Revolutionizing Access to Prosthetics

Born and raised in the DRC, Ed Epp has dedicated his life to serving the most marginalized. In 25 years with the Mennonite Central Committee and Mennonite Economic Development Associates – working worldwide, from China to Egypt – he was instrumental in supporting social justice initiatives to promote positive change. For instance, he led the disability movement formation in Jordan, Syria and Lebanon; promoted agricultural development for women in Afghanistan; provided medicine to children sanctioned in Iraq; and protected working children in Egypt. Today, Ed is Hope and Healing International’s visionary Executive Director – guiding the organization in its mission to ensure sustainable impact for children living with impairments and their families across the globe. Ed’s collaborative, enthusiastic approach to problem-solving and dedicated passion for development is driving Hope and Healing to the forefront of children’s disability issues.

Worldwide, 38 million people need prosthetics and orthotics annually, but only 10% (4 million) of them have access to these devices that they need to play, attend school, gain employment or go to market. Traditional production methods takes one week to fabricate one device through a lengthy, manual plaster-casting process. The WHO estimates it would take 42,000 newly qualified prosthetists to close the current production gap.

Nia Technologies Inc is a social enterprise founded by Hope and Healing International that has developed 3DPrintability, a complete toolchain that allows a technician to scan, rectify and print a prosthetic in 90 minutes, increasing productivity from one device to twenty per week.

This new 3D technology is designed for low-resource health facilities serving the poorest populations and enables the existing number of trained prosthetists to close the gap in access worldwide. By transforming the P&O industry, we can empower 34 million people annually.

38 million people annually suffer from limb loss, birth defects, musculoskeletal weakness, other illnesses or injuries that impair their mobility – resulting in higher rates of poverty, unemployment and illiteracy than their peers. Children with disabilities are at extremely high risk – up to four times more likely to die than their peers. One in ten of all children with disabilities attends school, and just one in 20 completes primary education. Children need, on average, 25 prosthetics over a lifetime. Worse, only 10% of people who currently need P&O devices can access them.  

The current plaster-casting production method for customized prosthetics and orthotics (P&Os) is slow, outdated, messy. This process is expensive – for the healthcare provider and the person in need – few facilities produce devices and even fewer people can access them. We have to find a better solution than the traditional method to create fitted prosthetic sleeves and individualized orthotics, especially for the most vulnerable.

Historically, 3D printing technology has been expensive and sensitive to rough conditions. We are seeking to transform the P&O industry through the application of 3DPrintability, a complete, user-friendly toolchain designed for low-resource environments – ensuring an affordable, easily adopted and replicable solution.

Nia Technologies Inc, a non-profit launched by Hope and Healing in 2015 with support from the University of Toronto, creates innovative technology solutions that tackle global problems in sustainable, responsive ways. We wanted to make 3D printing work in low-resource countries to produce individualized prosthetics and orthotics faster, cheaper, cleaner and easier - to ensure access for the 34 million people in need each year.

Nia has developed, tested and refined an integrated software package called 3DPrintAbility (3DPA) to increase the productivity of P&O technicians in the Global South. Clinical trials in 2017-2018 proved that prosthetic technicians in Africa and Asia can be trained in two weeks on the 3DPA toolchain, to use a tablet or mobile device to scan residual limbs, rectify digital models and print customized devices. This increase in productivity means a device can be fabricated in one day instead of one week, a 500% increase in productivity. 

Today two East African health facilities are scaling up the use of 3DPA to produce high-quality P&O devices for the most vulnerable patients. We seek to install and expand 3DPA’s reach to rehabilitative care providers worldwide to ensure access to these essential devices.

Revolutionizing P&O device production primarily impacts two groups. The first is 34 million people annually in need of assistive devices and their families; the second is the 7,000 current prosthetic/orthotic technicians who manufacture P&Os in the Global South. Hope and Healing International works closely with hospitals and other rehabilitative care providers in Africa, Asia and Latin America to address the needs of children with disabilities.

The WHO reports that people living with disabilities who lack access to assistive devices experience significantly lower quality of life. A prosthetic limb allows a child – previously unable to walk to school – gain an education, make friends and secure a brighter future. An orthotic fitted to a working mother reduces her pain, strengthens her community engagement and raises her income-earning capacity.

We work with local partners who provide rehabilitative care to conduct focus groups, survey patients, and gather data on impact measures. Each new 3DPA site includes potential beneficiaries in project development.

For technicians, we developed a virtual online community of practice platform called NiaNet that allows them to continue to learn from each other, share their experiences and guide further software improvements. During clinical trials, technicians provided input that greatly improved 3DPA.

Revolutionizing the production of P&Os eliminates a global barrier for millions with mobility impairments and allows the P&O industry to keep pace with new and replacement demands. It uses a recent technology applied in a new way to an old problem that can be easily learned and sustained in the Global South. By increasing the affordability and accessibility of P&Os through improved productivity, those who have been left behind because of mobility issues can now live, go to school, work and play as accepted and included members of society. The cycle of disability and poverty can be ended with 3DPA.

In 2013, my daughter came home from university talking about 3D printing. I was fascinated and wondered if 3D printing might solve a major barrier we saw in our work with children and adults with disabilities. The problem was how to address the massive gap in capacity to produce individualized P&O devices in low-resource settings. The WHO says it would take decades to train 42,000 more trained P&O technicians to reach the 90% of clients who currently need P&O devices and can’t get them.

I learned that 3D printing could produce prosthetics and has been used since the 1990s to do so, but they were very expensive and couldn't help the poorest kids in the world. We reached out to Dr. Matt Ratto, Bell University Labs Chair in Human-Computer Interaction, University of Toronto, to see if it was possible to take this expensive technology and adapt it for use in the poorest countries – with limited health resources, minimal infrastructure and low digital skills. He said yes! So, we entered into a partnership and launched Nia Technologies Inc to develop, test and scale a solution focused on the mobility needs of the poorest and most vulnerable children and adults.

I grew up in the Democratic Republic of the Congo as a missionary kid. I know that God loves all people equally, but the world is not always a fair or equal place. When my oldest daughter was born, I was working in the refugee camps in Lebanon. My colleague and friend who lived in the camp, had a baby born the same week. When we met and placed our two precious girls on the bed together, I realized that my daughter and his daughter would not have the same outcomes. Today, my daughter is a lawyer living in Canada, his daughter still lives in the refugee camp.

I have spent 33 years in international development living with and serving the most marginalized in society, organizing the disability movement in the Middle East, working with refugees in Iraq and Turkey and women in agricultural development in Afghanistan, and protecting working children in Egypt. For the last eleven years, I have led Hope and Healing International, committed to serving children with disabilities and their families – who are more isolated, stigmatized, neglected and abused than their peers. I find myself compelled to find new, innovative ways to level the playing field.

I have been blessed with experiences working in the Middle East, Africa, Asia and Latin America on disability and humanitarian issues that taught me to conceptualize and seize opportunities for disruptive change. My early work in business development equipped me to recognize innovative and sustainable business solutions; now, as a leader, I can commit to addressing crucial development challenges, like how to provide P&O devices to 34 million people annually in a world when there aren’t anywhere near enough technicians to produce them – especially when I have a solution like 3DPA.

I have proven the ability to bring experts from the field together, linking them to collaboratively solve problems, while I maintain the institutional and political cover to get the job done. I led Hope and Healing International’s staff and board through the process of exploring the idea of 3D printing as a way to close the gap in access to P&O devices worldwide. That was the first time our organization saw itself as a global leader in driving massive change in a whole industry (P&O manufacturing). Hope and Healing launched Nia Technologies Inc in 2015 and we have invested over $1 million in the startup, design, testing and now scale up of the 3DPA through our rehabilitative hospital partners in Africa and elsewhere.

We are now moving to take the product to scale, with a goal to transform the P&O industry.

We began testing the idea of 3D printing prosthetics as a project under Hope and Healing in 2014. We positioned it in the programs department. The problem was two-fold; first, it quickly began to consume the time and efforts of existing staff who found it exciting, to the detriment of other very important work. Second, even with this attention, we did not have the capacity or expertise for technological innovation and development that was needed. It was bringing down the programs department and hindering the technological progress.

My solution was to create a separate not-for-profit company named Nia Technologies, “owned” by Hope and Healing but separate in its operations and board. Nia hired staff who were highly trained to focus on what was needed, and then attracted initial grants from Google and other innovative funders who would not have come to Hope and Healing International. What was dragging down both Hope and Healing and 3DPA’s development became a strength and the foundation for future growth. The Nia board recently approved the establishment of a for-profit entity to sell 3DPA software in high-income countries, to help sustainably finance the provision of 3DPA in low-resource settings.

This story is about the importance of finding your true ‘why,’ as an organization. When I first became the Executive Director at Hope and Healing International in 2009, it was called cbm Canada, an affiliate of an international federation called CBM addressing disability worldwide. cbm Canada found itself sending 25% of our funding to support federation operations. So, I began asking questions, especially ‘why’.

I initiated a process where we listened to our local partners and beneficiaries, we conducted focus groups, interviews, and surveys, and examined our theory of change. As we analyzed what we knew from experience and what we learned from our inquiries, we determined that children with disabilities living in poverty are the most vulnerable. They risk losing years of quality of life without solutions. So, we developed an exit plan from CBM, changed our name to Hope and Healing International in 2019 and are focused on children with disabilities. Our programming includes 3DPA to provide P&O devices to all kids in need and a resiliency curriculum that addresses the unique needs of children with different abilities. Our goal is that all kids with disabilities experience being a loved child, cherished friend, included classmate and respected colleague.

3D printing, as compared with subtractive milling or other computer-aided manufacturing techniques, can be used to fabricate extremely complex objects with very little waste. Research, development and use of 3D-printing technology for upper-limb prosthetics (less than 15% of assistive devices needed globally) has emerged over the past several years with progressive improvements. Alternatively, 3D devices for lower limbs (much more widely needed) have lagged behind due to anatomical and engineering complexities. Several intricate 3D-printed device options – especially “bionic arms” – have emerged, at extremely exclusive costs. 3DPA’s focus on affordable lower-limb solutions is one unique aspect of our approach. 

3DPA is a turnkey solution for P&O providers, particularly in the Global South. While some organizations – Vorum, Ohio Willow Wood, Standard Cyborg – have developed components related to P&O production, none provide the holistic solution that Nia does. 3DPA enables the production of individualized, weight-bearing prosthetic and orthotic devices. Custom-fitting devices, compared with mass produced ones, are essential in weight-bearing devices to ensure mobility and improved health outcomes. Our use of FDM 3D-printing technology is distinguishable from other solutions because of its suitability for the Global South – with lower initial set-up costs, simplicity for less-skilled users and minimal material inputs. 3DPA includes new CAD software for scanning and rectification, and an innovative online learning platform. By designing and developing 3DPA intentionally for the Global South, our approach is more customized, user-friendly and responsive to the needs of healthcare workers, facilities and people with mobility impairments than other solutions.

Hope and Healing International’s theory of change is focused on providing children with disabilities the medical, rehabilitative and social/emotional services that improve their quality of life, making it possible for them to be productive and accepted members of society. For this project, the beneficiaries include all people in need of P&O devices. Our theory of change is simple: by transforming the P&O manufacturing process through a user-friendly, digital 3D-printing solution, we can increase the productivity of technicians dramatically and ultimately end the access gap to P&O devices for millions worldwide.

Activities:

·       Install 3DPA and train technicians in digital processes for P&O production 

·       Provide ongoing support and resources to rehabilitation workers via online platform

·       Build the capacity of sites to increase identification of children and adults in need of P&O devices

Outputs:

·       3DPA technology available on-site at rehabilitation facilities

·       P&O workshops become cleaner and safer for workers

·       Reduced materials are needed for P&O production – less waste produced

·       Technicians gain digital skills through 3DPA 

·       Other health workers participate in P&O production with new digital skills

·       Networks of 3DPA users form

Short-term Outcomes:

·       More devices are produced – cleaner, easier, faster and cheaper

·       Health facilities’ P&O production becomes financially viable

·       Rehabilitation workers are more confident, safer and happier in the workplace

·       Rehabilitation workers engage with one another to share knowledge and information  

·       More people with mobility impairments can access essential P&O devices

Long-term Outcomes:

·       People receiving 3D P&Os report improvements in mobility, less pain

·       People receiving 3D P&Os report increased health, education and quality of life outcomes

·       Rehabilitation professionals in the Global South have skills equal to their counterparts globally

·       More health care facilities enter the P&O production market using digital technology

·       The production gap closes – more devices are supplied for cheaper

The WHO reports health and wider socio-economic impacts of assistive device provision – for individuals who receive these essential P&Os, their families and communities. The widespread cross-sector benefits of inclusion, from higher GDP to more civic participation, have been well-documented. 

With recent 3DPA installation at two East African hospitals, we have trained 30 rehabilitation professionals. These health workers have served 274 people with mobility impairments, impacting the lives of at least 1,370 people. With the COVID-19 pandemic, service delivery has temporarily halted due to travel and care restrictions – limiting reach to date. Next year, we plan to train at least 200 additional rehabilitation workers directly and will reach more through facilities already implementing 3DPA. Our Tanzanian partner started a 3DPA pilot in refugee camps with three health centers to provide remote service. We expect to provide assistive devices for at least 2,250 people next year, impacting more than 11,000 people. In five years, we will fit more than 300,000 people with devices, impacting more than 1.6 million.

We intend to scale 3DPA through a hub and spoke approach by partnering with existing rehabilitation providers in Global South. As 3D printing commences and health workers’ skills improve, these sites will become model centers, training facilities and national production hubs. They will collaborate with other health facilities (‘spokes’) across their country/region to train other health workers in the initial stages of production – not only increasing client reach but also expanding interest in 3DPA. As costs lower, demand increases and awareness rises, more facilities will start 3D production directly – some becoming hubs themselves. Our current partners are supportive of this collaborative scaling strategy; with momentum building, 3DPA will impact thousands of health workers and millions of people with mobility impairments.

As the leader of Hope and Healing International, I believe that the most vulnerable in the poorest communities and countries are children caught in the cycle of poverty and disability. Our commitment to address the gap of access to P&O devices is because we think it is unacceptable that 90% of people living with mobility impairments have no hope of accessing treatment, including assistive devices. Our goal is to close this gap and reach all people who need P&O devices worldwide. We seek to transform the P&O industry by installing and implementing 3DPA across the Global South - increasing access to quality individualized P&Os by making their production cheaper, faster, cleaner and easier. Improved quality of life, health and education impacts will be demonstrated.

To that end, we have partnered with five new health facilities to start 3DPA production along with the two East African facilities already implementing 3DPA, which will serve as centers of excellence, training satellite locations using a hub and spoke model. This model can scale 3DPA in order to create sustainable impacts across national health systems – building a network of digitally-savvy rehabilitation professionals that can close the gap in device provision to essential P&Os for the 90% of 38 million people who annually lack access. The platform will also provide remote service delivery to reach more vulnerable populations.

Through our online learning platform, a community of practice uniting 3DPA users will supplement knowledge and skills, share best practices and promote continued adaptation and technology improvements.

The main barrier to achieving the sustainability of Nia Technologies Inc, the social enterprise formed to develop and scale up 3DPA to reach our short and medium-term goals is financial, how to move from grants to investment to income for sustainability. Over time, health centers will reduce costs with the installation of 3DPA for P&O service provision, but the immediate expenses of installation, training and implementation present barriers to entry for facilities in the Global South. We are looking for technical guidance on how to make that transition.

COVID-19 has increased the economic constraints facing both health facilities and individuals. While this can be a barrier, the mobility of 3DPA could become a benefit to increase access.

3DPA has minimized costs for adoption as much as possible, by using context-appropriate technology and ensuring a solution that is responsive to local needs, by engaging facilities and health workers in needs’ assessments and trials. But initial start-up costs remain a barrier for facilities.

While cultural or professional barriers to new technologies’ adoption might be expected, trials and installations to date have not faced this challenge – most technicians seem excited and able to learn a digital production method with immediate benefits to their work. Some health workers in the Global South have minimal, digital experience but the onsite 3DPA training has overcome this knowledge gap. Infrastructure challenges have emerged – such as low voltage stopping the 3D printing process – but simple solutions, like back-up batteries or solar panels, have overcome them.

Hope and Healing International and Nia Technologies are pursuing financial support to implement 3DPA in the Global South. Hope and Healing continues to support basic operations for Nia Technologies with $250,000 a year. In addition, fundraising through gifts from major donors, and grants from foundations, government agencies, corporate sponsors and others is on-going. Notably, 3DPA has been identified as a Top 100 solution for MacArthur’s 100&Change Competition, which seeks to identify impactful, durable, evidence-based and feasible solutions to pressing global problems (no award is made at this stage). Nia is also now creating a for-profit company to secure investors in order to support implementation in the Global South. The for-profit company could further develop 3DPA’s components (intellectual property) and sell the solution in the Global North. Nia will retain a right to use 3DPA royalty free, and its revenue share of the profits will support new installations in the Global South.

To increase adoption, we take every opportunity to present and exhibit at conferences, including the biennial ISPO World Congress. 3DPA has been featured in numerous print publications and digital media channels, promoting the innovation. Nia provides NiaFit software at no charge to training institutions wishing to explore digital P&O fabrication technologies with students. Nia engages with industry stakeholders at all levels.

Hope and Healing International supports 25 local implementing partners in 18 low-income countries worldwide. They are largely hospitals or Disabled People’s Organizations (DPOs) and provide medical, rehabilitative and social/emotional initiatives that serve children and adults living with disabilities and their families. We fund their specific programs for children with disabilities and 3DPA with an annual budget of $26 million CAD. For 3DPA, the following partners are most relevant:

·       CCBRT and CoRSU – two East African hospitals with national reach, are currently implementing 3DPA. We are also working with other health facilities interested in implementing 3DPA in other countries (CURE hospitals, American Leprosy Mission, and others)

·       Donors – Google Foundation, Grand Challenges Canada and AutoDesk Foundation supported R&D necessary for 3DPA. Hope and Healing International continues to provide financial and other support.

·       University of Toronto – research partner for ensuring 3DPA is relevant, effective, reliable and impactful.

Hope and Healing International formed Nia Technologies Inc to develop and market the 3DPA toolchain for the Global South to produce more affordable P&O devices with dramatic improvements in productivity, cost and waste by-products.

Nia provides ‘early adopter’ sites with a training package that includes on-site training of all key rehabilitation staff and provision of the 3DPA software and hardware needed to produce P&O devices and follow-up technical support. Early adopter sites then begin using 3DPA as an alternative to the traditional plaster-casting method. They are also able to scan patients remotely, off-site through mobile outreaches as well as in facilities.

Implementing sites are provided the turn-key 3DPA solution, which includes access to an online 3DPA community of practice to share key learnings and get technical assistance and feedback from peers. They also receive printers, computers, scanner/tablets, battery backup, replacement parts, peripherals and filament supplies. Ongoing technical support is provided online through Skype, NiaNet or other platforms for two years. This complete package equips and capacitates an implementing partner to launch and sustain 3DPA provision of P&O devices.

P&O patients will be more likely to have access to a P&O device because the limited number of P&O technicians can now produce up to 20 devices a week instead of just one or two. This reduces the amount of time a patient has to wait for the device from one week to one day, decreasing hospital visits and time away from home and work.

As part of our strategy to achieve financial sustainability, Hope and Healing and Nia Technologies are seeking investors for the creation of a for-profit company (NewCo) as a sister company to Nia Technologies Inc. NewCo will collaborate with potential distributors to sell NiaFit and other proprietary software using a modified software-as-a-service model to clients in the Global North. This for-profit will generate revenue through the sale of Nia’s intellectual property to institutions in the Global North – to further develop and innovate this technology. Nia’s share of NewCo profits will ensure Nia’s ongoing efforts in the Global South continue and expand. Nia is seeking an investment of up to and including $1,300,000 USD for a 40% equity interest in NewCo. NewCo is expected to yield a pre-tax internal rate of return of 30%.

In addition, we are seeking grants and other forms of investment capital to support immediate installation and implementation of 3DPA in the Global South. Once production at these sites reaches scale, they will be independently sustainable and will not require continued financial support.

Revenue Raised:

Hope and Healing International provides $250,000 per year to Nia Technologies Inc to provide the base funding for organizational operations. This investment covers basic staffing, office, travel, ongoing R&D, M&E and marketing/communications. Our investment includes $250,000 for FY 2020 funding and a commitment for the next 12 months, from July 1, 2020 – June 30, 2021 (also Nia’s fiscal year) for another $250,000.

Hope and Healing International has raised $2.5 million since 2014 to support the research and development of the 3DPA technology, clinical trials, and ongoing implementation (including installations, trainings, etc. to date).

Hope and Healing International and Nia Technologies Inc. are seeking grants to support the deployment of, and training on, 3DPA at health facilities across the Global South. For one facility, at least $140,000 USD is needed, though the amount varies slightly dependent on facility specifics (staff, infrastructure, catchment area, etc.).

For FY 2021, we are seeking $250,000 to help with the overall operating costs for Nia Technologies and funding for at least five new Early Adopter sites at $140,000 each – a total of $950,000. We have identified a number of facilities interested and ready to implement 3DPA once financial support is secured.

The $250,000 for Nia operating costs is being raised through Hope and Healing major donors. Funding for the five new early adopter sites will come from venture capital firms, grants, foundations, and other sources.

Hope and Healing is currently one of the Top 100 applications for the MacArthur 100&Change competition, and was also selected by Rockefeller Philanthropy Advisors and Columbia Business School’s Tamer Center for Social Enterprise as one of the top 12 applications in the Top 100 submissions. It is in the Bold Solutions platform for Lever for Change, the showcase for the top 100 submissions. We expect to hear about the next round with the selection of the ten finalists this summer.

We have submitted proposals to a number of venture capital funds for consideration from an equity perspective including Draper Richards Kaplan Foundation and University Impact.

Projected Expenses for Nia Operations: $250,000

Nia’s operating expenses for calendar year 2020 are expected to be approximately $250,000 USD.

• Personnel-$175,000
• Travel-$20,000
• Office Operating Costs-$10,000
• M&E-$20,000
• R&D Improvements-$20,000
• Marketing-$5,000

Cost to Set Up One Site and Support for 2 Years: $140,000

In order to scale up early adopter sites and expand the number of 3DPA centers of excellence for a period of 2 years, we anticipate an average cost of $140,000 for each new location which covers the following:

• Onsite training and set up-$30,000
• Hardware (printers, tablet, computer, scanner)-$30,000
• Software Licenses/year-$20,000
• Technical Support: $20,000
• Supplies--$20,000
• Service Fees-$20,000

People with disabilities, so often overlooked, need the attention and support of innovative, progressive organizations committed to sustainable global impact. Hope and Healing International’s award of this Prize will highlight commitment to the most marginalized, in keeping with the purpose of the Elevate Prize to reach the marginalized and those left behind.

Hope and Healing International is inspired by a belief that all people, worldwide, deserve quality healthcare – but especially the most stigmatized and vulnerable among us. With 90% of 38 million people with disabilities in need of P&O devices annually unable to access them – and an antiquated industry relying on the same lengthy, inefficient plaster-casting production process used for decades – we were driven to explore technological solutions. Promising initial findings, prompted us to engage a principal investigator at University of Toronto to finalize the solution design and then test the product in Uganda. A four-year old, Roseline, with congenital trans-tibial loss received the first individualized 3D-printed device. It was printed overnight and despite hours of travel the day before, as soon as her prosthetic was fitted, Roseline set off running – for the first time in her life – to see her brother. Since then, Hope and Healing and its social enterprise Nia Technologies Inc, have been committed to seeing more people run. We want to enable as many people with mobility impairments as possible to go to school or work, or even just play football and visit their friends.

As a non-profit charitable organization, Hope and Healing International values collaborative partnerships across all aspects of our work. We would love the opportunity to engage with organizations that can generate interest, awareness and excitement about this solution. In order to successfully revolutionize the P&O industry, we require partner health facilities willing to embrace this technology and implement it. We are also committed to rigorous monitoring and evaluation, identifying the right indicators and impact measures, analyzing and telling the story through data would better position the innovation. Finally, we seek innovative, inspired donors and investors to help us finance this solution and move it to a profit- based model. Social impact investing is a new model for us and better positioning our global solution to attract venture capital and impact investors would enable us to move more rapidly to transform the P&O industry globally.

Social Impact leaders, coaches or mentors could help Hope and Healing International to navigate the transition from proven technology to scale up and broad dissemination of 3DPA. We do not have a specific partner identified but would be open to working with a learning cohort as well as one-on-one coaching.

Hope and Healing would be very interested in partnering with international development organizations like USAID, GAC or DFID, in order to create broader impact on healthcare systems strengthening in low-resource countries and to evaluate the impact of the 3DPA innovation on outcomes for patients and the P&O industry.

From a technical perspective, the International Committee of the Red Cross leads the fabrication of the generic components of prosthetics that are not individualized (limb kits).The ICRC method of, and supplies for, P&O fabrication are used worldwide in low-income countries. 3DPA printed devices interfaces with ICRC componentry. Nia would like to form closer ties with the ICRC to encourage wider adoption.

From a scale up perspective, partnering with hospital networks, such as CURE International that focus on care for people living with disabilities, are ideal implementing partners for 3DPA.

In addition, P&O training institutions in the Global South responsible for training new technicians would be essential partners to facilitate the transition of the P&O industry to a digital future.