 (2023)

South Asia: 6,847 (2021), 8,031 (2022), 6,468 (2023)

ICRC predicts that the total volume of prostheses delivered in 2024 and 2025 will remain at a similar level. Due to a rise in global conflicts and the corresponding rise in humanitarian needs, ICRC is experiencing funding constraints for its global physical rehabilitation programmes. Consequently, the number of prostheses delivered is not expected to grow. In response to the funding constraints, ICRC began exploring new financing models and ended physical rehabilitation projects in 11 countries: Algeria, Democratic People's Republic of Korea, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Niger, the Philippines, Tanzania and Viet Nam [17]. 3

HI provides rehabilitation services across 42 countries [18]. Its prostheses procurement is mainly decentralized via countries with partial procurement from the headquarters. The data from headquarters procurement show an increase from 2021 to 2024.

Figure 3: HI headquarters’ procurement value for prostheses (2021-2024) 4

Bar chart showing financial growth over four years. In 2021, the value is €9,500; In 2022, the value increases to €69,000. In 2023, the value rises further to €158,000. In 2024, the value jumps significantly to €477,200.

3.Further edition from ICRC team. ↩︎

4.The data is provided by Humanity & Inclusion. Please note that the 2024 data is only up to the beginning of the year, and more should be expected for the full year. ↩︎

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NGOs, such as CURE International, ALTSO and ROMP, each deliver an average of around 500 prostheses per year. These NGOs fully or partially subsidise costs for patients. NGOs indicated that demand has been either steady or increasing over the last five years (see Figure 4). The primary products procured by these NGOs are lower-limb above-knee (AK) and below-knee (BK) sets, with ROMP reporting that over 90 per cent of its procurement is for lower limbs [19]. ALTSO and CURE focus on lower-limb products for children.

Figure 4: Total units of prostheses delivered by ROMP (2020-2025)

Bar chart with six vertical bars, representing a year from 2020 to 2025E. The height of each bar increases from left to right, showing growth over time. The values at the top of each bar are as follows: 2020: 215; 2021: 306; 2022: 403; 2023: 516; 2024: 691; 2025E: 680.

The price across all NGOs interviewed ranges from US$67 to US$450 for a BK set and from US$222 to US$700 for an AK set. NGOs report that users in LMICs are seeking higher-functionality prostheses than those currently available in LMICs. NGOs therefore expect to increasingly source higher-functionality products such as dynamic feet and higher-mobility-level knees.

The key selection criteria across NGOs are as follows: 1. price; 2. quality; and 3. logistics. The NGOs stated that they are trying to seek more affordable options from emerging countries. However, accessing product information, assessing quality and managing logistics is challenging. As a result, they often rely on global providers with a stronger local presence and reputation.

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Table 5: NGOs providing prostheses in LMICs

Organization A Leg to Stand On (ALTSO):
About NGO providing prosthetic limbs, orthotic braces and wheelchairs to children; active in 10+ countries
Volumes (units)
  • Average annual demand has remained steady: under 1,000
  • Total 24,000 since 2003
Type • Joshi: a modular lower limb system from lightweight aluminium materials
Suppliers • Designed by ALTSO and produced by a contract manufacturer in India.
Reference pricing • US$350 to donate a Joshi
Organization CURE International
About Christian NGO that operates 8 children’s hospitals around the world.
Volumes (units) • 2023: 459
Type • Mainly BK set and AK set for children
Suppliers

Mainly two channels:

Regal Prostheses (Hong Kong SAR) OADCPH, a distributor from Togo

Reference pricing
  • BK set: US$150
  • AK set: US$700
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Organization Humanity & Inclusion (HI)
About NGO providing rehabilitation services across 42 countries
Volumes (units)

No volume data available but HI shared the procurement funding for their headquarters.

2021: €9,500 2022: €69,000 2023: €158,000 2024: €477,2005

This does not include local programme purchases.

Type • Various components, such as knee joints, ankle joints, connectors, etc.
Suppliers
  • Ottobock, (2021)
  • Proteor (2021-2024)
  • ATP Supply (2021)
Reference pricing
  • Child Knee Joint (Steel, Lock): ≈US$190
  • Adult Knee Joint (Steel, Lock): ≈US$205
Organization ICRC - Physical Rehabilitation Programme
About An ICRC programme established in 1979 to support physical rehabilitation services globally.
Volumes (units)

2021: 22,231 2022: 24,817 2023: 22,376

The volume for 2024 and 2025 is predicted to remain stable.

Type
  • Prosthetic components, mainly SACH feet, AK and BK sets, polycentric and monocentric knee joints
  • Raw materials such as Polypropylene
Suppliers
  • Rehab Impulse: brand owned by ICRC and produced by Foundation Alfaset (Switzerland)
  • Other global manufacturers such as Ottobock and North Sea Plastics

5.The data were retrieved from September 2024 and therefore does not include the full year funding. ↩︎

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Organization ICRC - Physical Rehabilitation Programme
Reference pricing
  • SACH Foot: US$48.5 (Adult), US$34.5 (Child)
  • AK alignment kit: US$29.9 (Adult), US$24.5 (Child)
  • BK alignment kit: US$29.5 (Adult), US$23.5 (Child)
  • Knee joint: US$144 (Monocentric), US$218 (Polycentric)
Organization The Range of Motion Project (ROMP)
About NGO dedicated to ensuring access to high-quality prosthetic care, active in Guatemala and Ecuador.
Volumes (units)
  • 2021: 306
  • 2022: 403
  • 2023: 516
  • 2024: 691
  • 2025E: 680
  • Total 5,849 units since 2005
Type • Copoly Socket Fabrication
Suppliers
  • About 95 per cent of the components are recycled from the US.
  • The rest are procured directly from manufacturers or distributor.
Reference pricing
  • Patients first complete a socioeconomic study to determine their level of vulnerability and level of copay.
  • BK prosthesis copay: US$300-US$450
  • AK prosthesis copay: US$400-US$600
  • Socket replacement: US$450

Note: The list is not exhaustive, but shows the product types, volumes, manufacturer and prices in NGO procurement. The NGOs were strategically selected to cover different geographies and age groups.

Government market

Based on limited data, government demand for prostheses in LMICs is limited to a few more developed countries, with many countries still relying on NGOs for provision. Out of 12 countries surveyed, 6 (50 per cent) procure or subsidize prostheses.

Examples of governments procuring prostheses:

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Cambodia The government procures prostheses through the Ministry of Social Affairs, Veteran, and Youth Rehabilitation. According to primary survey data, in 2023 the government procured 4,257 units of prosthetics and orthotics at prices ranging from US$120 to US$585 per unit.
China Regional disabled persons' federations, public hospitals and rehabilitation centres announce tenders through local government websites and national platforms like the China Assistive Device and Technology Centre and the China Disabled Persons’ Federation. The government does not disclose the annual procurement volume of prostheses.
South Africa South Africa issued its most recent national transversal tender for rehabilitation equipment, including prostheses, in 2019 under bid number RT55. The tender covers the period from March 2020 to February 2023.
Zambia The government procures prostheses through public tenders and Requests for Proposals issued by the Zambia Public Procurement Authority. The latest tender for prostheses and orthoses closed in October 2024, but the value remains undisclosed [20].

Examples of governments subsidizing prostheses:

Georgia The government allocated GEL2.7 million (≈US$984,000) in 2020 and GEL 2.1 million (≈US$769,000) in 2021 for prostheses. It subsidised up to GEL 5,135 (≈US$1,885 dollars) for lower-limb prostheses and up to GEL 7,410 (≈ US$2,720 dollars) for upper- limb prostheses. In total, 379 state-subsidized prostheses were provided in 2020 and 262 in the first half of 2021 [21].
Indonesia The government procures prostheses through its national medical equipment procurement platform, “E-catalogue” [22]. It subsidizes up to IDR 2.8 million (≈US$177 dollars) for prostheses6. In 2018, the Indonesian national health insurance subsidized 401 prostheses, with a total reimbursement of IDR964.7 million (≈US$62,000 dollars), accounting for around 0.03 per cent of total government expenditure on assistive products that year [23]. The coverage remains limited due to a lack of national planning and funding.

6.Data collected by CHAI country team. ↩︎

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