This proposal is focused on extending the international commitment to universal health coverage (UHC) to people suffering limb loss in Low- and Middle-Income Countries. It builds on multi-disciplinary EPSRC- and MRC-funded research establishing the prevalence of limb loss; service-users' experiences of attempting to access and receive services and innovation in the design of 'Fit-For-Purpose' body-powered prostheses. This research has evidenced the need for more comprehensive and structural health systems change focused on the development of an integrated supply-chain system servicing regionally distributed service outlets. At present there is no system to manage and regulate the quality and costs of imports of devices and components from overseas. International donors have played a major role in defining the geography and characteristics of services with an emphasis on internal conflict in Northern Uganda. Since the end of this conflict funding has ceased and underfunded services do not meet needs resulting from significant foreign refugee flows into the West and growing domestic needs arising from Road Traffic Accidents, domestic violence, cancer and diabetes. The Ugandan Ministry of Health (MoH) has proposed the use of Public-Private-Partnerships in health system strengthening. Our proposal will design and test a PPP model as the basis for a more integrated and distributed partnership model to deliver universal health coverage for amputees. National Medical Stores is the sole provider of supplies into public hospitals. With the exception of the National Referral Hospital it is not supplying orthopaedic workshops with essential supplies and patients who do access these facilities are subject to user fees. Joint Medical Stores (JMS) is an established (not-for-profit) provider of medical supplies to the not-for profit sector. Our proposal focuses on building a PPP platform to support a social enterprise model for supplies management at national level. This will include a more transparent approach to international sourcing combined with efforts to reduce dependency on foreign supplies through local manufacture. We will exploit the potential of an upper limb socket designed by the EPSRC team for local manufacture and task-shifting. We propose a second-level PPP based on a model designed in Fort Portal Regional Referral Hospital to support supply chain management during COVID-19. A recently signed PPP involving an established health partnership with Knowledge for Change, a registered NGO and JMS will design and test a model to promote service-focused supply chain agility at a public hospital located in close proximity to fast-growing refugee camps. Our long-term aims are to use our innovations in prosthesis design, coupled with fine-resolution modelling of demand, to pilot new, distributed prosthesis service models, characterised through our collaboration with JMS. We propose to pilot a Public private partnership model to help support the more effective integration of foreign aid with one or more of the new service models. Towards the end of the project, we will bring together the key stakeholders to develop a larger scale project which will explore how we can build on the lessons learnt in this study. Our specific objectives are: 1. Supply Chain Innovation: Co-design and test the contribution that a Public-Private-Partnership approach can make to sustainable supply chain integration for prosthetics componentry and repair services. 2. Demonstrate the role that technological innovation can have on prosthetic services: Test the potential for local manufacture and supply-chain entry of a user-adjustable, locally repairable socket design. 3. ODA Innovation: Generate the evidence-base for a new model for Overseas Development Assistance (ODA) based on principles of partnership, social enterprise and sustainability

The finger and fingertip are the most frequently amputated body parts, due to work-related incidents. Yet because of space, weight and cost constraints, prosthetic fingers and fingertips are heavy and bulky with limited active motion and sensation. The aim of this project is to model, design, fabricate and validate an affordable body-powered prosthetic fingertip digit with integrated mechanical haptic feedback. It will do this by combining synergetic expertise in developing parameterised mathematical models of limb motion from the University of Warwick (UoW) and in creating soft, stiffness-controllable robotic structures and haptic feedback interfaces from University College London (UCL). Of key importance is its transformative nature, which we will achieve through close collaboration with (1) clinical experts from University Hospitals Coventry and Warwickshire (UHCW) and the UHCW Innovation Hub, who will provide consultation and clinical input throughout; and (2) strategic project partners, namely the Steeper Group and Ottobock SE & Co. KGaA, world leaders in the development of prosthetic devices; the Global Disability Hub CIC (GDI Hub), working with local communities, academics, experts and disabled people to drive innovation, co-design and collaboration; and e-NABLE, a worldwide charity that creates free protheses for those in need of an upper limb assistance. The objectives of the project are therefore: 1). to obtain an in-depth understanding of finger(tip) movements to recover hand functionality and the development of novel mathematical models that can accurately characterise and reproduce such movements. this will be achieved through the generation of a comprehensive portfolio of human hand grasps used in current everyday activities and validated mathematical models that can reproduce such taxonomies, compared to pre-existing models. 2). To create a pneumatically actuated, body-powered prosthetic fingertip with integrated haptic sensing feedback. This will be achieved through analysis comparing the design capabilities of the prosthetic fingertip when compared to human finger motion, testing the forces exerted using the prosthetic fingertip using appropriate experimental techniques. 3). To perform complete integration and validation of the mathematical models and body-powered prosthetic fingertip developed through verification in motion capture (gait) laboratories using patients in controlled environments as well as long-term validation studies.

The World Health Organisation says that there are about 100 million people globally who need prosthetic or orthotic (P&O) services and as populations age, more than two billion people are expected to require health-related assistive devices by 2030. In the UK the Disabled Living Foundation estimates that 6.5 million people live with mobility disablement, with many reliant on P&O services, including an estimated two million orthotic users. In parts of the developing world the aftermath of conflict, such as land mines, and greater rates of traumatic injuries from accidents, means there is a growing need for prosthetics and orthotics for younger people living in poor social and economic circumstances. Often they need P&O devices to stay at work and sustain their families. Poor devices, services and access to these contravene their basic human rights. In the context of this need, we want to establish the EPSRC Centre for Doctoral Training in P&O. This will address the national, and global, shortage of suitably skilled engineers and scientists to become future innovators in P&O technologies. Current academia, industry and care centres have limited researchers, and research activity has lagged behind rapid technology advancements. The Centre will support a minimum of 58 doctoral students whose studies will enable them to become leaders of the future. The Centre will bring together the only two P&O undergraduate education facilities in the UK (Salford and Strathclyde) with P&O research centres of excellence at Imperial College and the University of Southampton. Our vision is for the Centre to become the national and global leader in P&O research training, and the translation of research into innovation that impacts on the lives of people each day, in developed and developing countries. The Centre will work to support training for students from low and middle-income countries (LMIC). Our students will be immersed in industry and real-world experiences which will equip them to lead the P&O sector across technology, social or economic contexts. Our aims are to: 1. Develop a new model of P&O research training and translation of research into innovation. In addition to the doctoral training, this will result in Master's programmes operating across Institutions. 2. Produce ambitious PhD research projects that will be grounded in real-world challenges, but at the cutting-edge of new biomedical science and technologies. 3. Produce a significant impact on the UK P&O industry sector by leading innovation. 4. Have an international impact by attracting an increasing number of CDT students from overseas. 5. Establish a P&O student society which will have matured into a lasting doctoral community with international reach. 6. To have a significant impact on the training of doctoral candidates from LMIC. 7. Attract additional external funding for P&O research. Creating a new generation of P&O research leaders will, over time, have a significant economic, societal and health impact. For users, it will mean access to improved generations of assistive devices which will match the users' needs resulting in a better quality of life. Clinical services will benefit from improved service data, superior products and improved user outcomes. For industry, it will open up new market opportunities, nationally and globally. For the students themselves, they will have access to careers that have a real purpose, enabling them and their future teams to make a difference in the lives of people with disabilities.