Translating Impacts of Social Enterprise for Sustainability of Physical Rehabilitation Service
Lead Research Organisation:
University of Salford
Department Name: Sch of Health Sciences
Abstract
In Cambodia, Rehabilitation Financing involves a range of stakeholders (Ministry of Social Affairs, Veterans and Youth Rehabilitation, Ministry of Health, Ministry of Economy and Finance as well as donors, service providers, people with disabilities, social enterprises and government policymakers). Bringing together these stakeholders could provide a sustainable model for physical rehabilitation service provision.
The study aims to explore:
Stakeholders' strategies to sustain efficient, accessible and quality rehabilitation service
Perceived future of the physical rehabilitation services and challenges facing by stakeholders in financially support the physical rehabilitation centres
Proposed solutions and alternative models of financial supports to physical rehabilitation centres by stakeholders for the sustainability of physical rehabilitation centres' services
"Wished-for" financial policies changes and blended model endorsement by stakeholders
Suggested integration and implementation framework for financial sustainability of physical rehabilitation centre's service provision (Business, Social Enterprise, International Aids, Government's budget contribution, fee-paying service culture by users).
The overarching method for the project is a natural experiment. The project will broadly have two phases. The first phase will begin with a systematic review in the area of physical rehabilitation financing in less-resourced countries. It will then follow with a study on the current situation of rehabilitation financing and physical rehabilitation services in Cambodia. In the second phase Framework Analysis method will be used to understand a systematic approach in policymaking with emphases of thematic frameworks, mapping and interpretation. Focus groups will be used with a range of stakeholders including policy makers, service providers, DPOs, and a range of service managers. Semi-structured Interviews (conversational method) will be employed with stakeholders unable to attend the focus group.
The results from all two phases of data collection (systematic review and field data collection) will provide emerging themes and consolidate a deeper understanding through framework analyses.
The study aims to explore:
Stakeholders' strategies to sustain efficient, accessible and quality rehabilitation service
Perceived future of the physical rehabilitation services and challenges facing by stakeholders in financially support the physical rehabilitation centres
Proposed solutions and alternative models of financial supports to physical rehabilitation centres by stakeholders for the sustainability of physical rehabilitation centres' services
"Wished-for" financial policies changes and blended model endorsement by stakeholders
Suggested integration and implementation framework for financial sustainability of physical rehabilitation centre's service provision (Business, Social Enterprise, International Aids, Government's budget contribution, fee-paying service culture by users).
The overarching method for the project is a natural experiment. The project will broadly have two phases. The first phase will begin with a systematic review in the area of physical rehabilitation financing in less-resourced countries. It will then follow with a study on the current situation of rehabilitation financing and physical rehabilitation services in Cambodia. In the second phase Framework Analysis method will be used to understand a systematic approach in policymaking with emphases of thematic frameworks, mapping and interpretation. Focus groups will be used with a range of stakeholders including policy makers, service providers, DPOs, and a range of service managers. Semi-structured Interviews (conversational method) will be employed with stakeholders unable to attend the focus group.
The results from all two phases of data collection (systematic review and field data collection) will provide emerging themes and consolidate a deeper understanding through framework analyses.
Planned Impact
The CDT students will help create solutions for amputees and people with debilitating conditions such as stroke and diabetes, reducing mortality and enabling them to live more satisfying, productive and fulfilling lives. These solutions, co-created with industry and people living with disabilities, will have direct economic and societal benefits. The principal beneficiaries are industry, P&O service delivery, people who need P&O devices, and society in general.
Industry
The novel methods, devices and processes co-created with users and industry will have a direct economic value to our industry partners (by the creation of IP, new products, and improved industry and academic links). Our CDT graduates will be the natural potential employees of our industry partners and for companies in the wider healthcare technology sector. This will help address the identified critical skills need and shortage leading to improvement in the UK's competitiveness in this rapidly developing and growing global market. The CDT outcomes will help UK businesses spread risk (because new developments are well founded) and more confidently enter new markets with highly skilled employees (CDT graduates).
P&O service delivery
Doctoral engineering graduates with clinical knowledge are needed to improve the deployment of advanced technologies in practice. Our main UK industry partner, Blatchford, stated: "As technology develops it will become easier for the end-user (the patient), but the providers (the clinicians) are going to need to have a higher level of engineering training, ideally to PhD level". The British Association of Prosthetists and Orthotists estimates that no more than ten practising P&O clinicians have a PhD in the UK. Long-term P&O clinical academic leadership will be substantially improved by the CDT supporting a select number of clinically qualified P&O professionals to gain doctorates.
Users
The innovation of devices, use of device and patient monitoring, and innovation approaches in LMIC should not only lead to improved care but also lower healthcare costs. Diabetes UK estimates that the total healthcare expenditure related to foot ulceration and amputation in diabetes was £1billion (2014-15), with 2/3 of this related to foot ulceration. Small innovations could lead to large cost savings if targeted at the right aspects of care (e.g. earlier adoption, and reducing device abandonment).
An ability to work is fundamental to a person's place in society and their sense of purpose and has a significant societal impact in all territories. This is perhaps greatest in LMIC where attitudes towards disability may still be maturing, and appropriate social care infrastructure is not always in place. In these cases, an ability to work is essential for survival.
Improved design approaches will impact on all users regardless of context, since the device solutions will better match local and individual user needs. Addressing issues related to prosthetic/orthotic device abandonment (e.g. cosmesis) and improved adherence should also lead to greater social participation. Improved device solutions will shift focus from what users "cannot do" to what they now "can do", and help progress attitudes towards acceptance of disability.
Societal
The majority of the global P&O users are of working age, and a key economic impact will be keeping users in work. The average age at amputation due to diabetes is just 52 in the USA but much younger in countries with less well-developed health care and trauma services (e.g. 38 in Iran). Diabetes UK reports that 35-50% of people are of working age at diagnosis and that there are around 70,000 foot ulcers in the UK, precursors to amputation. There is a similar concern for stroke survivors around a quarter of whom are of working age and are 2-3 times more likely to be out of work after eight years.
Industry
The novel methods, devices and processes co-created with users and industry will have a direct economic value to our industry partners (by the creation of IP, new products, and improved industry and academic links). Our CDT graduates will be the natural potential employees of our industry partners and for companies in the wider healthcare technology sector. This will help address the identified critical skills need and shortage leading to improvement in the UK's competitiveness in this rapidly developing and growing global market. The CDT outcomes will help UK businesses spread risk (because new developments are well founded) and more confidently enter new markets with highly skilled employees (CDT graduates).
P&O service delivery
Doctoral engineering graduates with clinical knowledge are needed to improve the deployment of advanced technologies in practice. Our main UK industry partner, Blatchford, stated: "As technology develops it will become easier for the end-user (the patient), but the providers (the clinicians) are going to need to have a higher level of engineering training, ideally to PhD level". The British Association of Prosthetists and Orthotists estimates that no more than ten practising P&O clinicians have a PhD in the UK. Long-term P&O clinical academic leadership will be substantially improved by the CDT supporting a select number of clinically qualified P&O professionals to gain doctorates.
Users
The innovation of devices, use of device and patient monitoring, and innovation approaches in LMIC should not only lead to improved care but also lower healthcare costs. Diabetes UK estimates that the total healthcare expenditure related to foot ulceration and amputation in diabetes was £1billion (2014-15), with 2/3 of this related to foot ulceration. Small innovations could lead to large cost savings if targeted at the right aspects of care (e.g. earlier adoption, and reducing device abandonment).
An ability to work is fundamental to a person's place in society and their sense of purpose and has a significant societal impact in all territories. This is perhaps greatest in LMIC where attitudes towards disability may still be maturing, and appropriate social care infrastructure is not always in place. In these cases, an ability to work is essential for survival.
Improved design approaches will impact on all users regardless of context, since the device solutions will better match local and individual user needs. Addressing issues related to prosthetic/orthotic device abandonment (e.g. cosmesis) and improved adherence should also lead to greater social participation. Improved device solutions will shift focus from what users "cannot do" to what they now "can do", and help progress attitudes towards acceptance of disability.
Societal
The majority of the global P&O users are of working age, and a key economic impact will be keeping users in work. The average age at amputation due to diabetes is just 52 in the USA but much younger in countries with less well-developed health care and trauma services (e.g. 38 in Iran). Diabetes UK reports that 35-50% of people are of working age at diagnosis and that there are around 70,000 foot ulcers in the UK, precursors to amputation. There is a similar concern for stroke survivors around a quarter of whom are of working age and are 2-3 times more likely to be out of work after eight years.
Organisations
People |
ORCID iD |
| Malcolm Granat (Primary Supervisor) | |
| Sisary Kheng (Student) |
Studentship Projects
| Project Reference | Relationship | Related To | Start | End | Student Name |
|---|---|---|---|---|---|
| EP/S02249X/1 | 01/04/2019 | 30/09/2031 | |||
| 2309783 | Studentship | EP/S02249X/1 | 01/10/2019 | 30/09/2023 | Sisary Kheng |
| Description | This research project is simply broken down into three various studies. Study 1- The first study was the Narrative Review on the Extent of Application of Social Enterprise in Prosthetic and Orthotic Service within the Global Health Context. There is an increase of belief in how business innovations could make larger-scale, more sustainable impacts on the societies than a traditional charitable model. However, there is no one size fits all when it comes to solutions for sustainability in prosthetic and orthotic services in less-resource settings (LRSs). A successful model in LRSs may require triple tracks approach- multi-sectoral (the public, the private sector); multi-lateral organisations (actors in the sector), and donor agencies-to contribute to the financial sustainability for service provision. This narrative review aims to "explore the extent of application of social enterprise in prosthetic and orthotic services within the global health context". Two databases were searched; ScienceDirect (3,173) and PlosOne (2,132). After the screening, and duplication removal, leaving 47 papers to be included in the review. The findings from this review demonstrate that the contextual factors, challenges facing global health, and healthcare system's complexities affect the development of a novel approach to the financial sustainability of prosthetic and orthotic care in Low Resource Settings. The findings emphasised alternative, and solutions in service sustainability have been sought in the healthcare service delivery model. The implementation of three novel approaches in healthcare service has been studied on, privatisation (for-profit business), Public-Private-Partnership (PPP-subcontracted arrangement by government either through management contract or service contract) and Social Enterprise (SE-not-for profit business). The practice of SE in Prosthetic and Orthotic care is presented with minimal evidence, particularly, the principle of service sustainability in less-resourced settings. Therefore, stakeholders' engagement in the framework of co-design, co-creation and co-production with determinant of social value, social impacts and global good is a key to market-driven and sustainable innovation. The findings from this narrative review provided a baseline on the extent of the current practice of social enterprise framework in the global healthcare service.SE monopoly is not the answer to improve accessibility, affordability and quality of care. Further enhancement of feasibility to explore pluralistic models with privatization, PPP, public service quality management and public service capacity building serve as cornerstones to sustainability through the implementation of user-centred approach within the complex healthcare system and public financial reform agenda. The paradigm shifts for better global equality and sustainability through international public investment instead of international aid are encouraged. There is a significant need for well-coordinated, longitudinal, robust, coherent, and transferable research that could contribute to sustainability of its services in LRSs. Study 2-Document Analysis on Prosthetic and Orthotic Services in Cambodia with the use of PESTEL Tool. Prosthetic and Orthotic service is a need for a life-long intervention for those who are living with a permanent disability. Cambodia with its prolonged internal conflicts, civil wars, and legacy of landmines/Unexploded Remnants of War as well as with non-communicable diseases resulted from development and has a high demand in The issues related to the sustainability of prosthetic and orthotic services in Cambodia are critical. A long-term financing strategy is seen to be a multiple approach (blended method) post-international aid phase-out. This is an inevitable challenge for the government to retain the services with limited government budget and low priority for rehabilitation support from the government's priority list. This paper explores the nature of enabling and constraints on prosthetic and orthotic service delivery financing in Cambodia. A comprehensive policies, guidelines, and document reviews used PESTEL (Political, Economic, Social, Technological, Environmental, Legal) framework to assess systematic influences of rehabilitation financing in the context of Cambodia. The study design involves with analysis of documents which is a part of the triangulation approach for the main PhD project. The Study 1 was a Narrative Review on the Application of Social Enterprise for Prosthetic and Orthotic Service Financing Sustainability within Global Health Context. This Study 2 focuses on the Macro-environmental Analysis of Prosthetic and Orthotic Service Financing in Cambodia through analyses of document, policies, guidelines, and internal procedures. And Study 3 will explore Attitudes to and Perceptions of Social Enterprise to Support the Sustainability of Prosthetic and Orthotic Services in Cambodia. The findings from the analysis affirms that there is a world class, but need to further develop available data, supply chains, procedures, guidelines, policies, and human resource workforce available for Cambodia. However, there is yet public and private service (blended approach) in the field of prosthetics and orthotics. In conclusion, the financing strategies for prosthetic and orthotic services in Cambodia have been relying on charity model of care and will require a tremendous changes in thinking, disability service seeking behaviours, government protocol for public financing support, global healthcare awareness, system thinking, system strengthening, system reforms, and innovative solutions which could be learned from other sectors. Among others, integration of disability services into healthcare system for an improved continuum of care, better financing strategy, better public awareness, better staffed, and enhanced professional intervention are found to be an initial step for better funding of prosthetic and orthotic service in Cambodia. Study 3- Exploring the Perception on and Attitude to Social Enterprise Application for Sustainability of Prosthetic and Orthotic Service Financing in Cambodia. The study employes qualitative research method through a semi-structured interview with 20 various key stakeholders of prosthetic service in Cambodia from non-governmental organisations, government officials from the Ministry of Social Affairs, Veterans and Youth Rehabilitation, Ministry of Finance and Economy, Ministry of Labours and Vocational Training, Ministry of Health, Persons with Disability Foundation, Disability Action Council of Cambodia, Cambodian Disabled Person Organisation, Female Amputee Federation, and Association of the Spinal Cord Injury Association of Cambodia. I am now in the process of collecting data and expect that the data collection will be completed by May/June 2022. It is planned that the data will be analysed with the application of Reflexive Thematic Analysis (Braun and Clarked, 2021)The expected findings from this study three will reflect on the perception and attitude of Cambodian stakeholders toward the sustainability of financing strategies for Prosthetic and Orthotic Service in Cambodia. |
| Exploitation Route | The findings from this research project are the first one in its nature in a less-resourced setting. It is believed that the findings and recommendations from this study could potentially make cascading impacts on the models and practice of prosthetic and orthotic service financing in Cambodia and other countries whose development and history of prosthetic service has been heavily relying on international support where long-term sustainability is unclear. The lesson learned from this research could be potentially used by other countries with similar contexts, challenges, and visions for sustainability through a change of method for better results and better engagement of multiple and cross-cutting approaches. |
| Sectors | Communities and Social Services/Policy,Financial Services, and Management Consultancy,Healthcare,Government, Democracy and Justice |
| Description | So far, the stakeholders of prosthetic and orthotic services in Cambodia have been made aware of this study and there has been more frequent discussion about the potential new models of rehabilitation financing in Cambodia in a couple of years where current donors and external funding have been a challenge. Similarly, it is clear to the stakeholders that the Royal Government of Cambodia is not yet ready to absorb the full cost of prosthetic and orthotic service financing should international support ceases before the service itself could attract or be supported through multiple-source funding, not just international organisation and government budget per the current practice. The sector has to look, strategise, prepare and resource well in response to the withdrawal of international funding in years to come. Otherwise, the people with disabilities in Cambodia will continue to be the victims of this poor service planning, lack of harmonisation of strategic plans between the stakeholders, and the poor development of innovative approaches toward sustainability of service in a longer-run. |
| First Year Of Impact | 2020 |
| Sector | Communities and Social Services/Policy,Financial Services, and Management Consultancy,Healthcare,Government, Democracy and Justice,Security and Diplomacy |
| Impact Types | Societal,Economic,Policy & public services |